Kim Su-jin, Lee Kyu Eun, Choe Jun-Ho, Lee Jeonghun, Koo Do Hoon, Oh Seung Keun, Youn Yeo-Kyu
Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.
Surg Laparosc Endosc Percutan Tech. 2010 Oct;20(5):312-6. doi: 10.1097/SLE.0b013e3181f195fc.
Bilateral axillo-breast approach (BABA) endoscopic thyroidectomy has been successfully used for various thyroid diseases, with an excellent cosmetic outcome. Patients with a confirmed thyroid malignancy on a permanent thyroid section after endoscopic thyroid lobectomy require completion thyroidectomy. Here, we sought to demonstrate the feasibility of endoscopic completion thyroidectomy by BABA.
Between June, 2006 and February, 2009, 13 patients underwent endoscopic completion thyroidectomy by BABA for minimally invasive follicular thyroid and papillary thyroid carcinomas diagnosed after BABA endoscopic thyroid lobectomy. The median interval between thyroid lobectomy and completion thyroidectomy was 5.6 months (range, 4.2-28.2 mo). We used the same port sites (bilateral breast and axillary region) as were created at the initial operation. Flap adhesion was minimal. After identifying the remnant thyroid lobe, completion thyroidectomy was performed under full visualization of the thyroidal vessels, parathyroid glands, and recurrent laryngeal nerve.
We performed 5 right and 8 left endoscopic completion thyroidectomies by BABA. The mean operation time was 109.3±23.3 minutes. There were no cases of open conversion. The resulting 6 (46.2%) cases of transient hypocalcemia resolved within 2 postoperative weeks and there were no cases of vocal cord palsy or wound infection. One patient had immediate postoperative breast flap bleeding that required cauterization. No patient had evidence of recurrence, as indicated by follow-up neck ultrasonography and serum thyroglobulin levels. The cosmetic outcomes were excellent and all patients were satisfied.
BABA endoscopic thyroidectomy appears feasible and safe procedure for completion thyroidectomy, making it a viable technique for reapplication in cases of thyroid carcinoma diagnosed after endoscopic thyroid lobectomy.
双侧腋窝-乳房入路（BABA）内镜甲状腺切除术已成功应用于各种甲状腺疾病，美容效果极佳。在内镜甲状腺叶切除术后，甲状腺永久切片确诊为甲状腺恶性肿瘤的患者需要行甲状腺全切术。在此，我们旨在证明通过BABA行内镜甲状腺全切术的可行性。
2006年6月至2009年2月期间，13例患者因BABA内镜甲状腺叶切除术后诊断为微创滤泡性甲状腺癌和乳头状甲状腺癌，接受了BABA内镜甲状腺全切术。甲状腺叶切除术与甲状腺全切术之间的中位间隔时间为5.6个月（范围4.2 - 28.2个月）。我们使用了与初次手术相同的切口部位（双侧乳房和腋窝区域）。皮瓣粘连极少。在识别出残留的甲状腺叶后，在完全可视化甲状腺血管、甲状旁腺和喉返神经的情况下进行甲状腺全切术。
我们通过BABA进行了5例右侧和8例左侧内镜甲状腺全切术。平均手术时间为109.3±23.3分钟。无中转开放手术病例。6例（46.2%）出现短暂性低钙血症的患者在术后2周内恢复，无声带麻痹或伤口感染病例。1例患者术后立即出现乳房皮瓣出血，需要烧灼止血。随访颈部超声和血清甲状腺球蛋白水平显示，无患者有复发迹象。美容效果极佳，所有患者均满意。
BABA内镜甲状腺切除术对于甲状腺全切术似乎是一种可行且安全的手术方法，使其成为在内镜甲状腺叶切除术后诊断为甲状腺癌的病例中重新应用的可行技术。
