EP102 – Endoscopic Hemithyroidectomy Via Retroauricular Approach: First Case in Peru

     

    Moscoso, Edgar Salas¹; Diaz, Juan Postigo¹; Kowalski, Luiz Paulo²
    1 Department of Head and Neck Surgery, Oncosalud-AUNA, San Borja, Lima 41, Peru
    2 Department of Head and Neck Surgery and Otorhinolaryngology, A. C. Camargo Cancer Center, São Paulo, São Paulo, Brazil

     

    Background: Postoperative quality of life after thyroidectomy is considered as important an issue as disease control (1). Several operative techniques to decrease postoperative scarring have been investigated. (2,3). Recent guidelines for the management of thyroid nodules and cancers show that hemithyroidectomy may be performed in a selected group of patients (4). To further improve cosmetic outcomes and patient satisfaction, endoscopic approaches have been developed using incisions made outside the neck (5). Transaxillary and Retroauricular thyroidectomies have garnered immense interest, and various groups have reported initial successful experiences (6-10).

    Methods: This is a 10 year old patient who have been diagnosed a benign lesion in the right lobe of her thyroid with compressive symptoms and cosmetic concerns.

    Results: The patient underwent a right hemithyroidectomy and isthmusectomy via endoscopic retroauricular approach, with a time of 90 minutes and minimal bleeding. No complications occurred intraoperatively or postoperatively compared to the conventional surgical technique. The patient presented mild hypoesthesia of the earlobe with complete recovery within the first 48 hours. No bruising or changes in voice tone. Diet was initiated after 6 hours after surgery. Laryngeal nasofibroscopy was performed postoperatively, observing adequate mobility of both vocal cords.

    Discussion: Surgeons must be accustomed to the endoscopic surgical view and the handling of the instruments in order to prevent significant local complications, surgical accident or need for conversion into conventional open procedure.(29).

    Conclusion: Surgical management of the thyroid gland via Endoscopic retroauricular approach offer safety and comparable results with conventional open thyroidectomy, followed by better postoperative cosmetic outcomes and quality of life.

     

    References:

    1. Ryu J, Ryu YM, Jung YS, Kim SJ, Lee YJ, Lee EK, et al. Extent of thyroidectomy affects vocal and throat functions: a prospective observational study of lobectomy versus total thyroidectomy. Surgery 2013;154:611-20.
    2. Miccoli P, Berti P, Raffaelli M, Conte M, Materazzi G, Galleri D. Minimally invasive video-assisted thyroidectomy. Am J Surg 2001;181:567-70.
    3. Miccoli P, Berti P, Raffaelli M, Materazzi G, Baldacci S, Rossi G. Comparison between minimally invasive videoassisted thyroidectomy and conventional thyroidectomy: a prospective randomized study. Surgery 2001;130:1039-43.
    4. Francis GL, Waguespack SG, Bauer AJ, Angelos P, Benvenga S, Cerutti JM, Dinauer CA, Hamilton J, Hay ID, Luster M, Parisi MT, Rachmiel M, Thompson GB, Yamashita S; American Thyroid Association Guidelines Task Force. Management Guidelines for Children with Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid 2015l;25:716-59.
    5. Chung WY. Pros of robotic transaxillary thyroid surgery: its impact on cancer control and surgical quality. Thyroid 2012;22:986-7.
    6. Lewis CM, Chung WY, Holsinger FC. Feasibility and surgical approach of transaxillary robotic thyroidectomy without CO(2) insufflation. Head Neck 2010;32:121-6.
    7. Singer MC, Seybt MW, Terris DJ. Robotic facelift thyroidectomy: I. Preclinical simulation and morphometric assessment. Laryngoscope 2011;121:1631-5.
    8. Terris DJ, Singer MC, Seybt MW. Robotic facelift thyroidectomy: II. Clinical feasibility and safety. Laryngoscope 2011;121:1636-41.
    9. Hyun K, Byon W, Park HJ, Park Y, Park C, Yun JS. Comparison of swallowing disorder following gasless transaxillary endoscopic thyroidectomy versus conventional open thyroidectomy. Surg Endosc 2014;28:1914-20.
    10. Chung EJ, Park MW, Cho JG, Baek SK, Kwon SY, Woo JS, et al. A prospective 1-year comparative study of endoscopic hyroidectomy via a retroauricular approach versus conventional open thyroidectomy at a single institution. Ann Surg Oncol 2015;22:3014-21.
    11. M. Gagner, Endoscopic subtotal parathyroidectomy in patients with primary hyperparathyroidism, Br. J. Surg. 83 (1996) 875.
    12. P. Miccoli, P. Berti, M. Raffaelli, M. Conte, G. Materazzi, D. Galleri, Minimally invasive video-assisted thyroidectomy, Am. J. Surg. 181 (2001) 567e570.
    13. P. Micolli, R. Bellantone, M. Mourad, M. Walz, M. Raffaelli, P. Berti, Minimally invasive video-assisted thyroidectomy: multi-institutional experience, World J. Surg. 26 (2002) 972e975.
    14. D.J. Terris, P. Angelos, D.L. Steward, A.A. Simental, Minimally invasive videoassisted thyroidectomy: a multi-institutional North American experience, Arch. Otolaryngol. Head Neck Surg. 134 (2008) 81e84.
    15. Yu J, Bao S, Yu S, Zhang DQ, Loo W, Chow LWC, et al. Minimally invasive video-assisted thyroidectomy for the early stage differential thyroid carcinoma. J Transl Med. 2012;10 Suppl 1:S13.
    16. Rumsey N, Clarke A, White P: Exploring the psychosocial concerns of outpatients with disfiguring conditions. J Wound Care 12:247, 2003.
    17. Lee HS, Lee D, Koo YC, Shin HA, Koh YW, Choi EC. Endoscopic Resection of Upper Neck Masses via Retroauricular Approach Is Feasible With Excellent Cosmetic Outcomes, J Oral Maxillofac Surg. 2013r;71:520-7.
    18. Kang SW, Park JH, Jeong JS, Lee CR, Park S, Lee SH, et al. Prospects of robotic thyroidectomy using a gasless, transaxillary approach for the management of thyroid carcinoma.Surg Laparosc Endosc Percutan Tech 2011;21:223-9.
    19. Lee J, Nah KY, Kim RM, Ahn YH, Soh EY, Chung WY. Differences in postoperative outcomes, function, and cosmesis: open versus robotic thyroidectomy. Surg Endosc 2010;24: 3186-94.
    20. Sun GH, Peress L, Pynnonen MA. Systematic review and meta-analysis of robotic vs conventional thyroidectomy approaches for thyroid disease. Otolaryngol Head Neck Surg 2014;150:520-32.
    21. Lin S, Chen ZH, Jiang HG, Yu JR. Robotic thyroidectomy versus endoscopic thyroidectomy: a meta-analysis. World J Surg Oncol 2012;10:239.
    22. Lee DY, Lee KJ, Han WG, Oh KH, Cho JG, Baek SK, Kwon SY, Woo JS, Jung KY. Comparison of transaxillary approach, retroauricular approach, and conventional open hemithyroidectomy: A prospective study at single institution. Surgery 2016;159:524-31.
    23. McIvor NP, Flint DJ, Gillibrand J, Morton RP. Thyroid surgery and voice-related outcomes. Aust N Z J Surg 2000;70:179-83.
    24. de Pedro Netto I, Fae A, Vartanian JG, Barros AP, Correia LM, Toledo RN, et al. Voice and vocal selfassessment after  Thyroidectomy. Head Neck 2006;28:1106-14.
    25. Lombardi CP, Raffaelli M, D’Alatri L, Marchese MR, Rigante M, Paludetti G, et al. Voice and swallowing changes after thyroidectomy in patients without inferior laryngeal nerve injuries. Surgery 2006;140:1026-32.
    26. Scerrino G, Inviati A, Di Giovanni S, Paladino NC, Di Paola V, Lo Re G, et al. Esophageal motility changes after thyroidectomy; possible associations with postoperative voice and swallowing disorders: preliminary results. Otolaryngol Head Neck Surg 2013;148:926-32.
    27. Hong KH, Kim YK. Phonatory characteristics of patients undergoing thyroidectomy without laryngeal nerve injury. Otolaryngol Head Neck Surg 1997;117:399-404.
    28. Loucks TM, Poletto CJ, Saxon KG, Ludlow CL. Laryngeal muscle responses to mechanical displacement of the thyroid cartilage in humans. J Appl Physiol 2005;99:922-30.
    29. Lira RB, Chulam TC, Koh YW, Choi EC, Kowalski LP. Retroauricular Endoscope-Assisted Approach to the Neck: Early Experience in Latin America. Int Arch Otorhinolaryngol. 2016;20(2):138-44

 

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