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10.5005/jp-journals-10007-1093 WJOLS
ORIGINAL ARTICLE Endoscopic Right Lobectomy Axillary-breast Approach: Report of Two Cases
Endoscopic Right Lobectomy Axillary-breast

Approach: Report of Two Cases

Nina Irawati
Department of Surgery, Awalbros Hospital, Jalan Gajahmada Kav I Batam, Indonesia

Abstract
Background: We report our two initial experiences in the treatment of thyroid disease with endoscopic thyroidectomy. Minimally invasive
video-assisted thyroidectomy (MIVAT) was initially introduced by Miccoli. The modification was made by using axillary and breast
approach with CO 2 insufflation.
Method: A young woman patient with 5 cm right lobe thyroid disease, suspected benign. From physical examination, sonography and
FNAB findings were categorized as benign case. Thyroid function test was within normal limit. She was operated with endoscopic right
lobectomy. The procedure was carried out through incision of 5-10 mm axillary and breast. The right lobectomy procedure was
performed by dedicated instrument. No drain needed. The pathology result was follicular carcinoma, so further treatment needed. Other
patient, a woman with 4 cm right lobe thyroid cyst. FNAB proved benign, was operated with the same procedure, and pathology result
was benign cyst.
Result: Duration of first operation was 300 minutes and the second one was 120 minutes, minimal blood loss, and no major complication.
Patients were discharged 24 hours after operation. Cosmetic results and postoperative pain were excellent. Slight swelling on their
necks was found and reduced after 48 hours. Pain around shoulder until day-7 postoperation and significantly disappeared after 10 days.
Conclusion: We reported two cases, which were operated by endoscopic right lobectomy as a safe, reproducible technique with an
indication in a minority of patients/candidates to thyroidectomy and is characterized by a better postoperative discomfort. The duration
of operation would be a curve learning for each surgeon who wishes to perform it.
Keywords: Endoscopic thyroidectomy, Axillary-breast approach.

INTRODUCTION parathyroid and thyroid was developed by Gagner and
Neck surgery is one of the newest and most interesting Huscher in 1996 and 1997 respectively. Since then, various
applications of minimally invasive surgery technique in methods, including axillary, breast, and anterior chest
thyroid surgery, particularly with regard to eliminating the approaches have been introduced by many surgeons. The
unattractive scars. 1,2 use of endoscopy for complete thyroidectomy has been
It is well known that conventional thyroidectomy allows viewed with concern, although many surgeons have regarded
prompt postoperative recovery. In some clinical settings, it benign thyroid disease as an indication of endoscopic
is performed as an outpatient procedure. Findings have surgery. 4-7
shown that video-assisted and endoscopic procedure for CASE ILLUSTRATION I
thyroid surgery have some advantages over conventional
surgery in terms of cosmetic result and postoperative A 32-year-old woman with a lump on right anterior neck
recovery. These results support the development of since a year. The lump was not tender, meat ball size, non
endoscopic and video-assisted thyroid surgery. It should growing, and skin over was not red. No other lump was
be emphasized that these procedures are technically seen around her neck or other part of the body. No other
demanding and require a surgical team skilled in both person in her community had the same symptom.
endocrine and endoscopic surgery. This is particularly true From physical examination, general condition was good.
for some endoscopic techniques, such as endoscopic Local status showed lump on anterior neck region with no
thyroidectomy by breast or axillary approach. The redness and size around 5 cm in diameter. The lump was
endoscopic and video-assisted procedure requires a firm, not tender, moved upward on swallowing and no lymph
significant learning period, which can be time consuming node enlargement was seen around the neck. Laboratory
especially at the beginning of a surgeon's experience. 3 finding was within normal limit. Sonography and FNAB
Minimal access thyroid surgery was conceived primarily findings were concluded as benign case. She was operated
1
in Europe and Asia. Endoscopic neck surgery for the with right lobectomy endoscopically. Pathologic result was
World Journal of Laparoscopic Surgery, September-December 2010;3(3):109-112 109