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Nina Irawati

          < 45 years, tumor size < 2 cm, and no evidence of lymph  REFERENCES
                                                   16
          node metastasis or local invasion. Miccoli et al  showed  1. El-Labban GM. Minimally invasive Video-assisted
          that the completeness obtained with MIVAT for thyroid   thyroidectomy: A Single-blinded, randomized trial. The Internet
                                                                  Journal of Surgery 2010;22(2).
          cancer not exceeding 3.5 cm in diameter is similar to that  2. Bellantone R, Pio Lombardi C, Bossola M, et al. Video-assisted
          obtained with open surgery. As experience accumulates and  vs conventional thyroid lobectomy a randomized trial. Arch
          more techniques are developed, the indication in cases of  Surg. 2002;137:301-04.
          thyroid malignancy can be expanded. 4,6              3. Gal I, Solymosi T, Szabo Z, et al. Minimally invasive Video-
             Postoperative complications are hypocalcemia, recurrent  assisted thyroidectomy and conventional thyroidectomy:
                                                                  A Prospective Randomized Study. Surg Endosc 2008;22:2445-
          laryngeal nerve (RLN) paralysis, bleeding, infection, and  49.
              4,5
          pain.  Others, as a complication of using CO  insufflation,  4. Seung Chng Y, Ho Choe J, Ho Kang K, et al. Endoscopic thyro-
                                                2
          are hypercapnia, subcutaneous emphysema and severe      idectomy for thyroid malignancies: Comparison with Con-
                                  18
          tachycardia. 5,17  Gottlieb et al  reported severe increase in  ventional Open Thyroidectomy. World J Surg 2007;31:2302-
                                                                  06.
          PaCO , subcutaneous emphysema, and severe tachycardia  5. Lai Park Y, Kon Han W, Gila Bae W. 100 Cases of Endoscopic
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          by applied insufflations at relatively high pressure    Thyroidectomy. Surg Laparosc, Endosc and Percutan Tech
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          (15-20 mm Hg), whereas Ochiai et al  and Ohgami et al 11  2003;13(1):20-25.
          reported only minimal emphysema with the use of low  6. Eun Lee K, Rao J, Kyu Youn Y, et al. Endoscpic Thyroidectomy
                                                                  with the da Vinci Robot System Unsing the BABA Technique-
          pressure CO  insufflation (6 mm Hg).Tran Ngoc Luong     Our Initial Experience. Surg Laparosc, Endosc and Percutan Tech
                     2
          technique used 10 to 11 mm Hg insufflations of CO  without  2009;19(3):e71-75.
                                                    2
          severe complication appearence. The study of the appropriate  7. Lei Wang Y, Yong Zhang G, Xin Wang K. Endoscopic
                                                                  Thyroidectomy by A Modified Anterior Chest Approach:
          pressure to be used is still under observation. 10      A single institution's 5-year experience. Min Inv Therapy
             According to the literature, the conversion rate varies  2009;18:297-301.
          from 0 to 13%. The reasons include malignant histological  8. Minimally Invasive Thyroid Surgery. Available from:
                                                                  www.thyroidectomy.com.
          result, bleeding, difficulty of dissection, size of nodule and  9. Barlehner E, Benhidjeb T. Cervical Scarless Endoscopic
          thyroiditis. In some reports, 5 to 11% patients even required  Thyroidectomy: Axillo-bilateral-breast Approach (BABA). Surg
          a second operation for definitive malignant pathological  Endosc 2008;22:154-57.
          result. 6                                           10. Ngoc Luong T. Open and Endoscopic Thyroidectomy. Paper
                                                                  Lecture August 2009.
             We performed our first case using axillary-breast  11. Ohgami M, Ishii S, Arisawa Y, et al. Scarless Endoscopic
          approach similar to Tran Ngoc Luong technique. We did   Thyroidectomy: Breast Approach for Better Cosmesis. Surg
          not find any difficulty in identifying the anatomy during  Laparosc Endosc Percutan Tech 2002;21:2166-71.
          operation, so we did not convert to open method. The  12. Yamamoto M, Sasaki A, Asahi H, et al. Endoscopic Subtotal
                                                                  Thyroidectomy for Patients with Graves' Disease. Surg Today
          operation time was relatively faster than the first operation  2001;31:1-4.
          which Tran Ngoc Luong did. There was minimal blood  13. Ikeda Y, Takami H, Sasaki Y. Comparative Study of
          loss and no major complication was found including the  Thyroidectomies: Endoscopic Surgery vs Conventional Open
                                                                  Surgery. Surg Endosc 2001;16:1741-45.
          effect of CO  insufflation. This technique was safe and  14. Del Rio P, Sommaruga L, Ferreri G, et al. Preliminary Experience
                     2
          feasible to perform. It provides excellent view of vital  in Minimally Invasive Video-assisted Thyroidectomy (MIVAT).
          structure and has advantage over open method cosmetically,  Acta Bio 2006;77:27-29.
          although it has learning curve. As we get more familiar, the  15. Kitano H, Fujimura M, Kinoshita T, et al. Endoscopic Thyroid
          operating time will be shorter and also extending indication  Resection Using Cutaneous Elevation in Lieu of Insufflation.
                                                                  Surg Endosc 2002;16:88-91.
          for endoscopic thyroid surgery. We proved it with our  16. Miccoli P, Berti P, Raffaelli M, et al. Comparison between
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          blood loss.                                             Conventional Thyroidectomy: A prospective randomized study.
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          CONCLUSIONS                                         17. Ochiai R, Takeda J, Noguchi J. Subcutaneous Carbon Dioxide
                                                                  Insufflation Does Not Cause Hypercarbia During Endoscopic
          Since its introduction and establishment in 1997, endoscopic  Thyroidectomy. Anesth Analg 2000;90:760-62.
          thyroidectomy has yet to become a standard procedure. Thus,  18. Gottlieb A, Sprung J, Zheng XM, et al. Massive Subcutaneous
          this procedure will provide another surgical choice for patients  Emphysema and Severe Hypercarbia in a Patient During
                                                                  Endoscopic Transcervical Parathyroidectomy using Carbon
          with thyroid tumors and carcinoma.                      Dioxide Insufflation. Anesth Analg 1997;84:1154-56.




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