Page 15 - WJOLS

Effect of Endoscopic Thyroidectomy via Anterior Chest Wall Approach on Treatment of Benign Thyroid Tumors
World Journal of Laparoscopic Surgery, September-December 2008;1(3):13-16
Effect of Endoscopic Thyroidectomy via

Anterior Chest Wall Approach on Treatment of

Benign Thyroid Tumors

Mingliang Wang, Tao Zhang, Zhihai Mao, Feng Dong, Jianwen Li, Aiguo Lu, Weiguo Hu, Lu Zang
Yu Jiang, Minhua Zheng

Shanghai Minimally Invasive Surgery Center, Surgery Department of Shanghai Ruijin Hospital affiliated to Shanghai JiaoTong
University Medical School, Shanghai, China

Abstract INTRODUCTION
Objective: To evaluate the inflammatory response and acid-base Ever since the endoscopic thyroidectomy was originated and
equilibrium index, as well as other clinical facts of the endoscopic developed, this operation has been favoured world widely with
thyroidectomy via the anterior chest wall approach. its excellent clinical and cosmetic outcomes. However, this
operation requires insufflation of CO , which may impair acid-
2
Methods: 39 patients who received thyroidectomy in our surgical base equilibrium. Moreover, the dissection of skin flap is more
center during September 2007 and January 2008 were included in this extensive than conventional thyroidectomy. All these concerns
study. Twenty of the patients underwent an endoscopic surgery, and have been obsessing the surgeons whether it will cause more
the rest 19 received a conventional surgery. These patients’ data were damage to the human body than the conventional one.
compared within and between treatment groups with respect to clinical Our study tries to analyze and compare the differences
facts and inflammatory evaluations. Arterial blood gas data and between the endoscopic thyroidectomy and the conventional
electrolyte data were analyzed within the endoscopic group. thyroidectomy in respect of inflammatory response, arterial
blood gas (ABG) evaluation, as well as durations of operational
Results: Endoscopic thyroidectomy group showed shorter operative time and postoperational hospital stay.
time compared to that of conventional thyroidectomy group, although
the difference didn’t reach statistical significance. No significant PATIENTS AND METHODS
difference regarding postoperative hospital stay was observed between
two groups. Postoperative day 1 shows much higher values of IL-6 Thirty-nine (39) patients with benign thyroid diseases,
and TNF than that measured preoperative or postoperative day 3 in hospitalized in our surgical centre during September 2007 and
January 2008 were included in this study, preoperatively
both groups. CRP appeared to be significantly increased diagnosed by ultrasonography, including solitary nodule
postoperatively in both groups, although no difference between the (16 cases), multiple cysts (5) and multiple nodules (18). No
two groups was found. Although blood cortisol significantly increased concomitant disease was found. These patients were non-
in both groups postoperatively, the data of endoscopic group randomly treated in either endoscopic method or conventional
postoperative day 1 was lower than the same day of conventional procedure on account of the tumor diameter (< 5 cm), age (not
group. Arterial blood gas analysis showed that both PCO and TCO 2 necessary excluding criteria but recommended in relatively
2
were statistically different between preoperation and 30 min after young patients) and their own requests. Patients received either
insufflation. No insufflation complication was observed. unilateral or bilateral subtotal lobectomy according to their state
of lesions. Postoperative paraffin section indicates benign tumor
Conclusion: Compared with conventional thyroid surgery, endoscopic
thyroidectomy via anterior chest wall approach presented with no in all patients, including 21 cases of nodular goiter, 18 adenoma
including 2 with cystoid degeneration. No postoperative
significant difference in respect of both clinical facts and laboratory complications were observed, and no analgetics were applied
outcomes.
after surgery.
Keywords: Surgery; endoscopy; thyroidectomy; anterior chest wall We used 4-6 mmHg CO to sustain the operative space.
2
approach; inflammatory response; arterial blood gas analysis; Parametric data were evaluated by T-test and ANOVA
electrolyte. analysis.

13