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Combined thoracoscopic and axillary subcutaneous endoscopic thyroidectomy: a novel approach for cervicomediastinal goiters

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Abstract

Purpose

After our group described the first remote-access thyroidectomy series in 2000, the procedure has been further developed. Although a thoracoscopic approach with a conventional open cervical incision for thyroid goiters with mediastinal extension has been performed at many institutions, remote-access thyroidectomy for cervicomediastinal goiters has not been established. We have performed combined thoracoscopic and axillary subcutaneous endoscopic thyroidectomies (axillo-thoracic endoscopic thyroidectomies). Here, we describe a novel technique for performing a remote-access thyroidectomy for a cervicomediastinal goiter (CMG).

Patients and methods

The patients with CMGs who agreed to an axillo-thoracic endoscopic thyroidectomy at one of two hospitals in Japan underwent a remote-access thyroidectomy.

Results

We performed the axillo-thoracic endoscopic right or left hemithyroidectomy successfully, but most of the patients did not require the thoracoscopic procedure. None of the patients had complications, and none was converted to an open thyroidectomy.

Conclusions

Most thyroid goiters with substernal extension can be removed by the axillary approach, but some cases require a thoracoscopic approach. The novel approach described herein (axillo-thoracic endoscopic thyroidectomy) enables the safe excision of a CMG with high patient satisfaction for selected patients.

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References

  1. Berber E, Bernet V, Fahey TJ 3rd, Kebebew E, Shaha A, Stack BC Jr, Stang M, Steward DL, Terris DJ (2016) American Thyroid Association statement on remote-access thyroid surgery. Thyroid 26:331–337. https://doi.org/10.1089/thy.2015.0407

    Article  PubMed  PubMed Central  Google Scholar 

  2. Ikeda Y, Takami H, Sasaki Y, Kan S, Niimi M (2000) Endoscopic neck surgery by the axillary approach. J Am Coll Surg 191:336–340. https://doi.org/10.1016/s1072-7515(00)00342-2

    Article  CAS  PubMed  Google Scholar 

  3. Ohgami M, Ishii S, Arisawa Y, Ohmori T, Noga K, Furukawa T, Kitajima M (2000) Scarless endoscopic thyroidectomy: breast approach for better cosmesis. Surg Laparosc Endosc Percutan Tech 10:1–4

    Article  CAS  Google Scholar 

  4. Ikeda Y, Takami H, Niimi M, Kan S, Sasaki Y, Takayama J (2002) Endoscopic thyroidectomy and parathyroidectomy by the axillary approach. A preliminary report Surg Endosc 16:92–95. https://doi.org/10.1007/s004640080175

    Article  CAS  PubMed  Google Scholar 

  5. Saito Y, Ikeda Y, Katoh H, Nakao A, Takami H (2021) Is total endoscopic parathyroidectomy an acceptable treatment for patients with primary hyperparathyroidism due to a presumed solitary adenoma? — comparison of minimally invasive total endoscopic parathyroidectomy and open minimally invasive parathyroidectomy. Gland Surg 10:83–89. https://doi.org/10.21037/gs-20-526

    Article  PubMed  PubMed Central  Google Scholar 

  6. Saito Y, Takeuchi H, Fukuda K, Suda K, Nakamura R, Wada N, Kawakubo H, Kitagawa Y (2018) Size of recurrent laryngeal nerve as a new risk factor for postoperative vocal cord paralysis. Dis Esophagus 31. https://doi.org/10.1093/dote/dox162

  7. Chen AY, Bernet VJ, Carty SE, Davies TF, Ganly I, Inabnet WB III, Shaha AR (2014) American Thyroid Association statement on optimal surgical management of goiter. Thyroid 24:181–189. https://doi.org/10.1089/thy.2013.0291

    Article  PubMed  Google Scholar 

  8. Testini M, Gurrado A, Avenia N, Bellantone R, Biondi A, Brazzarola P, Calzolari F, Cavallaro G, De Toma G, Guida P (2011) Does mediastinal extension of the goiter increase morbidity of total thyroidectomy? A multicenter study of 19,662 patients. Ann Surg Oncol 18:2251–2259. https://doi.org/10.1245/s10434-011-1596-4

    Article  PubMed  Google Scholar 

  9. Nesti C, Wohlfarth B, Borbély YM, Kaderli RM (2021) Case report: modified thoracoscopic-assisted cervical resection for retrosternal goiter. Front Surg 8:695963. https://doi.org/10.3389/fsurg.2021.695963

    Article  PubMed  PubMed Central  Google Scholar 

  10. Masuda M, Wakasaki T, Tamae A, Komune N, Hara T, Uchiyama A (2007) [Mediastinal dissection for patients with differentiated thyroid carcinoma: sternotomy vs VATS (video-assisted thoracoscopic surgery)]. Nihon Jibiinkoka Gakkai Kaiho 110:758-761 (in Japanese) https://doi.org/10.3950/jibiinkoka.110.758

  11. Tae K, Song CM, Ji YB, Sung ES, Jeong JH, Kim DS (2016) Oncologic outcomes of robotic thyroidectomy: 5-year experience with propensity score matching. Surg Endosc 30:4785–4792. https://doi.org/10.1007/s00464-016-4808-y

    Article  PubMed  Google Scholar 

  12. Russell JO, Razavi CR, Garstka ME, Chen LW, Vasiliou E, Kang S-W, Tufano RP, Kandil E (2019) Remote-access thyroidectomy: a multi-institutional North American experience with transaxillary, robotic facelift, and transoral endoscopic vestibular approaches. J Am Coll Surg 228:516–522. https://doi.org/10.1016/j.jamcollsurg.2018.12.005

    Article  PubMed  Google Scholar 

  13. Nakao A, Saito Y, Ikeda Y, Takami H, Hoshino G, Miyata R, Tomita M, Sato M, Ishikura N, Mitsuya T (2021) Total endoscopic thyroidectomy after open neck biopsy of the follicular lymphoma of the thyroid gland. Asian J Endosc Surg 14:275–278. https://doi.org/10.1111/ases.12847

    Article  PubMed  Google Scholar 

  14. Ho K, Saito Y, Ikeda Y, Takami H, Tokuda T, Miyata R, Tomita M, Sato M, Ando N (2022) Remote-access hemithyroidectomy in a patient with papillary thyroid cancer after ipsilateral irradiation: A case report. Gland Surg 11:622–627. https://doi.org/10.21037/gs-21-715

    Article  PubMed  PubMed Central  Google Scholar 

  15. Zieliński M, Gwozdz P, Solarczyk-Bombik K, Wilkojc M, Czajkowski W, Kosinski S, Fryzlewicz E, Nabialek T, Szolkowska M, Pankowski J (2018) Video-assisted thoracic surgery thymectomy: subxiphoid approach. Mediastinum 2:45. https://doi.org/10.21037/med.2018.05.03

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Surgery, International Goodwill Hospital, 1-28-1 Nishigaoka, Izumi-ku, Yokohama, Kanagawa, 245-0006, Japan

    Yoshiyuki Saito, Atsushi Nakao, Keiso Ho, Toshiki Tokuda, Ryohei Miyata, Masato Tomita, Michio Sato & Nobutoshi Ando

  2. Department of Surgery, Keio University School of Medicine, Tokyo, Japan

    Yoshiyuki Saito & Atsushi Nakao

  3. Division of Thyroid and Parathyroid Endocrine Surgery, Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA

    Yoshiyuki Saito

  4. Department of Surgery Gastroenterology Center, International University of Health and Welfare, Mita Hospital, Tokyo, Japan

    Yoshiyuki Saito & Yoshifumi Ikeda

  5. Department of Surgery, International University of Health and Welfare, Atami Hospital, Atami, Shizuoka, Japan

    Yoshifumi Ikeda

  6. Department of Surgery, Ito Hospital, Tokyo, Japan

    Hiroshi Takami

Authors
  1. Yoshiyuki Saito
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  2. Yoshifumi Ikeda
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  3. Hiroshi Takami
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  4. Atsushi Nakao
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  5. Keiso Ho
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  6. Toshiki Tokuda
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  7. Ryohei Miyata
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  8. Masato Tomita
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  9. Michio Sato
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  10. Nobutoshi Ando
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Correspondence to Yoshiyuki Saito.

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Saito, Y., Ikeda, Y., Takami, H. et al. Combined thoracoscopic and axillary subcutaneous endoscopic thyroidectomy: a novel approach for cervicomediastinal goiters. Langenbecks Arch Surg 407, 2169–2175 (2022). https://doi.org/10.1007/s00423-022-02579-5

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  • DOI: https://doi.org/10.1007/s00423-022-02579-5

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