“scarless” (in the neck) endoscopic thyroidectomy (set): an evidence-based review of published techniques

Abstract
Background  Excision of the thyroid through a skin crease incision in the anterior neck provides good direct exposure to facilitate safe
dissection and a quick operation with low morbidity and minimal mortality. However, these patients still have a scar in the
neck. Technologic innovations have allowed surgeons to remove the thyroid gland from a remote site, providing a scarless outcome
in the neck. This study was designed to assess the different techniques of scarless (in the neck) endoscopic thyroidectomy
(SET) by reviewing the current literature.

Methods  A computer-assisted search of the Medline database through September 2007 was undertaken. The combination of terms used included
the following: endoscopic thyroidectomy; minimally invasive thyroidectomy; minimally invasive endocrine surgery; thyroidectomy
via the axillary approach; thyroidectomy via the anterior approach; and thyroidectomy via the breast approach. Additional
data were provided based on previously unpublished experience from our own unit with SET.

Results  There were seven studies that involved 186 patients in whom the thyroid was excised via the axillary method and five published
series that involved 169 patients who had thyroidectomies performed via the anterior approach. There were four published series
of thyroidectomies performed via a hybrid approach, which is a combination of both the anterior and axillary approach, involving
180 patients. Four studies compared SET and another approach for a thyroidectomy. In our unpublished series of SET, we performed
20 cases during a 2-year period comprising 11 cases via the axillary approach and 9 cases via the anterior/breast approach.
Nineteen cases were lobectomies and one case was an isthmusectomy. SET was associated with a longer operative time and increase
postoperative pain. Patients who had SET were satisfied with the aesthetic outcome of the procedure.

Conclusion  Scarless (in the neck) endoscopic thyroidectomy is not a minimally invasive technique but a maximally invasive one that involves
a longer operative time and greater postoperative pain. What it does provide is a safe excision of the thyroid pathology with
the absence of a scar in the neck. However, there is a steep learning curve. With experience and newer surgical instruments,
the operative time and postoperative pain might decrease.

Content Type Journal ArticleDOI 10.1007/s00268-008-9555-3Authors
Charles T. K. Tan, National University Hospital Department of Surgery, Endocrine Surgical Division 5 Lower Kent Ridge Road Singapore 119074 SingaporeW. K. Cheah, National University Hospital Department of Surgery, Endocrine Surgical Division 5 Lower Kent Ridge Road Singapore 119074 SingaporeLeigh Delbridge, University of Sydney Endocrine Surgical Unit Sydney Australia

Journal World Journal of SurgeryOnline ISSN 1432-2323Print ISSN 0364-2313 (Source: World Journal of Surgery)