We developed a new endoscopic thyroid surgery by the axillo-bilateral-breast approach (ABBA) method, which is different from the previously described breast approach (BA) in that the port sites are modified to obtain a better view and to prevent the interference of surgical instruments. This modification also improves cosmetic results by eliminating the parasternal incision, which results in hypertrophic scar in a significant number of cases treated with BA. Twelve patients with benign thyroid tumors successfully underwent endoscopic thyroid surgery by ABBA, and their clinical outcomes were compared with those of four patients treated with BA. The mean operation time was significantly shorter in the ABBA group than in the BA group (188 minutes vs. 270 minutes;P < 0.01). Furthermore, the mean blood loss in the ABBA group (53 mL) was half of that in the BA group (108 mL). Neither conversion to open surgery nor significant intraoperative complications were experienced. The operative scars by ABBA became inconspicuous in a few weeks. These results seem to indicate that ABBA is a better method than BA and can be a feasible option, particularly for young patients who opt for the better cosmetic outcome.
Endoscopic surgery was developed more than 10 years ago and has been applied to almost every surgical treatment of a variety of diseases. One of advantages of endoscopic surgery over conventional open surgery is its minimal surgical invasiveness, resulting in a decreased hospital stay and quicker return to normal activity. Another merit is that it can provide better cosmetic outcomes than open surgery. Endoscopic surgery has been applied to neck surgery, in which cosmetic consideration is very much emphasized.
Ohgami et al. (1) reported scarless endoscopic thyroid surgery by breast approach (BA;Fig. 1A). This technique seems to be most promising in a cosmetic viewpoint, because it leaves no operative scars in the neck and upper anterior chest. The incision at the parasternal port site, however, often becomes a hypertrophic scar (Fig. 2), whereas the areolar incisions become inconspicuous several weeks after the surgery. Furthermore, some parts of the operative procedures, e.g., dissection of the recurrent laryngeal nerve and division of the superior thyroid vessels, are sometimes difficult to perform in BA, because of the limited viewing angle and the interference of the endoscope and surgical instruments.
In order to resolve these problems, we developed a new technique by converting the port site from the parasternal region to the axilla on the tumor side, i.e., axillo-bilateral-breast approach (ABBA;Fig. 1B). In this paper, this new technique and its advantage over BA are presented.