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New Endoscopic Thyroidectomy With the Bilateral Areolar Approach: A Comparison With the Bilateral Axillo-Breast Approach

Hur, Sung Mo MD; Kim, Sung Hoon MD; Lee, Se Kyung MD; Kim, Wan Wook MD; Choe, Jun-Ho MD, PhD; Lee, Jeong Eon MD, PhD; Kim, Jung-Han MD, PhD; Nam, Seok-Jin MD, PhD; Yang, Jung-Hyun MD, PhD, FACS; Kim, Jee Soo MD, PhD

Surgical Laparoscopy, Endoscopy & Percutaneous Techniques: October 2011 - Volume 21 - Issue 5 - p e219–e224
doi: 10.1097/SLE.0b013e3182239989
Online Articles: Technical Reports

Purpose We developed the bilateral areolar approach (BAA) for less invasive endoscopic thyroidectomy to avoid scars on exposed areas. Here, we report our experience with the BAA technique and evaluate its feasibility through comparison with the bilateral axillo-breast approach (BABA).

Methods From January 2009 to November 2009, 88 patients with benign tumors of any size or papillary thyroid microcarcinomas were enrolled in the study. Of these patients, 50 patients underwent endoscopic thyroidectomy by BABA and 38 patients by BAA. The BAA technique was performed using one 11-mm port and three 5-mm ports through bilateral circumareolar incisions using flexible endoscopic instruments.

Results Comparing BAA with BABA, there were significant differences in the mean operation times [121.7±24.5 vs. 102.6±25 min for lobectomy (P<0.05) and 162.5±36.1 vs. 131±28 min for total thyroidectomy (P<0.05), respectively]. However, there were no significant differences in the duration of hospitalization, amount of drainage from the surgical sites, and occurrence of postoperative complications. Most of the patients after BAA and BABA were satisfied with the cosmetic result. However, among the patients who underwent the BABA procedure, 1 patient was dissatisfied and 2 patients experienced discomfort due to conspicuous axillary scar when they wore sleeveless clothes.

Conclusions Endoscopic thyroidectomy using the BAA procedure affords the advantages of minimal invasiveness and excellent cosmesis compared with other approaches including BABA. The BAA procedure is an attractive surgical option, particularly for patients with benign thyroid disease or small-sized papillary carcinoma who want an excellent cosmetic outcome.

Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea

The authors declare no conflict of interest.

Reprints: Jee Soo Kim, MD, PhD, Department of Surgery, Division of Breast and Endocrine Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul, Korea, 135-710 (e-mail:

Received May 23, 2010

Accepted May 9, 2011

© 2011 by Lippincott Williams & Wilkins