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Single Biaxillary Tunneling for Working Space Creation in Bilateral Axillo-Breast Approach (BABA) Thyroidectomy

Tsai, Chung-Yu MD*; Liu, Shiuh-Inn MD, PhD*,†; Chen, I-Shu MD*; Liang, Tsung-Jung MD*,†

Surgical Laparoscopy Endoscopy & Percutaneous Techniques: August 2019 - Volume 29 - Issue 4 - p e50–e52
doi: 10.1097/SLE.0000000000000625
Online Articles: Technical Reports

Background: Endoscopic thyroidectomy using the bilateral axillo-breast approach (BABA) achieves excellent cosmetic results. However, concerns have been raised about the extensive dissection and violation of the breast during working space preparation.

Materials and Methods: We developed a “single biaxillary tunneling” technique for working space creation in BABA thyroidectomy; this technique was applied in 30 cases.

Results: Skin bruise was hardly visible, and only minor and small bruises were observed. The whole process of working space creation typically finished within 20 to 30 minutes.

Conclusions: Limited blunt dissection by a single stroke of biaxillary tunneling is a simple method, which significantly reduces ecchymosis formation and is time-efficient. This method can be used in routine practice and is feasible for beginner surgeons.

*Department of Surgery, Division of General Surgery, Kaohsiung Veterans General Hospital, Zuoying, Kaohsiung

School of Medicine, National Yang-Ming University, Taipei, Taiwan

The authors declare no conflicts of interest.

Reprints: Tsung-Jung Liang, MD, Department of Surgery, Division of General Surgery, Kaohsiung Veterans General Hospital, No. 386, Dazhong 1st Rd, Zuoying District, Kaohsiung 81362, Taiwan (e-mail:

Received October 18, 2018

Accepted December 10, 2018

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