Endoscopic Thyroidectomy for Large-Sized Goiters: Merits of the Axillo-Breast Approach with Gas Insufflation

Background. Several minimal access approaches to the thyroid gland have been widely applied; nevertheless, such approaches are still challenging when dealing with large-sized thyroid nodules or goiters. We hereby evaluated the outcomes and highlighted the merits of endoscopic axillo-breast hemithyroidectomy (EABH) for large-sized unilateral goiters. Methods. Patients underwent EABH for unilateral large thyroid nodules >= 6 cm in its greatest dimension or unilateral large goiter (>= 60 ml sonographic volume) whatever the size of its contained nodules were identified from a prospectively maintained database. Their demographic data, clinicopathological profiles, and surgical and esthetic outcomes are reported and analyzed. Results. Over a 2-year period, 33 patients matched the selection criteria. Their mean age was 34.75 +/- 11.39 years. There were 30 women and 3 men. The majority of nodules were radiologically TIRADS3 and cytologically Bethesda 3. The mean sonographic dominant nodule greatest dimension was 5.29 +/- 1.48 cm (range: 3-9.5 cm). The mean sonographic volume of the pathological lobe was 101.86 +/- 54.45 ml (range: 60.11-236.88 ml). All cases were completed endoscopically with no conversion to open. The mean operative time was 110.76 +/- 18.75 minutes. No significant postoperative complications were reported except for one case with temporary vocal cord paresis. Most (87.9%) of the patients were extremely satisfied with the procedure. Conclusion. EABH with our suggested key steps could be considered an effective valid approach for unilateral large goiters in trained hands and in patients desirous for cosmesis.