New endoscopic thyroidectomy with the bilateral areolar approach: A comparison with the bilateral axillo-breast approach

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.