; Transaxillary Endoscopic Thyroidectomy: An Alternative to Traditional Open Thyroidectomy
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Transaxillary Endoscopic Thyroidectomy: An Alternative to Traditional Open Thyroidectomy

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BACKGROUND: The traditional thyroidectomy technique typically approaches the thyroid through a range of different sized transverse incisions in the neck. Such a scar can result in hypesthesias, paresthesias, and increased patient self-awareness. Furthermore, in some patients of darker-skin ethnicity, the traditional neck incision can result in hyperplastic and keloid scar formation in a highly visible area of the neck. In an effort to lessen this adverse cosmetic outcome, we recently began performing endoscopic thyroidectomy, as described by Ikeda et al, using an axillary approach to conceal the incisions. We recently reviewed our series and studied the feasibility and safety of this approach in patients undergoing thyroidectomy. We herein present our results in the use of this procedure in all patients requiring thyroid resection and highlight the potential advantage in patients having a tendency for hypertrophic cervical scarring. From August 2003 to January 2008 we performed a transaxillary endoscopic thyroidectomy on 53 patients. Forty-one patients were of African descent. All patients underwent successful completion of thyroidectomy using this approach. CONCLUSIONS: Excellent aesthetic results with no visible scarring in the neck region can be safely achieved with this innovative surgical technique. Although the procedure has been shown to be of benefit to all patients, an added advantage may be seen in those patients prone to hypertrophic scarring. Transaxillary endoscopic thyroidectomy is a safe alternative to the traditional open approach in select patients with benign thyroid disease.

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Transaxillary Endoscopic Thyroidectomy:
An Alternative to Traditional Open Thyroidectomy
Titus D. Duncan, MD; Qammar Rashid, MD; Fredne Speights, MD; Ijeoma Ejeh,MD



  Background: The traditional thyroidectomy technique typi-
                                                                          intervention. However, for some patients of darker-skin
  cally approaches the thyroid through a range of different
                                                                          ethnic origin such an incision can result in hyperplas-
  sized transverse incisions in the neck. Such a scar can result
                                                                          tic or keloid scar formation within a highly visible area
  in hypesthesias, paresthesias, and increased patient self-
                                                                          of the neck (Figure 1). This permanent cosmetic blem-
  awareness. Furthermore, in some patients of darker-skin eth-
                                                                          ish can lead to cervical hypesthesias, paresthesias, and
  nicity, the traditional neck incision can result in hyperplas-
                                                                          increased self-awareness.
  tic and keloid scar formation in a highly visible area of the
                                                                              The advantages of surgery performed using mini-
  neck. In an effort to lessen this adverse cosmetic outcome,
                                                                          mally invasive techniques in other areas of the body have
  we recently began performing endoscopic thyroidectomy,
                                                                          been well documented. Enhanced cosmesis, optical
  as described by Ikeda et al, using an axillary approach to
                                                                          enhancement, and improved visualization through video
  conceal the incisions. We recently reviewed our series and
                                                                          magnification have inspired the use of an endoscopic
  studied the feasibility and safety of this approach in patients
                                                                          approach to the thyroid and parathyroid glands.1
  undergoing thyroidectomy. We herein present our results
                                                                              Though endoscopic transaxillary thyroidectomy is a
  in the use of this procedure in all patients requiring thyroid
                                                                          maximally invasive technique, such a procedure may
  resection and highlight the potential advantage in patients
                                                                          provide superior cosmetic results (Figure 2) for patients
  having a tendency for hypertrophic cervical scarring.
                                                                          needing thyroidectomy, as the incisions are concealed
                                                                          within the patients’ axillary fossa (Figure 3). Takami et
  From August 2003 to January 2008 we performed a transax-                al2 was one of the first to describe this type of procedure
  illary endoscopic thyroidectomy on 53 patients. Forty-one               and the advantages of an endoscopic approach to exci-
  patients were of African descent. All patients underwent suc-           sion of the thyroid gland. Because of the increased
  cessful completion of thyroidectomy using this approach.                potential for 
								
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