Prospective evaluation of endoscopic approaches to the thyroid compartment

Objective: To compare a number of endoscopic approaches to the thyroid compartment. Design: Prospective, nonrandomized, experimental investigation in a porcine model. Methods: We performed a consecutive series of 13 endoscopic thyroidectomies using 5 distinct approaches. The procedures differed by the direction of the approach, incision placement, and use of facilitative maneuvers. The parameters assessed included procedure duration, estimated blood loss, heart rate, blood pressure, temperature, oxygen saturation, and arterial blood gas levels. The thyroid specimens were weighed and examined histologically. Results: Four of the endoscopic approaches were successfully used for resection of the thyroid (12 of 13 animals). The mean operative times were as follows: superior approach (n = 4), 47 ± 14.6 minutes; lateral axillary approach (n = 4), 67 ± 11.8 minutes; and superficial axillary (n = 3), 67.7 ± 22.3 minutes. The one axillary approach took 84 minutes. The precordial approach (n = 1) lasted 47 minutes and then required open conversion. The overall median estimated blood loss was 0 (range 0-100) mL. The mean change in blood pressure and pH from the beginning to the end of the procedure was -0.5 ± 24.1 mm Hg and 0.16 ± 0.07, respectively. The thyroid glands weighed 4.3 ± 0.9 g and had normal glandular architecture with no evidence of significant tissue trauma or thermal injury. There were no cases of pneumothorax, subcutaneous emphysema, or air embolism. Conclusion: A number of approaches to the thyroid compartment are conceivable. The superior approach proved to be the fastest and easiest, whereas the lateral axillary and superficial axillary were the best approaches from a cosmetic and clinical standpoint.