Scarless endoscopic thyroidectomy: Breast approach for better cosmesis

An original technique for performing endoscopic thyroidectomy using a breas t approach to avoid an operative scar in the neck was developed. The subcut aneous space in the breast area and the subplatysmal space in the neck were bluntly dissected through a 15-mm incision between the nipples, and CO2 wa s insufflated at 6 mm Hg to create the operative space. Three trocars were inserted at the breast, and dissection of the thyroid and division of the t hyroid vessels and parenchyma were performed endoscopically using an ultras onically activated scalpel. Four hemithyroidectomies and one partial resect ion of the thyroid for five female patients with thyroid adenomas 5 to 7 cm in diameter were successfully performed using this procedure. There were n o conversions to open surgery or complications. No scars were apparent in t he neck, and all patients were fully satisfied with the cosmetic results. E ndoscopic thyroidectomy using a breast approach and low-pressure subcutaneo us CO2 insufflation is a feasible and safe procedure, which results in sati sfactory cosmetic results.