양측 액와유방 접근법과 개방성 접근법과의 비교를 통한 일측 액와유방 접근 내시경 갑상선 전 절제술과 중심 경부 절제술의 수술적 완전성에 대한 평가

최익준,임일한,이병철,이국행,이명철 대한이비인후과학회 2018 대한이비인후과학회지 두경부외과학 Vol.61 No.12

Background and Objectives The aim of this study was to evaluate surgical completeness inendoscopic total thyroidectomy with central neck dissection via unilateral axillo-breast approach(UABA) compared with bilateral axillo-breast (BABA) and open approach (OA) by means ofthe radioactive iodine uptake (RAIU) ratio and thyroglobulin (Tg) of remnant thyroid. Subjects and Method From July 2010 to March 2013, 82 patients who had underwent totalthyroidectomy with central neck dissection and postoperative radioactive iodine (RAI) ablationfor papillary thyroid carcinoma were enrolled. Of these patients, 27 patients underwent UABA,24 patients BABA, and 31 patients OA. Clinicopathologic data, surgical outcome, stimulated Tgand RAIU ratio on the first postoperative RAI ablation scan were compared among 3 groups. Results Patients in the endoscopic surgery groups (UABA, BABA) were younger than thosein the OA groups. Invasiveness such as operation time, postoperative pain, and drain amount inUABA was less than that in BABA and severer than that in OA. Other variables regarding clinicopathologicand surgical data were not significantly different. Stimulated Tg and RAIU ratiodid not show significant differences among 3 groups (p=0.659 and p=0.664). Conclusion The completeness of UABA was comparable with that of BABA and OA. TheUABA may be a safe option for patients who need endoscopic thyroidectomy for papillarythyroid carcinoma.

로봇을 이용한 내시경적 갑상선절제술

박원서 ( Won Seo Park ),민선영 ( Sun Young Min ),고석환 ( Suck Hwan Koh ) 경희대학교 경희의료원 2010 慶熙醫學 Vol.26 No.1

Thyroid cancer incidence is increasing rapidly especially in young female patients and differentiated thyroid cancer has a good prognosis. For these reasons, cosmetic results of thyroid surgery are important. There were many efforts to minimize or hide the scars on the neck using endoscopic surgical technique via various methods such as cervical approach, anterior chest approach, breast approach, gasless axillary approach, axillo bilateral breast approach and bilateral axillo-breast approach (BABA). The BABA is ideal approach because of excellent cosmetic results, optimal view for both lobes of thyroid and distant port location to avoid interference of instruments. Most of all, the BABA is suitable for total thyroidectomy. But the endoscopic thyroidectomy via BABA has some limitations such as long learning curve and difficulty dissecting central and lateral lymph nodes due to rigidity of instruments. Robotic surgical system provides surgeons three dimensional image with 15 times magnification, articulated instruments increasing degree of freedom and ergonomically comfortable position. Grafting robotics on the endoscopic technique can overcome limitations of endoscopic thyroidectomy via BABA without losing the advantage of that. The authors introduce the methods and experiences of robot-assisted endoscopic thyroidectomy.

Bilateral axillo-breast approach (BABA) robotic neck dissection for papillary thyroid carcinomas

Kyung Ho Kang 대한신경모니터링학회 2023 Journal of Neuromonitoring & Neurophysiology Vol.3 No.2

Papillary thyroid carcinoma (PTC), the most commonly diagnosed thyroid malignancy, frequently presents with lymph node metastases. Effective management of metastatic lymph nodes is crucial due to the disease's high recurrence rates. Herein, we present our approach to robotic thyroidectomy and central/lateral neck node dissection, which has shown comparable oncologic outcomes, reduced complications, and improved cosmetic results compared to open surgeries. We detail the surgical procedure, from patient positioning and flap dissection, through central and lateral neck dissection, to closure. The BABA robotic modified radical neck dissection (MRND) is primarily recommended for patients with well-differentiated thyroid carcinoma, predominantly PTC, presenting with suspected or pathologically confirmed lateral neck metastasis. We also discuss the application of the da Vinci robot settings in performing precise procedures and preserving critical anatomical structures. This comprehensive review provides insights into the effectiveness of BABA robotic thyroid surgery and central/lateral neck node dissection in managing PTC.

Early Experience and the Feasibility of the Firefly Technology for Central Lymph Node Dissection (CLND) in Robotic Thyroidectomy Using the BABA

최진아,이지연,정진향,박호용,김완욱 대한내시경복강경외과학회 2017 Journal of Minimally Invasive Surgery Vol.20 No.3

In the bilateral axillo-breast approach (BABA), the camera is inserted through the areolar incision, and this raises the concern it might be difficult to identify the lymph nodes (LN). The purpose of this study is to evaluate the feasibility of the Firefly for central lymph node dissection (CLND) in robotic thyroidectomy using the BABA. This study evaluated 18 patients who underwent robotic surgery using Firefly between December 2015 and March 2016. For LN mapping, 0.05 ml of ICG was injected into the thyroid 3~4 minutes before CLND. Green-stained LN could be detected easily through a near-infrared camera. The number of retrieved LNs was 7.8±3.0 after CLND using the Firefly, which was higher than the 6.7±0.2 reported in previous surgeries. In addition, it helped to distinguish between the parathyroid and the LNs. The Firefly technology was helpful in identifying the LNs, guiding the CLND and performing a complete CLND.

Preoperative flap-site injection with ropivacaine and epinephrine in BABA robotic and endoscopic thyroidectomy safely reduces postoperative pain : A CONSORT-compliant double-blinded randomized controlled study (PAIN-BREKOR trial)

Lee, Joon-Hyop,Suh, Yong Joon,Song, Ra-Yeong,Yi, Jin Wook,Yu, Hyeong Won,Kwon, Hyungju,Choi, June Young,Lee, Kyu Eun Williams & Wilkins Co 2017 Medicine Vol.96 No.22

<P><B>Abstract</B></P><P><B>Background:</B></P><P>Clinical trials on bilateral axillo-breast approach (BABA) thyroidectomy show that levobupivacaine and ropivacaine significantly reduce postoperative pain, but they focused on BABA robotic thyroidectomy only and did not identify specific sites of significant pain relief. Our objective was to assess the pain reduction at various sites and safety of ropivacaine-epinephrine flap injection in BABA thyroidectomy.</P><P><B>Methods:</B></P><P>This prospective double-blinded randomized controlled trial was conducted in compliance with the revised CONSORT statement (ClinicalTrials.gov registration no. NCT02112370). Patients were randomized into the ropivacaine-epinephrine arm or control (normal saline) arm.</P><P><B>Results:</B></P><P>From January 2014 to May 2016, 148 patients participated. The primary endpoint was site-specific pain, as measured by numeric rating scale 12 hours after surgery. The ropivacaine-epinephrine group exhibited significantly less swallowing difficulty (<I>P</I> = .008), anterior neck pain (<I>P</I> = .016), and right (<I>P</I> = .019) and left (<I>P</I> = .035) chest pain. Secondary endpoints were systolic (<I>P</I> = .402), diastolic (<I>P</I> = .827) blood pressure, and pulse rate (<I>P</I> = .397) after injection before incision and during surgery. The vital signs of the groups just after injection did not differ. During surgery, the ropivacaine-epinephrine patients had higher pulse rates (99 ± 13.3 vs 88 ± 16.1, <I>P</I> < .001) but within normal range. There were no adverse events such as postoperative nausea and vomiting. There was no significant difference in pain scores in either patient group between patients who underwent robotic or endoscopic interventions.</P><P><B>Conclusion:</B></P><P>BABA flap-site injection with ropivacaine and epinephrine mix before incision effectively and safely reduced postoperative pain. Future studies should focus on tailoring ropivacaine and epinephrine dosage for individuals.</P>

Bilateral axillo-breast approach robotic total thyroidectomy without isthmectomy: a case report

Hyeji Kim,Hyeonuk Hwang,Hyungju Kwon Ewha Womans University School of Medicine 2024 EMJ (Ewha medical journal) Vol.47 No.1

A comparative study of postoperative pain for open thyroidectomy versus bilateral axillo-breast approach robotic thyroidectomy using a self-reporting application for iPad

Young Jun Chai,Junho Song,Jiyoung Kang,Jung-Woo Woo,Ra-Yeong Song,Hyungju Kwon,Su-Jin Kim,June Young Choi,Kyu Eun Lee 대한외과학회 2016 Annals of Surgical Treatment and Research(ASRT) Vol.90 No.5

Purpose: Postoperative pain for robotic thyroid surgeries including bilateral axillo-breast approach (BABA) has not been well studied. In this study, we have developed a self-reporting application (SRA) for iPad and prospectively collected pain scores from open thyroidectomy (OT) and BABA robotic thyroidectomy (RT) patients. Methods: Female patients who underwent total thyroidectomy for papillary thyroid carcinoma were included. Patients recorded pain scores for throat, anterior neck, posterior neck, chest, and back on postoperative days 1, 2, and 3. Once discharged, on postoperative day 14, a survey was also conducted on satisfaction of SRA and cosmesis. Results: A total of 54 patients were enrolled (27 BABA RT and 27 OT). There were no significant differences between the 2 groups in clinicopathological characteristics and postoperative complication rates. Postoperative pain scores at days 1, 2, 3, and 14 were not significantly different between the groups for throat, anterior neck, posterior neck, or back. Postoperative analgesic requirements were similar between the 2 groups. Wound satisfaction scores were significantly higher in the BABA RT group (BABA RT 7.4 vs. OT 5.7; P = 0.016). Satisfaction scores for the usefulness of SRA were above 7.2 for all four questionnaire items on the 10-point scale. Conclusion: Postoperative pain for BABA RT is equivalent to OT but offers greater cosmetic satisfaction for patients. A mobile device application such as SRA may facilitate proper assessment and management of pain in postoperative patients.

Robotic parathyroidectomy in primary hyperparathyroidism via the bilateral axillo-breast approach

Hye Lim Bae(Hye Lim Bae),Junice Wong(Junice Wong),Su-jin Kim(Su-jin Kim),JungHak Kwak(JungHak Kwak) 대한신경모니터링학회 2023 Journal of Neuromonitoring & Neurophysiology Vol.3 No.1

Primary hyperparathyroidism is a common endocrine disorder that can be cured through surgical intervention. The majority of cases are caused by a single hyperfunctioning parathyroid adenoma. Focused parathyroidectomy is becoming more common as pre-operative localization techniques have improved. This approach minimizes the size of the incision while allowing safe dissection of the parathyroid glands in the confined space of the neck. Recent studies have reported that robotic parathyroidectomy (RP) was feasible with similar complication and success rates to open surgery. This case report describes the use of the robotic platform for focused parathyroidectomy via bilateral axillo-breast approach (BABA), demonstrating the feasibility and potential benefits of this approach.

양측 액와 유방 접근 내시경 갑상선 절제술에 대한 5년간의 분석

박윤철(Yun Chul Park),유영재(Young Jae Ryu),조진성(Jin Seong Cho),윤정한(Jung Han Yoon),박민호(Min Ho Park) 대한갑상선-내분비외과학회 2015 The Koreran journal of Endocrine Surgery Vol.15 No.2

Purpose: We investigated the efficacy and safety of endoscopic thyroidectomy using bilateral axillo-breast approach (BABA) by analyzing short term surgical outcomes. Methods: We retrospectively evaluated 355 patients who underwent BABA endoscopic thyroidectomy between August 2006 and December 2011 at Chonnam National University Hospital and Hwasun Chonnam National University Hospital. The age, sex, clinical and pathologic characteristics of tumors, extent of operation, conversion rate to open thyroidectomy, operation time, hospital stay, thyroglobulin levels after thyroidectomy, recurrence, and complications were analyzed retrospectively. Results: The mean age of the patients was 35 years. The 355 patients comprised 345 females (97.2%) and 10 males (2.8%). The benign tumor was 37 cases (10.4%) and the malignant tumor was 318 cases (89.6%). 28 patients (75.7%) of the benign tumor underwent lobectomy. In malignant tumor, 159 patients (50.0%) underwent lobectomy and 152 patients (47.8%) underwent total thyroidectomy. Mean operation time was 121.1±49.9 minutes, and mean hospital days were 3.4±1.1 days. 21 (6.0%) transient hypocalcemia and 7 (2.0%) permanent hypocalcemia were occurred. The transient voice change occurred in 5 patients (1.4%), but nobody suffered from the permanent recurrent laryngeal nerve injury. 4 patients of recurrent (1.3%) papillary thyroid carcinoma were treated by surgery. Conclusion: Compare to open thyroidectomy with long term follow up studies, BABA endoscopic thyroidectomy is a useful treatment option for both benign and malignant thyroid tumor.

양측 액와유륜부 접근법을 이용한 무배액관 로봇 또는 내시경하 갑상선 절제술의 안정성에 대한 예비연구

문소향(So Hyang Moon),전영산(Young San Jeon),김완욱(Wan Wook Kim),강수환(Su Hwan Kang),정영주(Young Ju Jeong),최정은(Jung Eun Choi),조지형(Ji hyoung Cho) 대한갑상선-내분비외과학회 2015 The Koreran journal of Endocrine Surgery Vol.15 No.2

Purpose: The aim of this study was to evaluate the safety of robotic or endoscopic thyroidectomy via bilateral axillo-breast approach (BABA) without a drainage procedure. Methods: A total of 64 patients who underwent robotic or endoscopic thyroidectomy via BABA without a close suction drain between February and March 2012 were enrolled. We checked postoperative symptoms or signs including change of vital signs, dyspnea, swelling or fluctuation of anterior chest and neck and compression symptoms at 1, 6, 24, and 48 hours and 1 month after surgery. Postoperative ultrasonography was performed in patients with at least one or more postoperative symptoms or signs in order to confirm hematoma or fluid collection. Results: None of the enrolled patients had dyspnea or change of vital signs. Two of 64 patients had swelling, 1 of 64 patients had fluctuation on the anterior chest, and 1 of 64 patients had compression symptoms. Fluid collection was confirmed in 2 of 4 of the above mentioned patients and the collected fluid was aspirated. The amounts of aspirated fluid were 25 mL and 8 mL. Thereafter, the follow up ultrasonography showed no more fluid collection in all patients. In addition, we rechecked the above mentioned symptoms or signs at 1 month after surgery; none of the enrolled patients had symptoms or signs. Conclusion: Robotic or endoscopic thyroidectomy via BABA without a closed suction drain shows no serious seroma or hematoma collection. Therefore, we expect that robotic or endoscopic thyroidectomy via BABA without a closed suction drain can reduce the pain, discomfort or longer hospital stay as a result of closed suction drain using this method.