단일 기관에서의 기존 갑상선 수술과 무기하 및 가스주입 전흉부접근 내시경 갑상선절제술의 임상적 고찰

김미형(Mi-hyeong Kim),김태원(Tae-won Kim),김기환(Kee-hwan Kim),안창혁(Chang-hyeok An),배자성(Ja-sung Bae),박우찬(Woo-chan Park),김정수(Jeong-soo Kim) 대한외과학회 2010 Annals of Surgical Treatment and Research(ASRT) Vol.79 No.6

Purpose: After the first endoscopic thyroidectomy by Huscher in 1997, several surgeons reported their experiences with endoscopic thyroidectomies. And these papers showed that clinical outcomes of endoscopic thyroidectomy are similar to conventional thyroidectomy. But, there was no randomized prospective trial to determine which approach of endoscopic thyroidectomy achieved better results. We evaluated clinical data of gasless and gas insufflation endoscopic thyroidectomies with conventional thyroidectomy to define its advantages or disadvantages. Methods: Between 1999 and 2009, 1,117 patients underwent thyroidectomies (1,149 cases). 747 cases was performed by conventional open method, 402 cases by endoscopic thyroidectomy. Among them, 317 cases were operated by gasless techniques and 85 cases by carbon dioxide gas insufflation. Results: Between conventional and endoscopic thyroidectomy groups, operation time, hospitalization period, tumor size, and number of retrieved lymph nodes were similar (P-value >0.05). Among 441 thyroid cancer patients, 19 had recurrence, of which 15/301 (4.98%) had conventional thyroidectomy, and 4/140 (2.85%) had endoscopic thyroidectomy. After postoperative radioactive iodine therapy, follow-up Tg levels were checked in 274 patients, the levels were <2.0 ng/㎖ in 87.63% (163/186) of patients after conventional thyroidectomies and in 93.18 % (82/88) following endoscopic thyroidectomies. There were no significant differences (P-value=0.58). Complication incidences (hypocalcemia, hoarseness, bleeding, wound infection) in both groups were not significantly distinctive (P-value=0.58). Conclusion: Minimally invasive techniques are generally applied even for malignancy in selected cases because of its advantages, such as cosmetic results. Through this study, we showed similar clinical outcomes of conventional and gasless or gas insufflations endoscopic thyroidectomy.

갑상선암의 내시경 갑상선 절제술에서 근전절제술 및 전절제술의 임상적 비교

유한모,김태원,배자성<SUP>1<,SUP>,조항주,김기환,안창혁,박우찬<SUP>2<,SUP>,이동호<SUP>3<,SUP>,김정수,Han Mo Yoo,M,D,Tae Won Kim,M,D,Ja Sung Bae,M,D,<SUP>1<,SUP>,Hang Joo Cho,M,D,Kee Hwan Kim,M,D,Chang Hyuk An,M,D,Woo Chan Park,M 대한갑상선-내분비외과학회 2009 The Koreran journal of Endocrine Surgery Vol.9 No.4

Purpose: The aim of this study was to evaluate and compare the surgical outcomes of endoscopic total and near-total thyroidectomies in patients with thyroid cancer. Methods: Between February 2000 and January 2009, among 387 patients who underwent endoscopic thyroidectomy in our hospital, we evaluated 50 patients who underwent endoscopic total or near-total thyroidectomy. Thirty- five and 15 patients underwent endoscopic total thyroidectomy and near-total thyroidectomy, respectively. We analyzed the patients' clinicopathologic characteristics and post-operative complications between the two groups. Results: The mean size of tumors was 1.08 cm (range, 0.1∼3.5 cm) and the mean operative time was 192 minutes. Forty-nine tumors were papillary cancers and 1 tumor was a follicular cancer. Two patients in the endoscopic total thyroidectomy group underwent re-operation because of bleeding. In the near-total thyroidectomy group, one patient had transient hypocalcemia and one patient had temporary recurrent laryngeal nerve palsy. In the total thyroidectomy group, nine patients had transient hypocalcemia and one patient had temporary recurrent laryngeal nerve palsy. There was no statistical difference in the post-operative complicationrates between the two groups (P=0.254 for hypocalcemia and P=0.470 for injury to the recurrent laryngeal nerve). Conclusion: Based on our experience, endoscopic total thyroidectomy is a safe and feasible alternative to endoscopic near-total thyroidectomy. (Korean J Endocrine Surg 2009; 9:201-205)

갑상선 악성종양의 내시경하 갑상선 절제술

이승아,배자성,김기환,김지일,안창혁,박우찬,송병주,정상설,김정수,Seung Ah Lee,M.D.,Ja Seong Bae,M.D.,Kee Hwan Kim,M.D.,Ji Il Kim,M.D.,Chang Hyuck An,M.D.,Ph.D.,Woo Chan Park,M.D.,Ph.D.,Byung Joo Song,M.D.,Ph.D.,Sang Seol Jung,M.D 대한갑상선-내분비외과학회 2007 The Koreran journal of Endocrine Surgery Vol.7 No.2

Purpose: Endoscopic surgery to treat thyroid neoplasm was developed to solve the aesthetic problems that resulted from conventional open surgery. Although endoscopic thyroidectomy was initially performed in patients with benign thyroid neoplasm, its use has recently been extended to patients with Graves's disease and early cases of thyroid cancer.The purpose of this study was to determine whether this surgical approach is feasible and safe for the treatment of thyroid cancer. Methods: Between December 1999 and April 2006, 132 thyroid cancer patients at our institution were treated by either conventional thyroidectomy or endoscopic thyroidectomy. Endoscopic thyroidectomy was conducted using a gasless anterior neck skin lifting method. The inclusion criteria for endoscopic thyroidectomy in thyroid cancer patients included a tumor size of less than 2cm, absence of extrathyroidal extension, absence of cervical lymph node metastasis, and well differentiated cancers. Results: We performed endoscopic thyroidectomy in 29 thyroid cancer patients. There were no significant differences in operative time, the amount of drainage and the number of retrieved lymph nodes between conventional thyroidectomy and endoscopic thyroidectomy. In addition, although endoscopic thyroidectomy was associated with more complications, it was also associated with a shorter hospital stay. Conclusion: The completeness of surgical resection conducted via an endoscopic thyroidectomy may be comparable to that of conventional surgery, however, a larger series and longer follow-up evaluation are necessary for definitive conclusions to be drawn about its oncologic validity. (Korean J Endocrine Surg 2007;7:103-106)

로봇 갑상선 수술

태경 대한이비인후과학회 2010 대한이비인후과학회지 두경부외과학 Vol.53 No.8

Conventional open thyroidectomy provides direct exposure to perform safe and quick operations with minimal morbidity and almost no mortality. However, the procedure leaves a scar on the anterior neck. Thyroid nodules are common in young women, who are interested not only in treatment of the disease but also in aesthetic results. As a result, a variety of minimally invasive techniques to minimize neck scars and surgical morbidity have been developed. The minimally invasive thyroidectomy technique includes mini open incision thyroidectomy, video assisted minimally invasive thyroidectomy, and pure endoscopic thyroidectomy. However, there are some limitations to endoscopic thyroidectomy in obtaining adequate surgical viewing angles,precisely manipulating endoscopic instruments and meticulously dissecting tissues. These limitations result from the narrow working space, two-dimensional operative views and the use of inadequate endoscopic instruments. Recently, robotic technology using the da Vinci surgical system robot has been applied to minimally invasive thyroid surgery to overcome the limitations of endoscopic thyroidectomy. The da Vinci surgical system robot provides a three-dimensional 10-12 x magnified view of the surgical area. It also provides hand-tremor filtration,fine motion scaling, and precise and multi-articulated hand-like motions. Robotic thyroidectomy by a gasless unilateral axillo-breast or axillary approach using da Vinci surgical system robot is safe, feasible and cosmetically excellent procedure in properly selected patients. It might have an advantage in the preservation of recurrent laryngeal nerve and parathyroid gland with magnified view. However, it is more invasive than open thyroidectomy. The postoperative pain or discomfort is comparable with open thyroidectomy. The oncologic safety of robotic thyroidectomy should be verified with long-term follow-up data. Korean J Otorhinolaryngol-Head Neck Surg 2010;53:463-9

경부-액와접근법을 이용한 내시경 갑상선절제술과 로봇하 갑상선절제술의 비교 및 고찰

박영민,임우성,문병인 대한갑상선-내분비외과학회 2012 The Koreran journal of Endocrine Surgery Vol.12 No.4

Purpose: Endoscopic and robot-assisted thyroidectomy has shown rapid development worldwide. In addition, there is no treatment of choice for thyroidectomy as usual. We propose an endoscopic thyroidectomy using a cervico-transaxillary approach, comparing its results with those of robot-assisted thyroidectomy. We present this study in order to provide advantages and disadvantages. Methods: Between January 2010 and March 2012, 132 patients were recruited with clinicopathological data for this study. We divided patients into two groups, the endoscopic and the robot groups, with respect to their clinical characteristics, surgical outcomes. The outcomes were evaluated in terms of operation time, estimated blood loss, hemovac amount, hospital stay, and number of lymph nodes harvested. Results: A total of 132 patients (male 6 and female 126) were recruited with clinicopathological data for this study. Of these, 78 patients underwent endoscopic thyroidectomy (the endo group) and 54 underwent robot-assisted thyroidectomy (the robot group) using a cervico-transaxillary approach. The two groups did not differ significantly in terms of age, estimated blood loss, and complications. None of the patients experienced severe complications. Conclusion: Results of the preliminary comparison in this study show that both approaches are safe and feasible, with similar results. However, a smaller hemovac amount was observed with endoscopic thyroidectomy, compared to robot-assisted thyroidectomy. In order to cut costs, part of robot-assisted thyroidectomy could be replaced by endoscopic thyroidectomy.

Endoscopic Thyroidectomy Via the Cervico-axillary Approach for Thyroid Cancer: Initial Experience in a Single Institute

Jeong Shin An,Hyun Goo Kim,Se Hyun Paek,Jun Woo Lee,Juhyun Woo,Hyungju Kwon,Woosung Lim,Byung-In Moon,Nam Sun Paik 대한갑상선-내분비외과학회 2017 The Koreran journal of Endocrine Surgery Vol.17 No.1

Purpose: Endoscopic thyroidectomy using a cervico-axillary approach (CAA) provides optimal visualization with a smaller dissection plane. Despite the excellent cosmetic results and high patient satisfaction, the surgical and oncologic safety of CAA endoscopic surgery has not been fully established. The present study evaluated the feasibility, safety, and surgical outcomes of CAA endoscopic thyroidectomy. Methods: From October 2009 to April 2012, 100 patients with papillary thyroid cancer underwent CAA endoscopic thyroidectomy. Patient demographics, pathologic features, and surgical outcomes including complications and recurrence were collected. Results: CAA endoscopic thyroidectomy was successful in all patients, and none required conversion to open thyroidectomy. All patients underwent ipsilateral thyroid lobectomy with or without central compartment neck dissection. The mean tumor size was 1.0±0.6 cm (range, 0.5∼1.6), and 35.0% of tumors showed extrathyroidal extension. The mean number of harvested lymph nodes was 4.1±4.4, and metastasis was found in 12.0% of patients. The mean surgical time was 175.2±50.4 min, mean intraoperative blood loss was 42.5±69.2 ml, and the mean hospital stay was 3.3±0.6 days. There were five cases of postoperative transient hypocalcemia and eight cases of vocal cord palsy. No permanent complication or postoperative bleeding was observed. Patients continued to be seen for a median period of 63.7 months, and no recurrence of thyroid cancer was seen. Conclusion: CAA endoscopic thyroidectomy is a feasible and safe procedure for low-risk thyroid cancer, with excellent cosmesis. It can be recommended as an alternative option for selected patients with low-risk thyroid cancer.

Endoscopic Thyroidectomy Via the Cervico-axillary Approach for Thyroid Cancer: Initial Experience in a Single Institute

안정신,김현구,백세현,이준우,우주현,권형주,임우성,문병인,백남선 대한갑상선-내분비외과학회 2017 The Koreran journal of Endocrine Surgery Vol.17 No.1

Purpose: Endoscopic thyroidectomy using a cervico-axillary approach (CAA) provides optimal visualization with a smaller dissection plane. Despite the excellent cosmetic results and high patient satisfaction, the surgical and oncologic safety of CAA endoscopic surgery has not been fully established. The present study evaluated the feasibility, safety, and surgical outcomes of CAA endoscopic thyroidectomy.Methods: From October 2009 to April 2012, 100 patients with papillary thyroid cancer underwent CAA endoscopic thyroidectomy. Patient demographics, pathologic features, and surgical outcomes including complications and recurrence were collected. Results: CAA endoscopic thyroidectomy was successful in all patients, and none required conversion to open thyroidectomy. All patients underwent ipsilateral thyroid lobectomy with or without central compartment neck dissection. The mean tumor size was 1.0±0.6 cm (range, 0.5∼1.6), and 35.0% of tumors showed extrathyroidal extension. The mean number of harvested lymph nodes was 4.1±4.4, and metastasis was found in 12.0% of patients. The mean surgical time was 175.2±50.4 min, mean intraoperative blood loss was 42.5±69.2 ml, and the mean hospital stay was 3.3±0.6 days. There were five cases of postoperative transient hypocalcemia and eight cases of vocal cord palsy. No permanent complication or postoperative bleeding was observed. Patients continued to be seen for a median period of 63.7 months, and no recurrence of thyroid cancer was seen.Conclusion: CAA endoscopic thyroidectomy is a feasible and safe procedure for low-risk thyroid cancer, with excellent cosmesis. It can be recommended as an alternative option for selected patients with low-risk thyroid cancer.

Transaxillary Endoscopic Thyroidectomy versus Conventional Open Thyroidectomy for Papillary Thyroid Cancer: 5-year Surgical Outcomes

고우리,채병주,배자성,송병주,엄용화,이소희 대한갑상선-내분비외과학회 2016 The Koreran journal of Endocrine Surgery Vol.16 No.2

Purpose: The early surgical outcomes of endoscopic thyroidectomy in papillary thyroid cancer (PTC) are comparable to those of conventional open thyroidectomy; however, there is little evidence about long-term outcomes. The aim of this study was to compare the 5-year surgical outcomes of endoscopic versus open thyroidectomy. Methods: We reviewed 804 patients with PTC who underwent thyroidectomy between October 2008 and October 2010. Of these, 703 patients received conventional open thyroidectomy (OT group) and 101patients underwent endoscopic thyroidectomy (ET group). The clinicopathologic characteristics and surgical outcomes were compared between those treatments. Results: ET was applied significantly more often in young patients and females. The lobectomy and unilateral CCND were performed more frequently in ET, and the mean tumor size was smaller. The prevalence of extrathyroidal extension, multiplicity, and lymphatic invasion was more frequent in OT. The T and TNM stage were more advanced in OT, whereas the N status was similar between treatments. The mean surgical time was significantly longer for ET, while the number of retrieved lymph nodes was greater in OT. However, the stimulated thyroglobulin levels at first RAI ablation, total amount of RAI administration and 5-year recurrence rate did not significantly differ between groups. The incidence of transient hypocalcemia was significantly higher in OT, but the incidence of permanent hypocalcemia and transient/permanent recurrent laryngeal nerve injury were similar in both groups. Conclusion: Endoscopic thyroidectomy might be a safe and effective procedure in well-selected PTC patients.

Transaxillary Endoscopic Thyroidectomy versus Conventional Open Thyroidectomy for Papillary Thyroid Cancer: 5-year Surgical Outcomes

Woo Ree Koh,Byung Joo Chae,Ja Seong Bae,Byung Joo Song,Yong Hwa Eom,So Hee Lee 대한갑상선-내분비외과학회 2016 The Koreran journal of Endocrine Surgery Vol.16 No.2

Purpose: The early surgical outcomes of endoscopic thyroidectomy in papillary thyroid cancer (PTC) are comparable to those of conventional open thyroidectomy; however, there is little evidence about long-term outcomes. The aim of this study was to compare the 5-year surgical outcomes of endoscopic versus open thyroidectomy. Methods: We reviewed 804 patients with PTC who underwent thyroidectomy between October 2008 and October 2010. Of these, 703 patients received conventional open thyroidectomy (OT group) and 101patients underwent endoscopic thyroidectomy (ET group). The clinicopathologic characteristics and surgical outcomes were compared between those treatments. Results: ET was applied significantly more often in young patients and females. The lobectomy and unilateral CCND were performed more frequently in ET, and the mean tumor size was smaller. The prevalence of extrathyroidal extension, multiplicity, and lymphatic invasion was more frequent in OT. The T and TNM stage were more advanced in OT, whereas the N status was similar between treatments. The mean surgical time was significantly longer for ET, while the number of retrieved lymph nodes was greater in OT. However, the stimulated thyroglobulin levels at first RAI ablation, total amount of RAI administration and 5-year recurrence rate did not significantly differ between groups. The incidence of transient hypocalcemia was significantly higher in OT, but the incidence of permanent hypocalcemia and transient/permanent recurrent laryngeal nerve injury were similar in both groups. Conclusion: Endoscopic thyroidectomy might be a safe and effective procedure in well-selected PTC patients.

액와접근법과 흉부접근법을 통한 내시경 갑상선 절제술의 임상적 고찰

성기영,오세정,백종민,이도상,김욱,박일영,원종만,Gi Young Sung,M,D,Se Jeong Oh,M,D,Jong Min Baek,M,D,Do Sang Lee,M,D,Wook Kim,M,D,Il Young Park,M,D,and Jong Man Won,M,D 대한갑상선-내분비외과학회 2004 The Koreran journal of Endocrine Surgery Vol.4 No.1

Purpose: The thyroid suregry has recently become one of the newest fields for the application of endoscopic surgery. We have performed endoscopic thyroidectomy by an anterior chest approach and an axillary approach. In this study, we evaluated these two types of endoscopic procedures with regard to efficacy and patients' complaints after surgery.Methods: Between December 2000 and March 2002, 41 patients were treated by endoscopic thyroidectomy via axillary or anterior chest approach. Each procedure was performed by one surgeon under a general anesthesia. We analysed the operating time, postoperative complications, postoperative scar, the degree of pain to assess the surgical invasiveness of each procedure.Results: Three cases treated using anterior chest approach, and 2 cases treated using axillary approach were converted to conventional thyroidectomy. The mean age of patients was 36 years in anterior chest approach group and 30 years in axillary approach group. The operation time was 238⁑60 (160∼370) minutes in anterior chest approach and 178⁑71 (100∼295) minutes in axillary approach. Postoperative complications are; 1 case of a minimal hematoma, 3 cases of minor wound infection, 3 cases of chest pain in anterior chest approach group, and 1 case of a minimal hematoma, 1 case of transient recurrent laryngeal nerve injury, 1 cases of transient swallowing difficulties in axillary approach group.Conclusion: Endoscopic (gasless and axillary approach) thyroidectomy is a safe and effective procedure. Gasless endoscopic thyroidectomy is a useful procedure for unexperienced surgeon due to safety. Endoscopic thyroidectomy by the axillary approach is a better effective procedure with good cosmetic result for a unilateral tumor especially in young women. (Korean J Endocrine Surg 2003;4:26-30)