Clinical Application Of Endoscopic Thyroidectomy Via Axillary Approach With Endoscopic Thyroidectomy Via The Breast Approach

Objective:The efficacy of laparoscopic thyroid surgery with transaxillary approach and transbreast-breast approach was compared to compare the treatment effect,safety and feasibility of the two surgical methods.Methods:A retrospective analysis was conducted from November 2020 to December2022 in The Third Bethune Hospital of Jilin University,and patients who underwent laparoscopic thyroidectomy were divided into breast-breasted group and axillary group according to different surgical methods,and patients who met the inclusion and exclusion criteria were studied.Baseline data(age,sex,BMI,tumor diameter,preoperative TSH,number of lesions,tumor location),intraoperative situation(operation time,intraoperative blood loss,number of central lymph node dissection,number of positive lymph nodes),postoperative condition(postoperative first day drainage,total postoperative drainage,length of hospital stay),complications(postoperative temporary hoarseness,postoperative swallowing discomfort,hypoesthesia of the skin in the chest,postoperative serum calcium concentration,incision infection,postoperative bleeding,lymphatic leakage)were compared between the two groups.Total postoperative cosmetic satisfaction;To analyze the relationship between BMI and the efficacy of laparoscopic thyroid surgery.Results:In this study,a total of 71 cases were included,including 34 cases in the breast-breasted group,4 male patients,30 female patients,37 cases in the armpit group,5 male patients and 32 female patients,and the axillary group had shorter operation time,less intraoperative bleeding and less postoperative drainage(p<0.05)than the breast-breasted group;there was no significant difference in length of hospital stay between the two groups(p >0.05).There was 1 case(2.9%)of temporary recurrent laryngeal nerve injury in the pleural breast group and 2 cases(5.4%)of temporary recurrent laryngeal nerve injury in the axillary group,and no permanent recurrent laryngeal nerve injury in either group.The difference in postoperative drainage was slightly higher in patients with BMI>28 in the axillary group than in patients with BMI≤28(p<0.05),so the author believes that the effect of BMI on laparoscopic thyroid surgery may only lead to a slight difference in postoperative drainage.Conclusion:1、The clinical efficacy of laparoscopic thyroid surgery in both groups of breast-breast approach and axillary approach was the same,and it was safe and feasible.2、Laparoscopic thyroid surgery for axillary approaches is shorter,with less intraoperative bleeding and less postoperative drainage.3 、 The breast-breast approach can manage bilateral thyroid tumors,and the axillary approach is suitable for unilateral tumors.4、Laparoscopic thyroid surgery is not recommended in obese patients.