Endocrine Abstracts

Introduction: Trans-axillary surgery is an emerging technique for cervical approach with fantastic cosmetic result. With more than 50 cases treated by our group, we developed our technique with specific safe methodologies.

Aims: To present step-by-step technique of trans-axillary endoscopic thyroidectomy.

Material and methods: This is a video surgery that uses three trocars and a harmonic scalpel for dissection and ligation. Incisions are made in the armpit and areolar border.

Results: Technique is described in 10 steps: (i) trocars and patient position; (ii) dissection; (iii) landmarks (sternal notch, ECM anterior border, thyroid cartilage); (iv) omo-hyoid muscle dissection; (v) split strap muscles; (vi) upper pole dissection and ligation; (vii) ligation of the middle thyroid vein and recurrent laryngeal nerve (RLN) visualization; (viii) inferior pole ligation; (ix) lobectomy; (x) specimen removal and haemostasis; Three auxiliary techniques are used to increase safe and to reduce complications:

1. Intra-operative ultrasound

2. Neuromonitoring of the RLN

3. Indocyanine green (ICG) fluorescence for parathyroid vascular assessment

Conclusions: Cervical scar-less surgery is very appealing for the patient. For the surgeon with advanced laparoscopic skills this is a feasible and reproducible technique, with excellent results. Security techniques can have great value in more demanding cases.