Methods
From August 1998 to April 2008, a total of 100 patients with benign thyroid diseases underwent endoscopic thyroidectomy via
the breast approach. Among these patients, 42 underwent subtotal thyroidectomy for Graves’ disease.
Results
The resection was successfully completed endoscopically in 41 patients (98%). Overall, the mean operating time, mean blood
loss, and mean resected thyroid weight were 277 minutes, 76 ml, and 49.9 g, respectively. As the resected thyroid weight increased,
the operating time was significantly prolonged and the blood loss significantly increased. Morbidities included one permanent
and one temporary case of recurrent laryngeal nerve palsy with hypocalcemia. A hypertrophic scar was seen in the right breast
medial margin in three men. Thyroid function was classified as euthyroidism, hypothyroidism, and recurrent hyperthyroidism
in 5, 34, and 3 patients, respectively. At 92 months of median follow-up, two patients had modest operation-associated symptoms:
one with swallowing discomfort and another with paresthesia in the anterior chest wall at the time of discharge. However,
both patients’ symptoms disappeared within 36 months after surgery. Young women were highly satisfied, with an overall mean
satisfaction rating of 9.3 points.
Conclusions
Although the endoscopic approach may be relatively contraindicated for large thyroid glands, endoscopic subtotal thyroidectomy
via the breast approach is a safe, feasible procedure with excellent cosmetic benefits, and it may be the procedure of choice
in carefully selected patients with Graves’ disease.