endoscopic thyroidectomy -abba approach joint hospital surgical grand round dr. alex cf tsang
TRANSCRIPT
Endoscopic Thyroidectomy -ABBA Approach
Joint Hospital Surgical Grand Round
Dr. Alex CF TSANG
Endoscopic Thyroidectomy
History ABBA Approach Evolution of ABBA Approach- BABA 1 year experience of Endoscopic
thyroidectomy (BABA approach) in YCH
Conclusion
Endoscopic Thyroidectomy
History ABBA Approach Evolution of ABBA Approach- BABA 1 year experience of Endoscopic
thyroidectomy (BABA approach) in YCH
Conclusion
History-Endoscopic Thyroidectomy
Endoscopic neck surgery was first performed by Gagner in 1996 for the treatment of hyperparathyroidism.
Huscher in 1997 successfully applied it for thyroid benign tumor.
Now, several reports have described the feasibility and the better cosmetic results of endoscopic thyroidectomy than those of conventional open surgery
Broadly classified into two groups according to the position of incisions, the cervical approach the extracervical approach
Axilla Breast Hybrid Approach
ABBA BABA
History-Endoscopic Thyroidectomy
Broadly classified into two groups according to the position of incisions, the cervical approach the extracervical approach
Axilla Breast Hybrid Approach
ABBA BABA
History-Endoscopic Thyroidectomy
Broadly classified into two groups according to the position of incisions, the cervical approach the extracervical approach
Axilla Breast Hybrid Approach
ABBA BABA
History-Endoscopic Thyroidectomy
ABBA- Axillo- bilateral breast approach
First described by Shimazu et. al. in 2003. While he performed OT in breast
approach, he developed this approach: to obtain a better view to prevent interference of surgical
instruments to achieve better cosmetic results by
eliminating the parasternal incision, which results in hypertrophic scar
Endoscopic Thyroidectomy
History ABBA Approach Evolution of ABBA Approach- BABA 1 year experience of Endoscopic
thyroidectomy (BABA approach) in YCH
Conclusion
Incision of ABBA
Axillo-bilateral-breast approach. Three 10-mm ports locate at the axilla on the tumor side and at the upper margin of bilateral mammary areolas
Drawing the extent of dissection
Blunt dissection using tunneler with arrow-shaped tip
Three trocars were inserted at the upper margin of the both breast areola and ipsilateral axilla
Midline Incision- splitting the raphe of strap muscles
Division of Isthmus
Trachea
Identify and protect Recurrent Laryngeal nerve
RLN
Division of upper pedicle with Harmonic Ace
Endoscopic Thyroidectomy
History ABBA Approach Evolution of ABBA Approach- BABA 1 year experience of Endoscopic
thyroidectomy (BABA approach) in YCH
Conclusion
Drawback of ABBA
Limited angle for visualizing both lobes of the thyroid, other important structures including RLN, parathyroid glands.
Limited retraction for dissection
Hence, bilateral axillobreast approach (BABA) was developed to overcome the above problems
BABA- Bilateral axillo-breast approach
First described by Choe et. al. in 2007.
While working on ABBA approach, he developed this approach: to obtain a better view hence, to achieve total thyroidectomy
Incision for BABA approach
Endoscopic Thyroidectomy
History ABBA Approach Evolution of ABBA Approach- BABA 1 year experience of Endoscopic
thyroidectomy (BABA approach) in YCH
Conclusion
What is happening in the world?
What is happening in the world?
BABA Group (110 patients) Mean OT time: 165.3 minutes Conversion rate: 1.8%
cancer with capsular invasion tracheal perforation
What is happening in the world?
In this study, there were no breakdown information quoted between ABBA and BABA groups (135 patients) Postoperative complications: 7.4%
Transient vocal cord palsy 4 Transient hypocalcemia 4 Pneumothorax 1 Infection 1
Mean LOS: 4.0 days (range: 2 to 7 days) All patients satisfied about the cosmetic
outcome
What is happening in the world?
What is happening in the world?
What is happening in the world?
BABA Group (103 patients) Mean OT time: 165.1 minutes Post op Mean LOS: 3.18 days Conversion rate: not mentioned Complication rate: 54% (2.2% if
transient hypoCa and transient RLN palsy excluded)
All patients satisfied with the cosmetic outcome
How is our performance?
…let’s see…
Endoscopic Thyroidectomy
History ABBA Approach Evolution of ABBA Approach- BABA 1 year experience of Endoscopic
thyroidectomy (BABA approach) in YCH
Conclusion
Conclusion Endoscopic thyroidectomy by means of
BABA is safe procedure with good cosmetic outcome.
Endoscopic thyroidectomy is a new approach introduce in recent years. We are still on the early stage of the learning curve.
With more experience, OT time and complication related to surgery can be further improved.
Questions?
The End!~ Thanks~