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

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 Broadly classified into two groups according to the position of incisions, the cervical approach the extracervical approach Axilla Breast Hybrid Approach ABBA BABA

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

Trachea Division of Isthmus

Identify and protect Recurrent Laryngeal nerve RLN Identify and protect Recurrent Laryngeal nerve

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.

The End!~ Thanks~ Questions?