Gasless endoscopic thyroidectomy using trans-axillary approach;our experience in Pakistan

Objective >> To report our initial experience with the transaxillary endoscopic hemi thyroidectomy with gasless approach in limited resources and e-learning. Background The concept of endoscopic neck surgery for thyroid or parathyroid gland started with Gainer in 1996, where the first case of parathyroidectomy was performed, and after one year, hemithyroidectomy was performed by Hushner. After that, the concept of minimally invasive neck surgeries, especially thyroid and parathyroid glands, has started in different endoscopic techniques. Method 42-year-old lady with a right-sided solitary thyroid nodule underwent transaxillary endoscopic hemi thyroidectomy with a gasless approach in a trust hospital. The main outcome measures feasibility of that approach without the availability of a robot and some fancy instrument, gland and patient characteristics, operative time, cost-effectiveness,cosmesis, and complications. Results There was no conversion to open surgery. Operative time is 180 minutes. estimated blood loss was 10-12 ml. patient tolerated the surgery well. discharge on the first postoperative day. no perioperative or postoperative complications. low cost as compared to other endoscopic techniques.no evidence of postoperative vocal cord palsy or paresis. Conclusions Our first and initial experience demonstrates that this technique is a feasible, effective, and safe method for hemi thyroidectomy for a small and benign thyroid lesion in starting, and with experience, a subtotal or total thyroidectomy can be performed. The use of this approach is very cost-effective as compared to robotic and other endoscopic techniques, and with excellent cosmesis, it improved patients' confidence and trust in minimally invasive surgery.