Thyroidectomy via unilateral axillo-breast approach (UABA) with gas insufflation: prospective multicentre European study

This is a prospective cohort study of 253 patients who underwent thyroidectomy via unilateral axillo-breast approach (UABA) with gas insufflation from three university-affiliated European hospitals, between July 2015 and December 2020, with the main objective to evaluate surgical and cosmetic outcomes. To our best knowledge, this study could represent the largest European cohort multicentre study evaluating an endoscopic minimally invasive approach for thyroidectomy, specifically the UABA approach with gas insufflation for thyroidectomy. Our results suggest that in highly selected patients and with experienced minimally invasive endocrine surgical teams, UABA with gas insufflation for hemithyroidectomy is safe and effective for the treatment of unilateral thyroid pathologies, without major complications and with an excellent cosmetic profile. Background Extracervical approaches for thyroidectomy are seldom explored in the western population. The objective of this study was to evaluate the outcomes of hemithyroidectomy via endoscopic unilateral axillo-breast approach (UABA) with gas insufflation. Method Consecutive patients undergoing UABA hemithyroidectomy for symptomatic benign or cytologically indeterminate nodules (Bethesda III lesions) of less than 5 cm from July 2015 to December 2020 at three European institutions were included. Patients were excluded if presenting with a BMI more than 25 kg/m(2), had previous neck surgery and/or radiation, had bilateral thyroid lesions, retrosternal goitre, Hashimoto thyroiditis or Graves' disease. Follow-up was carried out at 2 weeks, 3 months and 1 year. Outcomes of interest were surgical (including operating time, mean duration of hospital stay and complications) and self-assessed cosmetic outcomes. Results Out of 984 patients treated with hemithyroidectomy during the study interval, 253 were selected, including 214 women and 39 men. Patients' mean age was of 46.6 years with a mean BMI of 22.57. Mean operating time was 72.9 minutes. A transient recurrent laryngeal nerve injury was reported in 3.6 per cent of the patients, but none was persistent. Transient pectoral/cervical hypoesthesia was noted in 24.1 per cent of patients, with no permanent hypoesthesia. Skin burns and subcutaneous hematoma developed in 2.4 per cent and 2 per cent of patients but resolved within the third month after surgery. There was no tracheal/oesophageal perforation, conversion to open surgery or reoperation. The final pathology revealed 241 benign nodules, nine underlying papillary thyroid carcinomas, and three cases of follicular carcinoma. Hospital discharge was achieved on the first in 68.8 per cent of the patients and on the second postoperative day in 31.2 per cent of the cases. All patients were satisfied with the cosmetic aspect. Conclusion In selected patients, UABA with gas insufflation for hemithyroidectomy could be performed for the treatment of unilateral thyroid pathologies.