Endoscopic Thyroid Lobectomy: Our Early Experience at Lahore General Hospital, Lahore, Pakistan

Author(s): Muhammad Imran Khokhar, Muhammad Abdulnasir Asghar, Danish Ali, Muhammad Qasim Farooq, Awais Amjad Malik, Suleman Asif, Muhammad Ahsan, Muhammad Farooq Afzal

Background
Conventional Thyroid Lobectomy leaves an unpleasant neck scar. Endoscopic thyroidectomy was first applied by Huschner in 1997. Amongst the best endoscopic techniques is the one we use, referred to as the endoscopic axillary-breast-shoulder approach (ABSA) innovated by Dr. Trans Ngoc Luong.

Objective
To examine the safety, feasibility and cosmetic outcome of endoscopic thyroid lobectomy.

Patients and Methods
We performed endoscopic lobectomy in 20 patients at Lahore General Hospital (LGH) from 9th September 2016 to 31st Dec 2019. We adopted axillary-breast-shoulder approach. Inclusion criteria were age 18-45 years, solitary nodule less than 5 cm and benign FNAC. Exclusion criteria were multiple nodules, solitary nodule more than 5 cm, age more than 45years, malignant FNAC, recurrent goiter and co-morbid like DM, HTN, IHD, COPD. The parameters studied were the conversion rate, operative time, hospital stay, complications, cosmetic outcome and patient satisfaction. The results were analyzed to draw rational conclusion.

Results
Successful endoscopic lobectomy was performed in almost all cases with conversion to open in two cases. The median operative time was 100 minutes. No preoperative injury was inflicted. One case sustained minor skin burns which healed without any residual scar. One patient developed full thickness skin burn and one patient had seroma. All patients were discharged on first postoperative day. Excellent cosmetic outcome achieved in all patients leading to their optimum satisfaction.

Conclusion
Endoscopic thyroid lobectomy is a safe and feasible procedure with satisfactory cosmetic outcome for benign solitary thyroid nodules in selected patients.