Endoscopic Thyroidectomy Incision Techniques

After generally anesthetized under tracheal incubation, the patient was placed in a supine position on a pad positioner, with the neck gently extended using a mildly sloping pillow under the shoulder and neck. Place the operated side body close to the edge of the surgical bed (Figure 1A), and the arm was naturally abducted at about 90 degrees at the arm board (Figure 1B), which could be adjusted if the clavicle is higher than the thyroid isthmus. The monitor was placed contralateral, and the surgeon and assistant were seated on either side of the patient's arm (Figure 1C).
For the classical design (5 (link)), the main oblique incision (about 3.5–4.5 cm in length) was made along the armpit's first or second natural skin fold. It should not exceed the anterior axillary line, whereby the endoscope and surgical instrument were placed. In addition, we made a 0.5 cm small incision at the intersection of the axillary front line and the upper edge of the breast; the location was 3.0–4.0 cm underneath the main incision, whereby a 5 mm trocar, and the cannula was then inserted (Figures 2A,B). For the zero-line design, an oblique incision (about 3.5–4.5 cm in length) parallel to the armpit stripes was made about 2 cm from the axillary top. The front end should not exceed the anterior axillary line. Define the line connecting the intersection of the incision with the lateral border of the pectoralis major and the highest point of the clavicle as the zero-line. After that, define the intersection of the reverse extension line of zero-line and the anterior midline of the chest (midline of the sternum) as the apex point, then draw a straight line along a 30-degree counterclockwise angle. A 0.5 cm trocar incision is then made at the intersection of this line and the lateral border of the pectoralis major; the 30-degree angle could be slightly different due to right-handed habit. When choosing the site of the trocar incision for a female patient, the breast should be retracted inferiorly, and kept the chest skin flattened (Figures 2D,E).