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Reoperative thyroid surgery is associated with a higher morbidity and has traditionally been done in conventional open approach. This study aimed to evaluate the safety and effectiveness of endoscopic areola approach for reoperative thyroid surgery. A retrospective study was conducted in 46 patients undergoing reoperative thyroid surgery with endoscopic areola approach (endoscopic group) and 70 patients with conventional open approach (open group). Perioperative and follow-up outcomes were compared between the two groups. Baseline characteristics were comparable between the two groups. Except for two cases of the endoscopic group intraoperatively converted to open surgery, all the other surgery was successfully completed. No significant difference was found between two groups concerning operation time, drainage volume, drainage time and postoperative hospital stay (all P> 0.05). Estimated blood loss was more in the open group than the endoscopic group (P= 0.000). Although not statistically significant, the overall complication rate was less in the endoscopic group than in the open group (21.7 vs. 37.1 %, P= 0.079). Of these complications, transient hypocalcemia was the most common (endoscopic group, 17.4 %; open group, 21.4 %; P= 0.594). One patient of the endoscopic group and 7 patients of the open group suffered from transient recurrent laryngeal nerve (RLN) paralysis (P= 0.210). Moreover, 2 patients of open group experienced permanent RLN paralysis. During the follow-up period (range 1–6 years), no recurrent case was encountered, but the endoscopic group had a higher cosmetic score (9.0 ± 0.9 vs. 5.9 ± 0.9, P= 0.000). In high-volume centers, with strict operation indication, sufficient preoperative evaluation and careful surgical maneuvers, endoscopic areola approach is a safe and effective method for reoperative thyroid surgery, allowing to provide a better cosmetic result and reduce intraoperative blood loss compared with open approach.

The aim of this study was to evaluate the effect and cosmetic results of endoscopic thyroidectomy (ETE) via the areola approach for patients with thyroid diseases. A total of 1,250 patients with thyroid diseases underwent ETE via the areola approach between April 2005 and January 2011. Of these, 898 were benign goiters, 260 were Graves’ disease, 28 were secondary hyperthyroidism, and 64 were papillary carcinomas. The surgery was successfully completed in 1,249 cases, and 1 case was converted to open surgery. The mean operation time, estimated blood loss, and hospital stay after surgery for patients with a goiter, hyperthyroidism, and papillary carcinoma were 94.4 min, 15.2 ml, 5.0 days, 97.9 min, 16.1 ml, 5.5 days, and 134.3 min, 18.6 ml, 6.4 days, respectively. Complications included 4 cases of postoperative bleeding, 1 case of transection of the recurrent laryngeal nerve (RLN) on one side, 7 cases of temporary RLN injury, 34 cases of transient hypocalcemia, 5 cases of skin bruising on the chest wall, and 1 case of subcutaneous infection in the neck. At 4.6-year (2.5–8 years) follow-up of 1,185 (94.8 %) patients, 3 patients with Graves’ disease had recurrence of hyperthyroidism, and 4 patients with nodular goiter had recurrence of small nodules. Four patients had discomfort on swallowing, 4 patients had an abnormal sensation of skin traction on the neck and the chest, and 1 patient with scar diathesis had mild scar hyperplasia. A total of 876 patients were satisfied, 4 equivocal, and 0 unsatisfied with the cosmetic results. ETE via the areola approach for patients with benign goiters, Graves’ disease, secondary hyperthyroidism, and papillary carcinomas without metastasis to lateral cervical lymph nodes is an effective and safe procedure with excellent cosmetic results.