, Kyu Eun Lee1 and June Young Choi1
(1)
Department of Surgery, Seoul National University Hospital, Seoul, Korea, Republic of (South Korea)
Abstract
While the bilateral axillo-breast approach (BABA) to endoscopic neck surgery resolves various benign and malignant thyroid and parathyroid diseases with minimal adverse effects and excellent cosmetic outcomes, it involves circumareolar incisions. Many patients, especially young female patients in westernized countries, are reluctant to have their breast involved. Consequently, we developed the bilateral axillo-postauricular approach (BAPA) that uses axillary and postauricular incisions.
Electronic supplementary material
The online version of this chapter (doi:10.​1007/​978-3-642-37262-9_​5) contains supplementary material, which is available to authorized users.
5.1 Introduction
While the bilateral axillo-breast approach (BABA) to endoscopic neck surgery resolves various benign and malignant thyroid and parathyroid diseases with minimal adverse effects and excellent cosmetic outcomes, it involves circumareolar incisions. Many patients, especially young female patients in westernized countries, are reluctant to have their breast involved. Consequently, we developed the bilateral axillo-postauricular approach (BAPA) that uses axillary and postauricular incisions.
Fig. 5.1
Comparison between (a) BABA and (b) BAPA robotic thyroid surgery
5.2 Patient Selection
We used the same eligibility criteria as for the BABA operation, namely, benign thyroid mass less than 5 cm in its largest diameter, papillary thyroid carcinoma not larger than 1 cm with low risk, follicular neoplasm, and parathyroid adenoma localized preoperatively. All patients consented to undergo BAPA robotic thyroid surgery.
5.3 Patient Position and Operating Room Setting
Under general endotracheal anesthesia, the patient was placed in a supine position. The neck was slightly extended, and both arms were mildly abducted to provide space for the insertion of the axillary ports. The operating room setting is shown in Fig. 5.2.
Fig. 5.2
Operative room setting for BAPA robotic thyroidectomy
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