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Retroauricular Single-Site Endoscopic Thyroidectomy—A Balanced Endoscopic Approach for Thyroid Excision

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1 Credit CME

To avoid the scar caused by the conventional transcervical thyroidectomy, various techniques of endoscopic thyroidectomy (ET) were developed for excellent postoperative cosmesis.1 However, ET needs to create enough working space via a dissection flap because there is no natural orifice access to the thyroid. Hence, we tried to find a balance between cosmesis, trauma, and en bloc tumor resection, which means simultaneous thyroid tumor removal and central neck dissection. Retroauricular single-site endoscopic thyroidectomy (RASSET) achieves superior cosmetic outcomes by concealing the incision in the single auricula posterior sulci. To minimize surgical trauma, the working space is created in the superficial layer of deep cervical fascia (DCF) between the sternocleidomastoid muscle (SCM) and platysma muscle, with a flap dissection area just between the strap muscles (sternohyoid, sternothyroid, omohyoid, and thyrohyoid) and the anterior border of the SCM. The thyroid gland, the recurrent laryngeal nerve (RLN), and the common carotid artery, surrounded by the middle layer of DCF, are fully exposed by pulling apart the strap muscles and SCM, which enables en bloc tumor resection in this layer (Figure, B). These operations make full use of the characteristics of natural anatomical structures and meet the requirements of membrane anatomy.

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Article Information

Corresponding Author: Dian Ouyang, MD, PhD, Department of Head and Neck Surgery, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng Rd E, Guangzhou, Guangdong 510060, China (ouyd@sysucc.org.cn).

Published Online: February 8, 2023. doi:10.1001/jamasurg.2022.7723

Conflict of Interest Disclosures: None reported.

References
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Ikeda  Y , Takami  H , Niimi  M , Kan  S , Sasaki  Y , Takayama  J .  Endoscopic thyroidectomy and parathyroidectomy by the axillary approach: a preliminary report.   Surg Endosc. 2002;16(1):92-95. doi:10.1007/s004640080175PubMedGoogle ScholarCrossref
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Anuwong  A , Ketwong  K , Jitpratoom  P , Sasanakietkul  T , Duh  QY .  Safety and outcomes of the transoral endoscopic thyroidectomy vestibular approach.   JAMA Surg. 2018;153(1):21-27. doi:10.1001/jamasurg.2017.3366PubMedGoogle ScholarCrossref
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Sun  H , Zheng  H , Wang  X , Zeng  Q , Wang  P , Wang  Y .  Comparison of transoral endoscopic thyroidectomy vestibular approach, total endoscopic thyroidectomy via areola approach, and conventional open thyroidectomy: a retrospective analysis of safety, trauma, and feasibility of central neck dissection in the treatment of papillary thyroid carcinoma.   Surg Endosc. 2020;34(1):268-274. doi:10.1007/s00464-019-06762-6PubMedGoogle ScholarCrossref
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AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

  • 1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
  • 1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
  • 1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
  • 1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
  • 1.00 credit toward the CME of the American Board of Surgery’s Continuous Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.

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