1. Endoscopic Thyroidectomy -ABBA Approach
Joint Hospital Surgical Grand Round
Dr. Alex CF TSANG

2. Endoscopic Thyroidectomy
History
ABBA Approach
Evolution of ABBA Approach- BABA
1 year experience of Endoscopic thyroidectomy (BABA approach) in YCH
Conclusion

3. Endoscopic Thyroidectomy
History
ABBA Approach
Evolution of ABBA Approach- BABA
1 year experience of Endoscopic thyroidectomy (BABA approach) in YCH
Conclusion

4. History-Endoscopic Thyroidectomy
Endoscopic neck surgery was first performed by Gagner in 1996 for the treatment of hyperparathyroidism.
Huscher in 1997 successfully applied it for thyroid benign tumor.
Now, several reports have described the feasibility and the better cosmetic results of endoscopic thyroidectomy than those of conventional open surgery

5. History-Endoscopic Thyroidectomy
Broadly classified into two groups according to the position of incisions,
the cervical approach
the extracervical approach
Axilla
Breast
Hybrid Approach
ABBA
BABA

6. History-Endoscopic Thyroidectomy
Broadly classified into two groups according to the position of incisions,
the cervical approach
the extracervical approach
Axilla
Breast
Hybrid Approach
ABBA
BABA

7. History-Endoscopic Thyroidectomy
Broadly classified into two groups according to the position of incisions,
the cervical approach
the extracervical approach
Axilla
Breast
Hybrid Approach
ABBA
BABA

8. ABBA- Axillo- bilateral breast approach
First described by Shimazu et. al. in 2003.
While he performed OT in breast approach, he developed this approach:
to obtain a better view
to prevent interference of surgical instruments
to achieve better cosmetic results by eliminating the parasternal incision, which results in hypertrophic scar

9. Endoscopic Thyroidectomy
History
ABBA Approach
Evolution of ABBA Approach- BABA
1 year experience of Endoscopic thyroidectomy (BABA approach) in YCH
Conclusion

10. Incision of ABBA
Axillo-bilateral-breast approach. Three 10-mm ports locate at the axilla on the tumor side and at the upper margin of bilateral mammary areolas

11. Drawing the extent of dissection

12. Blunt dissection using tunneler with arrow-shaped tip

13. Three trocars were inserted at the upper margin of the both breast areola and ipsilateral axilla

14. Midline Incision- splitting the raphe of strap muscles

15. Trachea
Division of Isthmus

16. Identify and protect Recurrent Laryngeal nerve
RLN
Identify and protect Recurrent Laryngeal nerve

17. Division of upper pedicle with Harmonic Ace

18. Endoscopic Thyroidectomy
History
ABBA Approach
Evolution of ABBA Approach- BABA
1 year experience of Endoscopic thyroidectomy (BABA approach) in YCH
Conclusion

19. Drawback of ABBA
Limited angle for visualizing both lobes of the thyroid, other important structures including RLN, parathyroid glands.
Limited retraction for dissection
Hence, bilateral axillobreast approach (BABA) was developed to overcome the above problems

20. BABA- Bilateral axillo-breast approach
First described by Choe et. al. in 2007.
While working on ABBA approach, he developed this approach:
to obtain a better view
hence, to achieve total thyroidectomy

21. Incision for BABA approach

22. Endoscopic Thyroidectomy
History
ABBA Approach
Evolution of ABBA Approach- BABA
1 year experience of Endoscopic thyroidectomy (BABA approach) in YCH
Conclusion

23. What is happening in the world?

24. What is happening in the world?
BABA Group (110 patients)
Mean OT time: minutes
Conversion rate: 1.8%
cancer with capsular invasion
tracheal perforation

25. What is happening in the world?
In this study, there were no breakdown information quoted between ABBA and BABA groups (135 patients)
Postoperative complications: 7.4%
Transient vocal cord palsy 4
Transient hypocalcemia 4
Pneumothorax 1
Infection 1
Mean LOS: 4.0 days (range: 2 to 7 days)
All patients satisfied about the cosmetic outcome

26. What is happening in the world?

27. What is happening in the world?

28. What is happening in the world?
BABA Group (103 patients)
Mean OT time: minutes
Post op Mean LOS: 3.18 days
Conversion rate: not mentioned
Complication rate: 54% (2.2% if transient hypoCa and transient RLN palsy excluded)
All patients satisfied with the cosmetic outcome

29. How is our performance?
…let’s see…

30. Endoscopic Thyroidectomy
History
ABBA Approach
Evolution of ABBA Approach- BABA
1 year experience of Endoscopic thyroidectomy (BABA approach) in YCH
Conclusion

31. Conclusion
Endoscopic thyroidectomy by means of BABA is safe procedure with good cosmetic outcome.
Endoscopic thyroidectomy is a new approach introduce in recent years. We are still on the early stage of the learning curve.
With more experience, OT time and complication related to surgery can be further improved.

32. The End!~ Thanks~
Questions?