1. 經雙側腋下、乳房行甲狀腺切除術 ─中國附醫經驗分享 BABA procedure in CMUH
Presenter:林建德
Superviser: 許士超 許家豪 陳德鴻 葉俊杰 楊宏仁 楊美都 鄭隆賓
中國醫藥大學附設醫院 外科部 一般外科

2. Outline of content Basic requirement Preliminary data Video sharing
Post-OP oncologic outcome, cosmetic outcome

3. Indication to BABA thyroidectomy
1. low-risk, well-differentiated thyroid carcinoma
i. <2 cm
ii. No local invasion (except only strap muscle)
iii. No cervical nodal metastasis
2. Graves disease
3. benign thyroid nodule up to 8 cm in size

4. Contraindication to BABA
1. Previous neck surgery, but previous BABA
2. Distant metastasis
3. Multiple lateral neck node metastases
4. Definite tumor invasion to an adjacent organ,
except strap muscles
5. Lesions located adjacent to TE groove or Berry
ligament

5. 2013.4~2014.6 Total: 4 / Lobectomy: 10 Mean OP time:351#
Sex
BMI
Procedure
time
Patho
Day-1 drain 1 F 25
Total
435
MNG 11 2 27
Total(Robo)
571
Papillary(T1aN0M0) 3 20
502
Papillary(T1bN0M0) 30 4 21
Lobectomy
367 35 5 M
322 48 6
234 45 7
227 56 8 19
321
115 9 24
Lobectomy(Robo)
428
Follicular adenoma
10*
342
Papillary(T3N0M0)
105
285 12
280
140
13*
Lobectomy(Re-operative)
311 14 23
300
Papillary(T2N0M0)
100
Total: 4 / Lobectomy: 10
Mean OP time:351
Total: 452 / Lobectomy: 312
Papillary carcinoma: 4
Mean POD1 drain: 70ml

6. Home made pillow

7. Neck hyperextension

8. Final setting

9. All instruments

10. Marking of dissected region

11. Hydro-­dissection with
epinephrine solution (1mg /200cc)

12. Intraoperative nerve mapping with nerve monitor

13. Case sharing

14. Basic history • 36 y/o female, 163cm, 54kg
• Neck goiter with atypia on FNA 3 years ago
• Echo: cystic goiter
• FNA: follicular neoplasm
• Pre-­op thyroglobulin: 455 ng/ml
• Scheduled wedding ceremony on 2014-­November

15. Pre-­op CT

16. Endo-Left lobe

17. Endo-­Right lobectomy

18. Immediate post-­op pic

19. Wearing Home-made Bra before extubation

20. Post-­op 2 week

21. Good oncological outcome in selected patients

22. Pre-­op CT: suspected malignancy→Robo-BABA

23. Post-­op 6th month after 120mCi I-131 ablation

24. Post-­op 2 year stimulated thyroglobulin<0.1
TSH > * uIU/mL

25. Summary • Adequate Hydro-­dissection(~400cc) is important
• Endo-­peanut is effective and efficient to dissect
• Nerve monitor is also helpful for beginners
• Endo-­BABA procedure is a feasible approach for
beginners, particularly general surgeons

26. Thanks for your attentions