Impact of Large Thyroid Nodules (≥4 cm) on Surgical Outcomes Following Endoscopic Thyroidectomy Through the Bilateral Axillo-Breast Approach.

Abstract

Objective: Endoscopic thyroidectomy through the bilateral axillo-breast approach (BABA) is predominantly used in cases involving low-risk thyroid malignancies and benign nodules measuring <4 cm. However, the efficacy and safety of this technique in larger goiters remain underexplored.

Methods: This retrospective study compared perioperative data and pathologic outcomes among patients who underwent endoscopic BABA thyroidectomy categorized on the basis of the size of the dominant nodule (<4 vs ≥4 cm).

Results: Among the 113 included patients, 81 (72%) had a dominant nodule measuring <4 cm (group 1) and 32 (28%) presented with a nodule measuring ≥4 cm (group 2). Group 2 experienced longer operative times, greater blood loss, and higher drainage volumes than group 1. However, pain scores and length of postoperative hospital stay were similar between the groups. None of the patients required conversion to open surgery. The incidence rates of vocal cord palsy and hypoparathyroidism did not differ significantly between groups. In group 2, three patients developed seroma (9%) and one exhibited delayed bleeding (3%). Pathologic examination revealed that 6 patients (19%) in group 2 had malignant neoplasms; 3 were identified in the dominant nodule, whereas the remaining 3 were identified in separate, smaller nodules. Throughout the mean follow-up period of 43 months, no recurrence or metastasis was reported.

Conclusions: Endoscopic BABA thyroidectomy is a viable option for patients with large thyroid nodules (≥4 cm); however, this technique requires careful execution.