Objective: With a total endoscopic thyroidectomy, it is extremely important to establish sufficient space. To solve this problem, the author has developed a new device, which is a retractor-shaped wire for retraction of the strap muscles without an additional port. Atraumatic tools for pushing and pulling without breaking the thyroid are necessary because intra-operative bleeding is a frequent cause of conversion to open procedure. To solve this problem, the author has developed a new device, which is a spatula-shaped wire that is attached to the end of an endoscopic aspirator. This spatula-shape wire can be used to push and pull the thyroid firmly without it breaking of thyroid tissue.
Material and Method: From 15 March 2011 to 15 April 2014, the author used these new devices in 18 consecutive patients
who were considered eligible for the surgery.
Results: Lobectomy with isthmusectomy was performed on 12 patients (67%). Through the same incisions, a subtotal
thyroidectomy was accomplished in four cases (22%) and the Hartley-Dunhill procedure was performed on two cases (11%).
The mean specimen weight on the histological report was 33.12 grams (range, 8.4 to 79.6 grams). Two cases of left lobectomy
with isthmusectomy had previously had a conventional right lobectomy. There was one case with the same procedure which
had had a suspicious nodule on Graves’ disease treated with radioactive iodine one and a half years ago. There was a case
of chronic thyroiditis in one Dunhill procedure. No hemorrhage occurred during the procedures. There were three cases of
subcutaneous bruising. There were no other complications detected and no cases were converted to open thyroidectomy.
Conclusion: Thyroid surgery with the unilateral axillo-breast approach and the new tools is safe and effective. These tools
make it possible to operate on larger thyroid lesions and perform thyroid surgery on patients who have had traditional thyroid surgery, Graves’ disease, and chronic thyroiditis.

Keywords: Spatula-shaped wires, Retractor-shaped wire, Endoscopic thyroidectomy