Prophylactic drainage after thyroid surgery, many surgeons have routinely used it to prevent post thyroidectomy cervical hematoma. With advances in surgical methods of hemostasis, the rate of post thyroidectomy cervical hematoma has decreased significantly to about 0.1%. The aim of this study is to evaluate the outcome of thyroidectomy with drain vs no drain, while we achieved the hemostasis by an Ultrasonic scalpel in all cases. We conducted this study in Al-Shiffa general hospital, Basrah, Iraq, during the period from January 2016 to January 2018. Eighty patients with different thyroid pathologies and candidates for total or near total thyroidectomy have been included; forty patients were undergoing thyroid surgery with drain in the period during 2016. We compared the results with results of a selected similar characteristics group of forty patients that undergo thyroid surgery with no drain in the period during 2017. The results of this study show that, the patients with no drain reported a significant shorter mean duration of surgery in comparison to patients with drain (53.13±14.16 and 60.49±7.78 minutes) respectively, P-value = 0.01. In addition, patients with no drain also reported a significant shorter mean duration of hospital stays in comparison to patients with 2

Open thyroidectomy; is the gold standard surgical procedure for thyroid diseases, but the incision scar in the anterior aspect of the neck due to this approach cannot be avoided and may results in a permanent cosmetic defect. Therefore, there is a need to improve postoperative quality of life, including cosmetics. Recently, transoral endoscopic thyroidectomy has been developed; it is a natural orifice thyroid surgery, minimally invasive and completely scar free. This study aimed to describe the outcome, patient's satisfaction, and complications after hemithyroidectomy for benign thyroid nodules by transoral endoscopic vestibular approach in comparison with open approach. This study was conducted in Al-Shiffa General hospital, Basrah, Iraq from August 2017 to June 2019 and was approved by a local ethical committee. Fifty patients with benign thyroid nodules who are candidate for hemithyroidectomy were included in the study; they were divided into two groups according to the method for thyroidectomy which was either conventional open or transoral endoscopic thyroidectomy vestibular approach based on the patients' preferences. All operations were performed by the same surgical team. The results of this study showed that 24 (48%) of them operated upon by transoral endoscopic thyroidectomy vestibular approach, while the remaining 26 (52%) patients have been operated upon by open thyroidectomy approach. Transoral endoscopic thyroidectomy vestibular approach reported significant longer operative time, has comparable rate of complications with an excellent cosmetic outcome and better postoperative patients' satisfaction in comparison to open thyroidectomy. In conclusion, transoral endoscopic thyroidectomy vestibular approach is a safe and feasible procedure with an excellent cosmetic outcome and better patients' satisfaction. At present, it is a relatively time-consuming procedure and, therefore, candidate patients with a strong motivation for scar free surgery are recommended.

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