How Should the Surgical Approach In Thyroidectomy Be Selected? A Prospective Study Comparing the Trauma of 3 Different Thyroidectomy Surgical Approaches

Abstract

Objective: To compare the trauma of 3 different surgical approaches and provide a reference for clinicians in choosing the operative procedure. Patients and Methods: A total of 150 patients were divided into the total endoscopic thyroidectomy (TET), endoscopic-assisted thyroidectomy (EAT), and conventional open thyroidectomy (COT) groups, with 50 patients in each group. The peripheral blood C-reactive protein (CRP) levels at different postoperative time points, operative time, intraoperative blood loss, postoperative drainage volume, postoperative pain, degree of satisfaction with the incision appearance, postoperative extubation time, and swallowing discomfort 3 months after surgery were compared among the groups that received different surgical approaches. Results: The operative time of TET was longer than that of COT and EAT. The intraoperative blood loss was significantly lower in the TET and EAT groups than in the COT group. The postoperative drainage volume was lowest after EAT and highest after TET. The extubation time was significantly shorter after EAT than after TET and COT. The 6-hour CRP level was significantly higher after TET than after EAT and COT, and the 24-hour CRP level was better in the EAT group than in the other 2 groups. The CRP levels at 72 hours postoperatively were lowest in the EAT group and highest in the TET group. Postoperative pain was significantly lower after EAT than after TET and COT. Cosmetic satisfaction was highest in the TET group and lowest in the COT group. Swallowing discomfort was lowest in the EAT group and highest in the TET group. There was a positive correlation between the drainage volume on the first postoperative day, the drainage tube removal time, dysphagia, and the CRP level in each period. There was a positive correlation between pain, cosmetic satisfaction and CRP in 2 of the time periods. Conclusions: All 3 types of thyroidectomy are safe and reliable in benign tumor resection. Therefore, in clinical practice, the age, sex, and cosmetic needs of the patients, and the oncological safety should all be considered to provide patients with the most appropriate recommendations. In view of oncological safety, TET should be carefully selected for malignant tumor resection.

Comparison of cosmetic outcomes between remote‐access and conventional thyroidectomy: A review of the current literature

“…Strict patient selection and recognition of the possibility of unusual complications in combination with growing experience are important for the safety of patients and the success of the surgery. 15,20,24 Despite our findings, this study had several limitations. First, only one RCT 11 fulfilled the inclusion criteria and was considered suitable for data extraction, whereas the rest of the eight cohorts were prospective or retrospective nonrandomized.…”

“…Some scars are camouflaged well with the skin crease and provide an acceptable cosmetic outcome, while others may heal with hypertrophy or keloid formation and affect the patients' postoperative quality of life even further, leaving a permanent defect. 15,20,[24][25][26] The emergence of endoscopic neck surgery has enabled the resection of the thyroid gland from a remote site incision, where the scar can be hidden with regular clothing or even when the arm is in the neutral position. Because of the high incidence of thyroid diseases in young people and especially in female patients, the cosmetic requirements increased and the option of a scarless outcome in the neck was more frequently preferred.…”

“…Because of the high incidence of thyroid diseases in young people and especially in female patients, the cosmetic requirements increased and the option of a scarless outcome in the neck was more frequently preferred. 4,15,18,20,25 This inference was strongly stated by the notably greater satisfaction with the cosmetic outcome accomplished after transoral, transaxillary, and postauricular thyroidectomy compared to the conventional method. 27,28 Lee et al 27 reported slight superiority of the transoral and transaxillary approaches over the postauricular facelift technique; however, no statistically significant differences were detected.…”

“…The emergence of endoscopic neck surgery has enabled the resection of the thyroid gland from a remote site incision, where the scar can be hidden with regular clothing or even when the arm is in the neutral position. Because of the high incidence of thyroid diseases in young people and especially in female patients, the cosmetic requirements increased and the option of a scarless outcome in the neck was more frequently preferred 4,15,18,20,25 …”

“…Therefore, besides the expectations in terms of the cosmetic outcome and patients' preferences, additional factors such as age, sex, clinicopathologic characteristics, and oncological safety have to be considered to provide patients with the most accurate and suitable surgical approach. Strict patient selection and recognition of the possibility of unusual complications in combination with growing experience are important for the safety of patients and the success of the surgery 15,20,24 …”