Objective and Subjective Scar Aesthetics in Minimal Access vs Conventional Access Parathyroidectomy and Thyroidectomy Surgical Procedures

Abstract

To determine if performing parathyroidectomy surgery through minimal access (MA) incisions has any notable aesthetic or quality-of-life impact on patients compared with conventional access (CON) techniques.Design: Paired cohort with (1) a prospective MA incision and scar cohort and (2) a sex-and age-matched (within 3 years) retrospective CON incision and scar cohort.Setting: Tertiary care center.Patients: Fifteen patients enrolled in prospective study protocol over a 2-year period; 11 patients met inclusion criteria. A sex-and age-matched retrospective cohort of patients was selected from a patient population undergoing surgical treatment of thyroid neoplastic diseases using a CON approach. Inclusion criteria were use of MA incision for parathyroidectomy and return for longterm follow-up scar assessment.Interventions: Minimal access parathyroidectomy surgery vs CON thyroidectomy surgical procedures, postoperative follow-up assessment of scar aesthetics by patient and naive viewers, and digital photography and analysis of the surgical incision site. All patients were followed for at least 8 months after surgery. Main Outcome Measures:The Patient and Observer Scar Assessment Scale (POSAS), Vancouver Scar Scale, and photographic scar analysis by naive viewers.Results: There was no significant difference in scar assessment scale scores between the MA and CON cohorts and no clinically significant difference in overall patient satisfaction with scars between cohorts (POSAS: Patient Scar Assessment Scale, P=.14, and Observer Scar Assessment Scale, P=.79; Vancouver Scar Scale, P=.76). There was increased visibility of scars in the CON cohort to naive viewers.Conclusions: Although they were more readily visible to naive viewers, CON (larger) cervical scars created in parathyroidectomy or thyroidectomy surgery do not translate into decreased patient satisfaction with their scar result. This may indicate a limited quality-of-life benefit in using MA approaches in transcervical surgical procedures.

Letter to the Editor regarding “Reducing neck incision length during thyroid surgery does not improve satisfaction in patients” by Kim et al.

“…There have been few more previous studies which have derived similar conclusions [2][3][4][5]; however, none have been as extensive as the present study. The sample size is large and very heterogeneous; therefore, there can be many confounding factors which I would like to highlight.…”

Patient and observer scar assessment scores favour the late appearance of a transverse cervical incision over a vertical incision in patients undergoing carotid endarterectomy for stroke risk reduction

“…Similarly, for the patient component score, the patient self-rates the scar in 6 categories: pain, itching (on a scale of 1 [no complaints] to 10 [worst imaginable]), colour, stiffness, thickness and irregularity (on a scale of 1 [normal skin] to 10 [very different]). The POSAS has previously been used to report on scar outcomes following neck surgery (parathyroidectomy and thyroidectomy), 16 but to our knowledge it has not been applied previously to study differences in the outcomes of vertical and transverse incisions for CEA.…”

A paired comparison analysis of third-party rater thyroidectomy scar preference

“…These biases are overcome by one of the principal strengths of our experimental design: third-party observer-based assessment and the use of the rigorous paired comparison method of evaluation. Of the above-mentioned literature, only O'Connell et al 14 and Casserly et al 20 used observer-based ratings as part of their studies. Observer-based ratings have been used elsewhere to evaluate thyroidectomy scar aesthetics without making a comparison to other approaches and to compare alternative methods of skin closure.…”

“…These lengths were chosen as previous studies have defined minimally invasive approaches as having incision lengths of 2.5-4.0 cm and conventional approaches as having incision lengths of 5.0-10.0 cm. 4,[10][11][12][13][14] The minimum limits of these ranges were chosen for the simulated scars' lengths as it was felt that this would be a more useful comparison than the upper limits or averages of these ranges.…”