Quality of life and surgical outcome of ABBA versus EndoCATS endoscopic thyroid surgery: a single center experience

Abstract

Background Thyroid surgery is often performed, especially in young female patients. As patient satisfaction become more and more important, different extra-cervical “remote” approaches have evolved to avoid visible scars in the neck for better cosmetic outcome. The most common remote approaches are the transaxillary and retroauricular. Aim of this work is to compare Endoscopic Cephalic Access Thyroid Surgery (EndoCATS) and axillo-bilateral-breast approach (ABBA) to standard open procedures regarding perioperative outcome and in addition to control cohorts regarding quality of life (QoL) and patient satisfaction. Methods In a single center, 59 EndoCATS und 52 ABBA procedures were included out of a 2 years period and compared to 225 open procedures using propensity-score matching. For the endoscopic procedures, cosmetic outcome, patient satisfaction and QoL (SF-12 questionnaire) were examined in prospective follow-up. For QoL a German standard cohort and non-surgically patients with thyroid disease were used as controls. Result The overall perioperative outcome was similar for all endoscopic compared to open thyroid surgeries. Surgical time was longer for endoscopic procedures. There were no cases of permanent hypoparathyroidism and no significant differences regarding temporary or permanent recurrent laryngeal nerve (RLN) palsies between open and ABBA or EndoCATS procedures (χ2; p = 0.893 and 0.840). For ABBA and EndoCATS, 89.6% and 94.2% of patients were satisfied with the surgical procedure. Regarding QoL, there was an overall significant difference in distribution for physical, but not for mental health between groups (p < 0.001 and 0.658). Both endoscopic groups performed slightly worse regarding physical health, but without significant difference between the individual groups in post hoc multiple comparison. Conclusion Endoscopic thyroid surgery is safe with comparable perioperative outcome in experienced high-volume centers. Patient satisfaction and cosmetic results are excellent; QoL is impaired in surgical patients, as they perform slightly worse compared to German standard cohort and non-surgical patients.

Facelift thyroid surgery: A systematic review of indications, surgical and functional outcomes

“…The mean BMI ranged from 23.6 to 27.4 in patients benefiting from endoscopic or robotic FTS. Among comparative studies, the following thyroid surgery approaches were considered in comparison with FTS: transcervical ‘open’ surgery (N = 5) [ 18 , 19 , 22 , 23 , 25 ], TAT (N = 6) [ 12 , 16 , 21 – 23 , 25 ], and TO (N = 3) [ 20 , 22 , 24 ]. Endoscopic and robotic FTS were performed in 6 [ 14 , 19 , 23 – 26 ], and 14 studies [ 11 – 13 , 15 – 24 , 26 ], respectively (Additional file 1 : Appendix 2).…”

“…Recurrent cancer 7. Preoperative vocal fold palsy Wirth [ 25 ] Germany (Munich) (Hausham) (Bad Aibling) Not clearly specified 1. Hemi or total thyroidectomy 2.…”

“…The surgical and functional outcomes are summarized in Table 2 . The mean operative time of FTS ranged from 88 to 201 min for hemi-thyroidectomy [ 11 – 14 , 16 , 18 , 20 , 22 ] and 132–220 min for total thyroidectomy [ 15 – 17 , 22 , 23 , 25 , 26 ] but in both cases, may depend on the approach (robotic versus endoscopic) and the realization of lymph node dissection [ 15 , 18 ] or neck lift surgery (Additional file 1 : Appendix 2) [ 13 , 26 ]. The time of the different surgical steps was assessed in five studies [ 11 , 13 , 17 , 21 , 26 ].…”

“…The shorter time of CT compared with FTS and TAT was corroborated in the study of Lee et al [ 23 ] where authors reported additionally that TAT and FTS were associated with higher amount of drainage than CT (Additional file 1 : Appendix 2). Recently, Wirth et al showed that the operative time of TAT was significantly longer than those of FTS and CT [ 25 ].…”

“…The most prevalent complications consisted of earlobe hypoesthesia, hematoma, seroma, transient hypocalcemia and transient recurrent nerve palsy. About hematoma, only two authors reported distinct prevalence of minor (2.5 & 28.8%) and major (2.5 & 3.4%) hemorrhage; the second requiring surgical revision [ 25 , 26 ]. Moreover, they observed that minor hemorrhage occurred more frequently in TAT approach compared with FTS and CT, corroborating the observations of Russell et al [ 22 ] Postoperative pain was assessed in two studies and authors reported significant decrease of pain scores in the postoperative few weeks [ 16 , 21 ].…”