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Comparison of transoral endoscopic thyroidectomy vestibular approach, total endoscopic thyroidectomy via areola approach, and conventional open thyroidectomy: a retrospective analysis of safety, trauma, and feasibility of central neck dissection in the treatment of papillary thyroid carcinoma

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Abstract

Background

Transoral endoscopic thyroidectomy vestibular approach (TOETVA) and total endoscopic thyroidectomy via areola approach (ETA) are commonly used endoscopic thyroidectomy approaches. This study compares the effectiveness of these approaches with conventional open thyroidectomy (COT) in terms of safety, associated trauma, and feasibility of central neck dissection in the treatment of papillary thyroid carcinoma (PTC).

Methods

This retrospective study included patients who underwent TOETVA (n = 100), ETA (n = 119), and COT (n = 289). All patients had a pathological diagnosis of PTC and underwent unilateral lobectomy and central neck dissection. We analyzed operative time, postoperative drainage volume, postoperative C-reactive protein (CRP), preoperative and postoperative white blood cell (WBC) count and parathyroid hormone (PTH) levels, parathyroid damage, hoarseness, total number of central lymph nodes, and number of metastatic central lymph nodes.

Results

The clinical characteristics across the three groups were similar except for patient sex and age. There was a higher proportion of young women in the TOETVA and ETA groups than in the COT group. There were significant differences between the three groups regarding operative time (P = 0.000), postoperative drainage volume (P = 0.000), postoperative CRP (P = 0.000), ∆WBC (P = 0.000), and length of postoperative hospital stay (P = 0.021); in the TOETVA and ETA groups, operative time (P = 0.445), postoperative drainage volume (P = 0.677), and length of postoperative hospital stay (P = 0.145) were not significantly different. The percentage of cases with parathyroid gland damage (P = 0.459) and hoarseness (P > 0.05) was similar in all groups. All three procedures were efficient in performing a central lymph node dissection.

Conclusions

Although considered more traumatic, TOETVA and ETA are both safe treatment options for PTC. They can both achieve similar therapeutic effects of central neck dissection in the treatment of PTC when compared with open surgery.

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Acknowledgements

We would like to thank Editage [www.editage.cn] for English language editing.

Funding

This study did not receive any funding.

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Author notes

  1. Haiqing Sun and Haitao Zheng contributed equally to this work.

Authors and Affiliations

  1. Department of Thyroid Surgery, Yantai Yuhuangding Hospital, Yantai, 264000, Shangdong, China

    Haiqing Sun, Haitao Zheng & Xiaojie Wang

  2. Department of Thyroid Surgery, Qilu Hospital of Shandong University, Jinan, 250012, Shandong, China

    Qingdong Zeng

  3. Department of Thyroid Surgery, The Second Affiliated Hospital of Zhejiang University, School of Medicine, 88 Jiefang Road, Hangzhou, 310009, Zhejiang, China

    Ping Wang & Yong Wang

Authors
  1. Haiqing Sun
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  2. Haitao Zheng
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  3. Xiaojie Wang
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  4. Qingdong Zeng
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  5. Ping Wang
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  6. Yong Wang
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Correspondence to Yong Wang.

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Haiqing Sun, Haitao Zheng, Xiaojie Wang, Qingdong Zeng, Ping Wang, and Yong Wang have no conflicts of interest or financial ties to disclose.

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Sun, H., Zheng, H., Wang, X. et al. Comparison of transoral endoscopic thyroidectomy vestibular approach, total endoscopic thyroidectomy via areola approach, and conventional open thyroidectomy: a retrospective analysis of safety, trauma, and feasibility of central neck dissection in the treatment of papillary thyroid carcinoma. Surg Endosc 34, 268–274 (2020). https://doi.org/10.1007/s00464-019-06762-6

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  • DOI: https://doi.org/10.1007/s00464-019-06762-6

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