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Comparison of swallowing disorder following gasless transaxillary endoscopic thyroidectomy versus conventional open thyroidectomy

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Abstract

Background

In conventional open thyroidectomy, it is necessary to create a sub-platysma muscle flap in front of the strap muscle to provide working space. Adhesion between the flap and the strap muscle can occur after the operation, disrupting strap muscle movement and causing a swallowing disorder. Gasless transaxillary endoscopic thyroidectomy approaches the thyroid through the posterior of the strap muscle and does not require a sub-platysma muscle flap. The present study compared flap/muscle adhesion and occurrence of swallowing disorder following gasless transaxillary endoscopic thyroidectomy versus conventional open thyroidectomy.

Methods

Patients (N = 47) receiving thyroidectomy at the Kangbuk Samsung Medical Center, Seoul, Korea, were divided into two groups: group O (24 patients) underwent conventional open thyroidectomy, and group E (23 patients) underwent gasless transaxillary endoscopic thyroidectomy. The subjective Swallowing Impairment Index (SIS)-6 was used to evaluate the degree of post-operative swallowing disorder. Video recordings of swallowing movement were used to determine the contraction/relaxation (CR) ratio and evaluate adhesion, pre-operation, 3 days post-operation, and 1 month post-operation. Barium videofluoroscopy was used to measure movement of the hyoid bone and strap muscle.

Results

Group O had significantly higher post-operative SIS-6 scores than group E (p < 0.027), indicating greater swallowing disorder. The CR ratio increased in group O after the operation and continued to increase during 1 month post-operation, but decreased in group E (p < 0.001). Videofluoroscopy showed that hyoid bone movement in group O decreased by 55.46 and 56.75 % at 3 days and 1 month post-operation, respectively, while the corresponding decreases in group E were 84.04 and 83.69 %.

Conclusions

Conventional open thyroidectomy allowed adhesion of the strap muscle and sub-platysma muscle flap, resulting in non-specific dysphagia. These complications did not occur following gasless transaxillary endoscopic thyroidectomy.

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Disclosures

Keehoon Hyun, Wooseok Byon, Hee-Jin Park, Yonglai Park, Chanheun Park, and Ji-Sup Yun declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article. The authors received no financial support for the research, authorship and/or publication of this article.

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Authors and Affiliations

  1. Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, #29 Saemunan-ro, Jongno-gu, 110-746, Seoul, Republic of Korea

    Keehoon Hyun, Wooseok Byon, Yonglai Park, Chanheun Park & Ji-Sup Yun

  2. Breast-Thyroid cancer center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, #29 Saemunan-ro, Jongno-gu, 110-746, Seoul, Republic of Korea

    Keehoon Hyun, Wooseok Byon, Yonglai Park, Chanheun Park & Ji-Sup Yun

  3. Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 110-746, Seoul, Republic of Korea

    Hee-Jin Park

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  1. Keehoon Hyun
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  2. Wooseok Byon
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  3. Hee-Jin Park
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Correspondence to Ji-Sup Yun.

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Hyun, K., Byon, W., Park, HJ. et al. Comparison of swallowing disorder following gasless transaxillary endoscopic thyroidectomy versus conventional open thyroidectomy. Surg Endosc 28, 1914–1920 (2014). https://doi.org/10.1007/s00464-013-3413-6

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  • DOI: https://doi.org/10.1007/s00464-013-3413-6

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