Introduction Endoscopic thyroidectomy (ET) has become a well-established surgical technique that is mainly performed for benign thyroid lesions. Several endoscopic approaches are available, such as transaxillary, unilateral axillo-breast approach (UABA), modified anterior chest wall approach (MACWA), bilateral axillo-breast approach, and most recently the transoral approach and the robotic-assisted techniques. There is no recommended approach, because each approach has its own positive and negative attributes. We, herein, compare between UABA and MACWA in terms of surgical and cosmetic outcomes. Methods This prospective study was conducted from April 2016 to August 2017. Forty patients with unilateral benign thyroid lesions were selected. Of them, 20 patients underwent ET using UABA, and 20 patients underwent ET using MACWA. Gas insufflation was implemented for all patients. Clinicopathologic data, surgical outcomes, and cosmetic outcomes in both groups were analyzed. Results There was no significant difference between both groups in the clinicopathologic characteristics. The mean surgical time was significantly longer in the UABA group compared with the chest wall group (147.3 vs. 124.3 min). The postoperative pain scores were relatively lower in the UABA group compared with the MACWA group. We reported a higher rate of persistent paresthesia, neck contracture with swallowing discomfort, and hypertrophic scars in the MACWA group. Cosmetic satisfaction scores for patients who underwent UABA were higher than for those who underwent MACWA. Conclusions Both approaches were similar in terms of safety, feasibility, and operative complications. Even though the surgical time was longer, patients who underwent the UABA reported relatively less postoperative pain, superior cosmetic results, scar perception, and patient satisfaction compared with MACWA.

Endoscopic Thyroidectomy Using the Unilateral Axillo-breast Approach Versus the Modified Anterior Chest Wall Approach: A Prospective Comparative Study.

Aim

The purpose of this study was to test the hypothesis that video-assisted thyroidectomy (VAT) affords comparable safety and efficacy compared to open conventional thyroidectomy (CT).



Patients and Methods

Randomized, controlled trials comparing VAT with CT were ascertained by a methodical search using the MEDLINE, Pubmed, Ovid, Embase and Cochrane Library electronic databases. Primary meta-analysis outcomes were operative time, intraoperative blood loss and complications, including transient recurrent laryngeal nerve palsy (TRP), transient hypoparathyroidism (TH), permanent recurrent laryngeal nerve palsy (PRP), permanent hypoparathyroidism (PH) and wound infection (WI). The secondary outcomes were postoperative pain within 12, 24 and 48 h after the operation, length of hospital stay and cosmetic result.



Results

Operative time was significantly less with CT than with VAT, while VAT was associated with better cosmetic result and less pain at 24 h, postoperatively. Blood loss, TRP, TH, PRP, PH, WI and postoperative pain at 48 h did not reach significance between procedures. Comparisons between two procedures concerning postoperative pain within 12 h and length of hospital stay depicted statistically-significant differences in favour of VAT, but only in the fixed-effects model.



Conclusions

VAT is a safe procedure that produces outcomes; in view of short-term adverse events, similar to CT, it needs a longer operative time and produces better cosmetic results and less postoperative pain in the early phase.

Meta‐analysis of video‐assisted thyroidectomy versus conventional thyroidectomy

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Meta‐analysis of video‐assisted thyroidectomy versus conventional thyroidectomy