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.
Similar content being viewed by others
References
Wang C, Zhai H, Liu W, Li J, Yang J, Hu Y, Huang J, Yang W, Pan Y, Ding H (2014) Thyroidectomy: a novel endoscopic oral vestibular approach. Surgery 155:33–38
Anuwong Angkoon (2016) Transoral endoscopic thyroidectomy vestibular approach: a series of the first 60 human cases. World J Surg 40:491–497
Anuwong Angkoon, Ketwong Khwannara, Jitpratoom Pornpeera, Sasanakietkul Thanyawat, Duh Quan-Yang (2018) Safety and outcomes of the transoral endoscopic thyroidectomy vestibular approach. JAMA Surg 153:21–27
Yang Jingge, Wang Cunchuan, Li Jinyi, Yang Wah, Cao Guo, Wong Hong-meng, Zhai Hening, Liu Weijun (2015) Complete endoscopic thyroidectomy via oral vestibular approach versus areola approach for treatment of thyroid diseases. J Laparoendosc Adv Surg Tech 25:470–476
Wu Y-J, Chi S-Y, Elsarawy A, Chan Y-C, Chou F-F, Lin Y-C, Wee S-Y, Pan C-C, Cheng B-C, Lin C-C (2018) What is the appropriate nodular diameter in thyroid cancer for extraction by transoral endoscopic thyroidectomy vestibular approach without breaking the specimens? A surgicopathologic study. Surg Laparosc Endosc Percutaneous Tech 28:390–393
Wang Y, Zhang Z, Zhao Q, Xie Q, Yan H, Yu X, Xiang C, Zhang M, Wang P (2018) Transoral endoscopic thyroid surgery via the tri-vestibular approach with a hybrid space-maintaining method: a preliminary report. Head Neck 40:1774–1779
Wang Cunchuan, Feng Zhiqi, Li Jinyi, Yang Wah, Zhai Hening, Choi Nim, Yang Jingge, Hu Youzhu, Pan Yunlong, Cao Guo (2015) Endoscopic thyroidectomy via areola approach: summary of 1250 cases in a single institution. Surg Endosc 29:192–201
Miccoli P, Berti P, Raffaelli M, Conte M, Materazzi G, Galleri D (2001) Minimally invasive video-assisted thyroidectomy. Am J Surg 181:567–570
Shimizu K, Akira S, Tanaka S (1998) Video-assisted neck surgery: endoscopic resection of benign thyroid tumor aiming at scarless surgery on the neck. J Surg Oncol 69:178–180
Ikeda Y, Takami H, Sasaki Y, Kan S, Niimi M (2000) Endoscopic neck surgery by the axillary approach. J Am Coll Surg 191:336–340
Shimazu K, Shiba E, Tamaki Y, Takiguchi S, Taniguchi E, Ohashi S, Noguchi S (2003) Endoscopic thyroid surgery through the axillo-bilateral-breast approach. Surg Laparosc Endosc Percutaneous Tech 13:196–201
Wilhelm Thomas, Andreas Metzig (2010) Endoscopic minimally invasive thyroidectomy: first clinical experience. Surg Endosc 24:1757–1758
Haugen BR, Alexander EK, Bible KC (2016) 2015 American thyroid association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: the American thyroid association guidelines task force on thyroid nodules and differentiated thyroid cancer. Thyroid 26(1):1–133
Qu N, Zhang L, Qh JI et al (2015) Risk factors for central compartment lymph node metastasis in papillary thyroid microcarcinoma: a meta-analysis. World J Surg 39:2459–2470
Mehanna H, Almaqbili T, Carter B et al (2014) Differences in the recurrence and mortality outcomes rates of incidental and nonincidental papillary thyroid microcarcinoma: a systematic review and meta-analysis of 21 329 person-years of follow-up. J Clic Endocr Metab 99:2834–2843
Chinese Mdical Association (2012) Thyroid management guidelines on thyroid nodules and differentiated thyroid cancer. Chin J Endoscinol Metab 10(28):779–797
Oncology Chinese Association Of Thyroid, Association Chinese Anti-Cancer (2017) Chinese expert consensus and guidelines for the diagnosis and treatment of papillary thyroid microcarcinoma. Cancer Biol Med 14:203–211
Cho Jinbeom, Lee Dosang, Baek Jongmin, Lee Junhyun, Park Yohan, Sung Kiyoung (2017) Single-incision endoscopic thyroidectomy by the axillary approach with gas inflation for the benign thyroid tumor: retrospective analysis for a single surgeon’s experience. Surg Endosc 31:437–444
Vasileiadis I, Karatzas T, Charitoudis G, Karakostas E, Tseleni-Balafouta S, Kouraklis G (2016) Association of intraoperative neuromonitoring with reduced recurrent laryngeal nerve injury in patients undergoing total thyroidectomy. JAMA Otolaryngol Head Neck Surg 142:994–1001
Su A, Gong Y, Wu W, Gong R, Li Z, Zhu J (2018) Does the number of parathyroid glands autotransplanted affect the incidence of hypoparathyroidism and recovery of parathyroid function? Surgery 161:124–129
Li Z, Wang P, Wang Y, Xu S, Cao L, Que R, Zhou F (2011) Endoscopic lateral neck dissection via breast approach for papillary thyroid carcinoma: a preliminary report. Surg Endosc 25:890–896
Acknowledgements
We would like to thank Editage [www.editage.cn] for English language editing.
Funding
This study did not receive any funding.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Disclosures
Haiqing Sun, Haitao Zheng, Xiaojie Wang, Qingdong Zeng, Ping Wang, and Yong Wang have no conflicts of interest or financial ties to disclose.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
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
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-019-06762-6