Ambulatory Endoscopic Thyroidectomy via a Chest-Breast Approach Has an Acceptable Safety Profile for Thyroid Nodule

Abstract

IntroductionWith the growing esthetic requirements, endoscopic thyroidectomy develops rapidly and is widely accepted by practitioners and patients to avoid the neck scar caused by open thyroidectomy. Although ambulatory open thyroidectomy is adopted by multiple medical centers, the safety and potential of ambulatory endoscopic thyroidectomy via a chest-breast approach (ETCBA) is poorly investigated.Material and MethodsPatients with thyroid nodules who received conventional or ambulatory ETCBA at Xiangya hospital, Central South University from January 2017 to June 2020 were retrospectively included. The incidence of postoperative complications, 30-days readmission rate, financial cost, duration of hospitalization, mental health were mainly investigated.ResultsA total of 260 patients were included with 206 (79.2%) suffering from thyroid carcinoma, while 159 of 260 received ambulatory ETCBA. There was no statistically significant difference in the incidence of postoperative complications (P=0.249) or 30-days readmission rate (P=1.000). In addition, The mean economic cost of the ambulatory group had a 29.5% reduction compared with the conventional group (P<0.001). Meanwhile, the duration of hospitalization of the ambulatory group was also significantly shorter than the conventional group (P<0.001). Patients received ambulatory ETCBA showed a higher level of anxiety (P=0.041) and stress (P=0.016). Subgroup analyses showed consistent results among patients with thyroid cancer with a 12.9% higher complication incidence than the conventional ETCBA (P=0.068).ConclusionAmbulatory ETCBA is as safe as conventional ETCBA for selective patients with thyroid nodules or thyroid cancer, however with significant economic benefits and shorter duration of hospitalization. Extra attention should be paid to manage the anxiety and stress of patients who received ambulatory ETCBA.

The ambulatory transoral endoscopic thyroidectomy vestibular approach is safe and economical for patients with thyroid nodules

“…In our study, there was no significant difference in HAM-A scores between the two groups, indicating that patients in the ambulatory group were no more anxious than those in the conventional group. Zeyu-Zhang reported more anxiety among patients in the ambulatory group (30,31); this may be because we used multimedia to provide patients with a complete understanding of their condition and how to ensure their safety after discharge, thereby reducing anxiety.…”

The safety, benefits and future development of overnight and outpatient thyroidectomy

“…There is no statistically significant difference in the incidence of postoperative hemorrhage between overnight thyroidectomy and inpatient thyroidectomy in terms of the incidence of postoperative hemorrhage ( 17 ). The difference in hypoparathyroidism in ECTBA was also not statistically significant ( 15 ). A prospective randomized controlled trial of 411 patients showed no difference in the incidence of complications such as hypoparathyroidism, hoarseness, hematoma, and wound infection between overnight and inpatient thyroidectomy ( 16 ).…”

“…It is as safe as patients with benign thyroid nodules or thyroid cancer, with significant economic benefits and shorter hospital stays. Particular attention should be paid to the relief of anxiety and stress in patients receiving overnight ETCBA ( 15 ). The details of the two studies are shown in Table 1 .…”

“…Cytological examination Bethesda grade less than grade 4, or nodules less than 2 cm in the case of Bethesda grade ≥ 5, and no lateral lymph node spread or mediastinal metastasis ( 14 ). The exclusion criteria for patients with ETCBA were lateral lymph node metastasis ( 15 ). Different from the impatient surgery, the location of the post-operative recovery of the patients in the overnight thyroidectomy is close to the medical institution, which is also a factor to be considered.…”

“…In addition to routine preoperative preparation for surgery, all patients underwent preoperative neck ultrasound to assess thyroid nodule size and lymph nodes before surgery. Some medical institutions will perform ultrasound-guided fine-needle aspiration and pathological classification of patients with suspicious nodules ( 14 , 15 ). Different approaches of overnight endoscopic thyroidectomy have different requirements for preoperative preparation.…”