Comparative study of endoscopic thyroidectomy versus conventional open thyroidectomy in papillary thyroid microcarcinoma (PTMC) patients

Abstract

Background: The aim of this study was to evaluate and compare the early surgical outcomes of endoscopic and conventional open thyroidectomies in patients with papillary thyroid microcarcinoma (PTMC). Methods: Between September 2005 and December 2007, 499 patients with PTMC were enrolled. 275 patients underwent gasless endoscopic thyroidectomy via the axillary route (endo group), and 224 patients underwent conventional open thyroidectomy (open group). We analyzed the patient's clinico-pathologic characteristics and surgical completeness between the two groups. Results: The endo group was younger than the open group. The open group underwent more extensive surgery than the endo group. The operative time was longer in the endo group than the open group (138.5 AE 49.0 minvs. 105.5 AE 41.6 min; P < 0.0001), and a lesser number of lymph nodes were retrieved in the endo group compared to the open group (5.05 AE 2.94 vs. 5.96 AE 4.50, P ¼ 0.007). We experienced complications in the endo group, such as transient hypocalcemia, transient RLN palsies, tracheal injuries, and esophageal injuries. Therewas no abnormal uptake on RAI scans in the two groups. From among patients who had undergone total thyroidectomy, all patients in the endo group had <1 ng/ml of serum Tg post-operatively; the seven patients in the open group had >1 ng/ml of serum Tg post-operatively. Tumor recurrence was detected in the open group only (n ¼ 6). Also we checked the post-operative Tg in patients who had undergone lobectomy in the two groups, and found that there were no statistical differences in the two groups. Conclusions: According to our experience, gasless endoscopic thyroidectomy using a trans-axillary approach is a safe and feasible alternative to conventional open thyroidectomy in selected patients with PTMC.

Differences in postoperative outcomes, function, and cosmesis: open versus robotic thyroidectomy

“…The surgical techniques for conventional open and robotic thyroidectomy with our approach have been described in detail elsewhere, so a detailed description of the technique is therefore beyond the scope of this report [7,[12][13][14][15].…”

“…Endoscopic thyroidectomy has several advantages over conventional thyroidectomy [4][5][6][7][8]. However, endoscopic thyroidectomy is a difficult technique for surgeons because of difficulties with adequate visualization and precise manipulation of the surgical field.…”

Comparison of Endoscopic and Robotic Thyroidectomy

“…The robot and endoscopy techniques and trocar arrangement have been described in detail elsewhere. 4,[6][7][8][9][14][15][16] Briefly, the patient was positioned in a supine position on a small shoulder roll. The ipsilateral arm was placed on an arm board and extended cephalad to expose the axilla.…”

“…[1][2][3][4][5] However, endoscopic thyroidectomy is a technically challenging procedure and has not been universally adopted. Two reasons for this may be that the 2-dimensional visual representation and nonflexible endoscopic instruments can make it difficult to adequately visualize the surgical field and to manipulate instruments.…”

Endoscopic Thyroidectomy: A Literature Review and Update

“…Figure 3 shows the endoscopic view of transaxillary thyroidectomy. On the other hand, some studies suggested that the trans-axillary approach might be associated with a higher rate of transient hypocalcemia and transient RLN palsy [36,37]. In a patient with a low-risk papillary thyroid microcarcinoma, Jeong et al reported that trans-axillary thyroidectomy with prophylactic central neck dissection was feasible.…”