Prophylactic antibiotics may not be necessary for transoral endoscopic thyroidectomy

Abstract

BackgroundWith the recent advances in thyroid cancer surgery techniques and the increasing number of patients concerned about cosmetics, the use of transoral endoscopic thyroidectomy is increasing globally. The aim of this study was to determine whether transoral endoscopic thyroidectomy is truly a clean-contaminated surgery.MethodsFrom September 2016 to April 2018, 20 patients with thyroid cancer underwent transoral endoscopic thyroidectomy performed by a single surgeon at Gangnam Severance Hospital. Before and after surgery, the oral cavity was swabbed to obtain culture samples, and antibiotics were administered before and after surgery each once.ResultsOf the total 20 patients, no bacteria were identified before or after surgery in eight (40%) patients. Bacteria were identified both before and after surgery in seven patients (35%). In four patients (20%), bacteria were not identified before surgery, but bacteria were identified after surgery. Bacteria were identified before surgery but not after surgery in one patient (5%). No surgical site infection was observed. All the bacteria identified were normal flora of the oral cavity and skin.ConclusionsThere was no difference between the preoperative culture and postoperative culture of the oral cavity in patients undergoing TOET, and there were no postoperative surgical site infection with prophylactic pre & post-operative antibiotics use. Considering the patient's position and surgical extent in TOET, it appears to be difficult for non-indigenous bacteria to invade the surgical site in oral cavity.

Modern Surgical Techniques of Thyroidectomy and Advances in the Prevention and Treatment of Perioperative Complications

“…Their study also found that the use of prophylactic antibiotics and enoral mucosal disinfection before surgery may be effective in reducing the risk of infection [82]. However, another study reached a different conclusion, showing that the use of prophylactic antibiotics may not be necessary in TOETVA due to the normal flora in the oral cavity acting as a barrier against potential pathogens [83]. This study also found that this procedure may not require prophy-lactic antibiotics because there is no invasion of non-resident bacterial flora [83].…”

“…However, another study reached a different conclusion, showing that the use of prophylactic antibiotics may not be necessary in TOETVA due to the normal flora in the oral cavity acting as a barrier against potential pathogens [83]. This study also found that this procedure may not require prophy-lactic antibiotics because there is no invasion of non-resident bacterial flora [83]. However, the study had a small sample size and was retrospective in design, so further studies are needed to confirm these findings.…”