Comparison of the effect between endoscopic thyroidectomy and open thyroidectomy in treatment of benign thyroid diseases / 新乡医学院学报

Objective To compare the clinical effect of endoscopic thyroidectomy and open thyroidectomy in the treat-ment of benign thyroid diseases. Methods A total of 120 patients with benign thyroid diseases were selected from March 2015 to June 2017 in the Third Affiliated Hospital of Xinxiang Medical University. The patients were divided into endoscopic opera-tion group(n = 62)and open operation group(n = 58)according to the treatment methods. The patients in the open operation group were treated with conventional open thyroidectomy,and the patients in the endoscopic operation group were treated with endoscopic thyroidectomy. The operation time,intraoperative bleeding volume,postoperative drainage volume and hospitalization time were recorded in the two groups;and the intraoperative and postoperative complications were observed. The pain of the pa-tients in the two groups was evaluated by visual analogue scale(VAS)at the time points of 6,12 and 24 hours after operation. The cosmetic satisfaction of the patients in the two groups was evaluated by numerical scoring system(NSS)at the time points of 1 and 3 months after operation. Results The operation time and hospitalization time in the endoscopic operation group were significantly shorter than those in the open operation group(P < 0. 05),and the intraoperative bleeding volume and postopera-tive drainage volume in the endoscopic operation group were significantly lower than those in the open operation group(P <0. 05). The VAS score of pain in the endoscopic operation group was significantly lower than that in the open operation group at the time points of 6,12 and 24 hours after operation(P < 0. 05). The NSS score in the endoscopic operation group was sig-nificantly higher than that in the open operation group at the time points of 1 and 3 months after operation(P < 0. 05). The in-cidence of complications in the endoscopic operation group and the open operation group was 12. 90％(8 / 62)and 39. 66％(23 / 58)respectively,the incidence of complications in the endoscopic operation group was significantly lower than that in the open operation group(χ2 = 11. 210,P < 0. 05). Conclusion Endoscopic thyroidectomy is reliable in the treatment of benign thyroid diseases. It has the advantages of small trauma,short operation time,quick recovery,light postoperative pain,small sur-gical scar and fewer complications and so on.

Transaxillary Endoscopic Thyroidectomy versus Conventional Open Thyroidectomy for Papillary Thyroid Cancer: 5-year Surgical Outcomes / 대한내분비외과학회지

PURPOSE: The early surgical outcomes of endoscopic thyroidectomy in papillary thyroid cancer (PTC) are comparable to those of conventional open thyroidectomy; however, there is little evidence about long-term outcomes. The aim of this study was to compare the 5-year surgical outcomes of endoscopic versus open thyroidectomy. METHODS: We reviewed 804 patients with PTC who underwent thyroidectomy between October 2008 and October 2010. Of these, 703 patients received conventional open thyroidectomy (OT group) and 101patients underwent endoscopic thyroidectomy (ET group). The clinicopathologic characteristics and surgical outcomes were compared between those treatments. RESULTS: ET was applied significantly more often in young patients and females. The lobectomy and unilateral CCND were performed more frequently in ET, and the mean tumor size was smaller. The prevalence of extrathyroidal extension, multiplicity, and lymphatic invasion was more frequent in OT. The T and TNM stage were more advanced in OT, whereas the N status was similar between treatments. The mean surgical time was significantly longer for ET, while the number of retrieved lymph nodes was greater in OT. However, the stimulated thyroglobulin levels at first RAI ablation, total amount of RAI administration and 5-year recurrence rate did not significantly differ between groups. The incidence of transient hypocalcemia was significantly higher in OT, but the incidence of permanent hypocalcemia and transient/permanent recurrent laryngeal nerve injury were similar in both groups. CONCLUSION: Endoscopic thyroidectomy might be a safe and effective procedure in well-selected PTC patients

Clinical Comparative Evaluation of Open Method and Gasless or Gas Insufflation Anterior Chest Approach in Endoscopic Thyroidectomy in a Single Institution

PURPOSE: After the first endoscopic thyroidectomy by Huscher in 1997, several surgeons reported their experiences with endoscopic thyroidectomies. And these papers showed that clinical outcomes of endoscopic thyroidectomy are similar to conventional thyroidectomy. But, there was no randomized prospective trial to determine which approach of endoscopic thyroidectomy achieved better results. We evaluated clinical data of gasless and gas insufflation endoscopic thyroidectomies with conventional thyroidectomy to define its advantages or disadvantages. METHODS: Between 1999 and 2009, 1,117 patients underwent thyroidectomies (1,149 cases). 747 cases was performed by conventional open method, 402 cases by endoscopic thyroidectomy. Among them, 317 cases were operated by gasless techniques and 85 cases by carbon dioxide gas insufflation. RESULTS: Between conventional and endoscopic thyroidectomy groups, operation time, hospitalization period, tumor size, and number of retrieved lymph nodes were similar (P-value >0.05). Among 441 thyroid cancer patients, 19 had recurrence, of which 15/301 (4.98%) had conventional thyroidectomy, and 4/140 (2.85%) had endoscopic thyroidectomy. After postoperative radioactive iodine therapy, follow-up Tg levels were checked in 274 patients, the levels were <2.0 ng/ml in 87.63% (163/186) of patients after conventional thyroidectomies and in 93.18% (82/88) following endoscopic thyroidectomies. There were no significant differences (P-value=0.58). Complication incidences (hypocalcemia, hoarseness, bleeding, wound infection) in both groups were not significantly distinctive (P-value=0.58). CONCLUSION: Minimally invasive techniques are generally applied even for malignancy in selected cases because of its advantages, such as cosmetic results. Through this study, we showed similar clinical outcomes of conventional and gasless or gas insufflations endoscopic thyroidectomy.

Clinical Analysis between the Endoscopic Thyroidectomy and the Open Thyroidectomy during the Same Period

PURPOSE: We peformed endoscopic thyroidectomy and open thyroidectomy during the same period. In this study, we analyzed the result (merits and demerits) between endoscopic procedure and open procedure. METHODS: From Aug. 2003 to Aug. 2004, each procedure was performed in 92 patients. Conventional open thyroidectomy was underwent in 50 patients and endoscopic thyroidectomy was underwent in 42 patients. We performed the endoscopic thyroidectomy using breast approach. The 2 incisions, which could use 12 mm ports were placed on the areolar area of the breast as a circumferential fashion. The remaining 1 incision, which could use 5 mm port was placed on the right subclavicular area, 3~4 cm below right clavicle. We used 25 degree, a rigid laparoscope with 5 mm Hg of CO2 insufflation pressure. We also compared the results of mean ages and sex ratio, pathologic diagnosis, extent of operation, mean hospital day, mean operation time between open surgery group and endoscopic thyroidectomy group. RESULTS: We found that the mean age in the endoscopic group was younger, inversely the operation time was longer than in the open surgery group significantly (P0.05). The endoscopic group in the aspect of cosmetic was satisfactory. CONCLUSION: We could perform the endoscopic thyroidectomy safely and feasibly. The endoscopic surgery was cosmetically satisfactory. We expect it can increase the extent of surgery.

Clinical Analysis of Three Different Surgical Techniques in Unilateral Thyroid Lobectomy / 대한내분비외과학회지

PURPOSE: The conventional surgical treatment for thyroid disease requires long skin incision with skin flap that can result in prominent scar, parethesia, hypesthesia in the neck. With recent developement in surgical techniques for thyroid tumors, several apporaches have been applied to neck surgery. We performed thyroid operations with 3 different methods and evaluated the role of respective operation method. METHODS: Three different surgical methods; conventional, minimally invasive open, and endoscopic thyroidectomy with axillary approach, were performed on 60 patients who were admitted to Ajou medical center from June to December 2003. All patients were diagnosed as having a benighn mass in unilateral lobe of thyroid gland preoperatively by ultrasonography and fine needle aspiration cytology. We compared the clinical results of respective 3 operation methods each other. RESULTS: Hospital stay and the operation time for minimal invasive open thyroidectomy was significantly shorter than those for endoscopic thyroidectomy (P<0.000). Amounts of post operative analgesics were the lowest in minimal invasive open thyroidectomy than other groups (P<0.019). The patients who was treated by using endoscopic procrdure were more satisfied with the cosmetic result. There was no significant complication in three groups. CONCLUSION: Minimally invasive open thyroidectomy and endoscopic thyroidectomy can be performed safely with cosmetic benefit, and then recommanded as a alternative operative method in selected patients.