Breast approach endoscopic thyroidectomy versus conventional thyroidectomy:A comparison study / 中国微创外科杂志

ABSTRACT

Objective To compare the clinical efficacy between endoscopic thyroidectomy via breast approach and conventional open thyroidectomy in patients with nodular goiter.Methods A series of 75 patients with unilateral nodular goiter was divided into two groups,either receiving endoscopic thyroidectomy through breast approach(Endoscopic Group,24 cases)or conventional open thyroidectomy(Open Group,51 cases).The therapeutic efficacy was compared between the two groups.Results In the Endoscopic Group,the endoscopic operation was successfully performed in 23 cases,whereas a conversion to open surgery was needed in 1 case because of large nodule(6 cm in diameter)and extensive adhesion of infrahyoid muscles(resulted from a previous injection therapy).The operating time was significantly longer in the Endoscopic Group(100.4?26.6 min)than in the Open Group(73.5?14.5 min)(t=5.627;P=0.000).The postoperative drainage volume in the Endoscopic Group(66.7?24.9 ml)was significantly more than that in the Open Group(13.3?6.4 ml)(t=14.403,P=0.000).The postoperative hospital stay was significantly longer in the Endoscopic Group(4.3?1.1 d)than in the Open Group(3.6?0.9 d)(t=2.886;P=0.005).The Endoscopic Group had significant higher hospital costs(11 572?1675.1 yuan)than the Open Group(5015.9?1211.0 yuan)(t=19.058;P=0.000).And a satisfactory cosmetic result was achieved in significantly more patients in the Endoscopic Group(22/24 cases)than in the Open Group(34/51 cases)(?2=7.235;P=0.007).There was no significant difference in intraoperative blood loss between the Endoscopic Group(22.5?15.3 ml)and the Open Group(18.3?7.5 ml)(t=1.273;P=0.207),and in consumption of analgesics between the Endoscopic Group(9/24 cases)and the Open Group(21/51 cases)(?2=0.028;P=0.867),respectively.No severe complications were encountered,such as massive hemorrhage,injuries of the recurrent or superior laryngeal nerve,or parathyroid gland injury.During a follow-up for 6 months,none of the patients was found recurrence after surgery.Conclusions Both breast approach endoscopic thyroidectomy and conventional open thyroidectomy are safe and effective.The former gives better cosmetic outcomes but slower recovery and high hospital costs compared to the latter.