A Comparative Study of Clinicopathological Profile and Surgical Outcomes of Endoscopic (Bilateral Axillo-Breast Approach) Versus Conventional Total Thyroidectomy for Thyroid Tumors

Abstract

Surgical techniques are evolving more rapidly than ever. Minimal access endocrine surgery is the latest amalgamation of technology and surgical skills. Endoscopic thyroid surgery is usually demanded by young patients to avoid neck scar. The aim of this study was to review our experience and compare outcomes of endoscopic total thyroidectomy (ETT) using bilateral axillo-breast approach (BABA) with conventional open total thyroidectomy (COT), performed during January 2015–December 2018. Patients were divided into 2 groups: group A, through ETT, and group B, through COT. A total of 40 patients underwent ETT and 121 COT. There was no difference in both group in terms of age (median 38 years in group A vs 42 years in group B; p = 0.209) and gender (M:F = 1, 12.33 in group A vs 1:8.31 in group B; p = 0.763). Mean tumor size was significantly less in group A (3.90 cm in group A and 4.55 cm in group B; p = 0.048). Forty-five percent of patients developed transient hypocalcemia in group A, and 12.5% required IV calcium, whereas in group B, 52.89% of patients developed transient hypocalcemia, and 17.36% of patient required IV calcium. There was no permanent hypocalcemia in both groups. One (2.5%) patient had permanent voice change in ETT group. Increased postoperative stay (5.18 days in group A and 4.03 days in group B; p = <0.001) and operating time (median 195 min in group A and 165 min in group B; p = <0.001) in group A. A total of 11 patients had surgery for differentiated thyroid carcinoma in group A and 29 in group B. Postoperative parameters were comparable in both groups. Endoscopic procedures can be safely applied in various thyroid disease, even in larger goiter and malignant diseases. Although operating time, drainage, and hospital stay are longer in ETT, but perioperative outcomes are comparable with open surgeries.