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

Abstract

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/㎖ 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.