Abstract
BackgroundUse of the novel transoral endoscopic thyroidectomy vestibular approach (TOETVA) is increasing worldwide. Although several studies have compared safety and efficacy of TOETVA and other approaches, most focused on comparisons in the context of unilateral thyroidectomy. Therefore, the present study aimed to compare the safety and surgical completeness of TOETVA with conventional open thyroidectomy (COT) in patients with papillary thyroid carcinoma (PTC) undergoing total thyroidectomy and central neck dissection.MethodsThe medical records of patients who underwent TOETVA or COT by a single surgeon between June 2017 and October 2021 were retrospectively reviewed. All patients were diagnosed with PTC and underwent total thyroidectomy with central neck dissection. Propensity score-matching (PSM) was used to reduce potential selection bias and to adjust for differences in baseline clinicopathological characteristics.ResultsAfter PSM, 84 (TOETVA: 28; COT: 56) patients remained in the study population. There were no significant differences in sex, mean age, combined thyroiditis, tumor size, capsule invasion, tumor multifocality in the same lobe, or tumor location between the groups. Operative time was longer (190.54 ± 28.26 vs. 123.93 ± 29.78 min, P<0.001), while postoperative drainage volume (161.07 ± 225.30 vs. 71.16 ± 28.56 ml, P=0.045) was greater, in the TOETVA group than in the COT group. The groups exhibited no significant differences in the mean number of central lymph nodes retrieved (9.39 ± 4.01 vs. 10.71 ± 5.17, P=0.202), mean number of metastatic central lymph nodes (1.36 ± 1.93 vs. 1.77 ± 2.31, P=0.421), postoperative mean thyroglobulin levels (0.08 ± 0.24 vs. 0.10 ± 0.27, P=0.686), rate of transient hypoparathyroidism (TOETVA: 67.9% vs. COT: 66.1%, P=0.870), rate of transient vocal cord palsy (TOETVA: 0% vs. COT: 1.8%, P=1.000), or other complications (TOETVA: 3.6% vs. COT: 0%, P=0.333).ConclusionsTOETVA is a safe approach in select patients with PTC and exhibits similar efficacy to COT in terms of surgical completeness.
Highlights
After Propensity score-matching (PSM), 84 (TOETVA: 28; conventional open thyroidectomy (COT): 56) patients remained in the study population
Following the first transoral thyroidectomy performed by Wilhelm and Metzig in 2009 [1], Nakajo et al and Wang et al reported the first use of the transoral endoscopic thyroidectomy vestibular approach (TOETVA) in 2013 [2, 3], which is widely utilized worldwide
After PSM, 84 (n=28, TOETVA group; n=56, COT group) patients remained in the study population (Figure 1), and the two matched groups were well balanced in terms of the seven covariates
Summary
Following the first transoral thyroidectomy performed by Wilhelm and Metzig in 2009 [1], Nakajo et al and Wang et al reported the first use of the transoral endoscopic thyroidectomy vestibular approach (TOETVA) in 2013 [2, 3], which is widely utilized worldwide. Most patients in these previous studies underwent unilateral thyroidectomy, and comparative studies of total thyroidectomy and central neck dissection are lacking. In the present study, we aimed to compare the safety and surgical completeness of TOETVA with COT in patients with papillary thyroid carcinoma (PTC) who underwent total thyroidectomy and central neck dissection. Use of the novel transoral endoscopic thyroidectomy vestibular approach (TOETVA) is increasing worldwide. The present study aimed to compare the safety and surgical completeness of TOETVA with conventional open thyroidectomy (COT) in patients with papillary thyroid carcinoma (PTC) undergoing total thyroidectomy and central neck dissection
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