Abstract
BackgroundIn this study, we aimed to compare the kinetics of intact parathyroid hormone (iPTH) during the perioperative period of endoscopic thyroidectomy via bilateral areola approach (ETBAA) in the same period, following a traditional open thyroidectomy approach (OTA).MethodsWe conducted a prospective observational study of patients who were undergoing thyroidectomy and level VI clearance. Patients who had been affected by papillary thyroid cancer (PTC) were stratified into three groups: those eligible for endoscopic treatment (ETBAA); patients who were eligible for ETBAA but had opted for OTA (OTA-L); and patients who were not suitable for endoscopic intervention (OTA-H). A process for locating parathyroid glands was utilized to stratify gland dissection laboriousness. In Type A, the gland is firmly fixed to thyroid gland. This type can be sub-classified into three subtypes. A1: the parathyroid gland is attached to the inherent thyroid capsule. A2: the gland is partially embedded in the thyroid gland. A3: the gland is located in the thyroid tissue. Type B is defined as a gland which is separated from the thyroid gland. The iPTH was sampled at wound closure.ResultsThere were 100 patients in each group. We found a significant difference between the ETBAA and OTA-H groups for type A2, as well as a loss of parathyroid glands and a number of parathyroid transplantation procedures. The endoscopic group was treated during an earlier stage of thyroid cancer. The iPTH profile of each group decreased, although this was the most consistent in the OTA-H group. A comparison of ETBAA with OTA-L demonstrates that the iPTH level change is similar.ConclusionThere is no advantage of endoscopic treatment for preserving parathyroid function.
Highlights
This study aims to compare the kinetics of intact parathyroid hormone (iPTH) in the perioperative period of endoscopic thyroidectomy via bilateral areola approach (ETBAA) with the same period following a traditional open thyroidectomy approach (OTA)
Groups: (A) patients who were eligible for endoscopic treatment and who accepted ETBAA (ETBAA); (B) patients eligible for ETBAA yet who opted for OTA (OTA-L); (C) those cancer patients who were ineligible for endoscopic intervention who had undergone OTA (OTA-H)
Patients were stratified into three groups: those eligible for endoscopic treatment (ETBAA); patients who were eligible for ETBAA and had opted for OTA (OTA-L); and patients who were not suitable for endoscopic intervention (OTA-H). iPTH measurements for each patient were taken at preestablished points during the periods before and after surgery
Summary
We aimed to compare the kinetics of intact parathyroid hormone (iPTH) during the perioperative period of endoscopic thyroidectomy via bilateral areola approach (ETBAA) in the same period, following a traditional open thyroidectomy approach (OTA). The prevalence of hypocalcemia following thyroidectomy and central compartment lymph node dissection (CND) for papillary thyroid cancer (PTC) is high, with overall rates of 25% transient and 3% permanent [1]. This may be a result of manipulation of the parathyroid. This study aims to compare the kinetics of iPTH in the perioperative period of endoscopic thyroidectomy via bilateral areola approach (ETBAA) with the same period following a traditional open thyroidectomy approach (OTA). Limited data is available for assessing the state of the parathyroid following CND in endoscopic thyroidectomy [1,2,3,4,5,6,7,8,9,10,11].
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