The Effect of Adjustment of Endotracheal Tube Cuff Pressure during Scarless Remote Access Endoscopic and Robotic Thyroidectomy on Laryngo-Pharyngeal Complications: Prospective Randomized and Controlled Trial.

Chang-Hoon Koo,June-Yong Choi,Eun-Su Choi,Young-Tae Jeon,Ah-Young Oh,Jung-Hee Ryu,Hye-Min Sohn

doi:10.3390/jcm8111787

Abstract

Scarless remote access endoscopic and robotic thyroidectomy has been recently performed as a safe and feasible method. However, little is known about the laryngo-pharyngeal complications after surgery and the effect of adjusting the endotracheal tube cuff pressure during surgery on laryngo-pharyngeal complications. Patients were randomized into two groups: the control group (n = 52) and adjusted group (n = 52). The initial cuff pressure was set to 25 mmHg and then monitored without adjustment (control group) or with adjustment at approximately 25 mmHg (adjusted group) throughout surgery. The incidences and severity of postoperative sore throat (POST), hoarseness, dysphagia, and cough were recorded at 1, 6, 24, and 48 h after surgery. Cuff pressures of the control group changed significantly over time and were higher than those of the adjusted group. The incidence of POST was lower in the adjusted group at 24 h postoperatively (p = 0.035), and there was a significant difference in the severity of POST at 6 and 24 h postoperatively between the two groups. There were no differences in the incidence of hoarseness, dysphagia, and cough between the two groups, except dysphagia and cough at 6 h postoperatively. Therefore, intraoperative monitoring and adjustment of the cuff pressure can reduce the incidence of laryngo-pharyngeal complications.

Highlights

Invasive techniques have been frequently used for thyroidectomy since their remote approach provides cosmetic benefit [1,2]
To the best of our knowledge, this is the first randomized clinical trial evaluating the effect of adjustment of endotracheal cuff pressures on postoperative laryngo-pharyngeal complications after Scarless remote access endoscopic and robotic thyroidectomy (SERT)
The results of this present study suggest that the adjustment of endotracheal cuff pressure during surgery decreased the incidence of laryngo-pharyngeal complications, such as postoperative sore throat (POST) and cough, after surgery

Summary

Introduction

Invasive techniques have been frequently used for thyroidectomy since their remote approach provides cosmetic benefit [1,2]. Laryngo-pharyngeal complications, including postoperative sore throat (POST), hoarseness, dysphagia, and cough, are common [3]. These complications can lead to distress, degrading the quality of life of patients during recovery and, the prevention and evaluation of these symptoms are required to enhance the quality of recovery and patient satisfaction. Scarless remote access endoscopic and robotic thyroidectomy (SERT) has been developed recently to minimize neck incisions and to offer great cosmetic satisfaction, but little is known about the laryngo-pharyngeal complications after SERT

Methods

Results

Discussion

Conclusion