Total Endoscopic Thyroidectomy: A Comparison of the Trans-Axilloareolar and the Trans-Thoracoareolar Approaches

Abstract

Background and objective: Endoscopic thyroidectomy making  the scar outside the  neck area has a cosmetic appeal for patient. We have developed endoscopic thyroidectomy  procedures  using  the trans-axilloareolar and the trans-thoracoareolar approaches in Udonthani hospital. The objective of this study was to evaluate and compare the surgical outcomes of endoscopic thyroidectomy between the trans-axilloareolar and the trans-thoracoareolar approaches in patients with clinical thyroid nodule.

Methods: Of the 87 patients  enrolled from January 2008 to December 2011 in this retrospective study, 52 underwent endoscopic thyroidectomy via the trans-axilloareolar approach (A-A group); 35 underwent endoscopic thyroidectomy via the trans- thoracoareolar approach (T-A group). Demographic data, clinico-pathologic characteristics, operative and hospitalization times between the two groups were analyzed. Complication such as hypocalcemia, recurrent laryngeal nerve palsy and wound complication were also evaluated. The Pearson Chi-Square test, Mann-Whitney U test, Student’s t-test and Fisher’s exact test were used for statistical analysis.

Results: The A-A group was older than the T-A group (39.9±11.4  vs 37.0±10.4 yrs, p=0.234). The size of thyroid nodule in the A-A group was smaller than the T-A group (3.6±0.9 vs 4.4±1.2 cm., p=0.002). Estimated blood loss in the A-A group was less than in the T-A group (36.0±22.0 vs 69.4±86.2 cc, p=0.175).  The operative time was shorter in the A-A group than the T-A group (100.5±30.2 vs 104.6±34.8 min, p=0.562). The mean hospitalization duration in the A-A group was longer than the T-A group (4.2±2.1 vs 4.1±1.0  days,  p=0.534). The total charged cost was higher in the A-A group than the T-A group (25,735.3±6,340.9 baht  vs. 23,876.8±3,434.2 baht, p=0.357). Most thyroid nodules were of  nodular goiter type. The complications in the A-A group and T-A group, such as transient recurrent laryngeal nerve paralysis, occurred in 23.1% and 11.4% of patients, respectively, (p=0.169). Transient hypocalcemia occurred in 5.8% and 5.7% of patients, respectively, (p=1.000). Hypertrophic scar occurred 5.7% in the T-A group. There were no conversion to open surgery.

Conclusion: Endoscopic thyroidectomy via trans-axilloareolar and trans-thoracoareolar approaches are safe and gives favorable cosmetic results. There were no significant differences in operative time,  mean hospitalization duration, total cost, estimated blood loss and complications between the two groups.