Comparative Study of Three-ports Endoscopic Thyroidectomy Versus Conventional Open Thyroidectomy in Patients with Clinical Solitary Thyroid Nodule (CSTN)

Abstract

Background and objective: Endoscopic technique have recently been applied to thyroid surgery in Udonthani Hospital. We developed three-ports endoscopic thyroidectomy by axillary approach in stead of four-ports. The aim of this study was to evaluate and compare the surgical outcomes of three-port endoscopic and conventional open thyroidectomies in patients with clinical solitary thyroid nodule (CSTN).

Methods: Retrospective study between January 2007 and December 2010 at Udonthani Hospital, 124 patients with CSTN were enrolled. Fifty-two patients underwent endoscopic thyroidectomy via the axillary approach (endo group), and 72 patients underwent conventional open thyroidectomy (open group). We analyzed the patient demographic data, the patient’s clinico-pathologic characteristics, operative and hospitalization times between the two groups. Complication such as hypocalcemia, recurrent laryngeal nerve palsy and wound complication were also evaluated. The Chi-Square test, Mann-Whitney U test and t-test were used for statistical analysis.

Results: The endo group was younger than the open group. The operative time was longer in the endo group than the open group (111.0 ± 29.3 min vs. 48.7 ± 13.0 min; P= 0.000). The mean hospitalization period was 4.53 days following endoscopic thyroidectomy and 3.15 days after open thyroidectomy. The total cost was higher in the endo group than the open group (28,593.85 ± 5,378.65 baht vs. 19,694.19 ± 3,347.42 baht; P= 0.000). We experienced complications in the endo group and open group, such as transient hypocalcemia occurred in 7.6% and 15.2% of patients, respectively. Transient recurrent laryngeal nerve paralysis occurred in 5.7% and 6.9% of patients, respectively. Seroma and hypertrophic scar occurred in 1.3% and 4.1%, respectively only in open group.

Conclusions: According to our experience, Three-ports endoscopic thyroidectomy using a trans-axillary approach was safed and feasible alternative to conventional open thyroidectomy in patients with CSTN but the disadvantage was spent more time, more cost and had statistically significant. The complications were not statistically significant but its was less than in endo group and also gave cosmetic benefit. In the nearly future if the surgeon had more skill and surgical  technique, we will develop endoscopic thyroidectomy by a trans-axillary approach in thyroid cancer group.

Key words:  Endoscopic thyroidectomy,   Conventional open thyroidectomy