Comparison of transoral vestibular and chest-breast endoscopic thyroidectomy for papillary thyroid carcinoma

Abstract

Abstract Background Transoral endoscopic thyroidectomy with the vestibular approach (TOETVA) and endoscopic total thyroidectomy with the thoracoabdominal approach (ETCB) are common procedures for endoscopic thyroidectomy. We investigated the efficacies of these two approaches for treating papillary thyroid carcinoma (PTC) in terms of safety, trauma, and feasibility of central neck dissection (CND). Methods TOETVA (n = 298) and ETCB (n = 202) patients were retrospectively evaluated. All patients were pathologically diagnosed with PTC and underwent CND. Surgical time and postoperative drainage, drainage time, drainage tube removaltime, hospital stay, leukocyte count, and neutrophil percentage (NEUT%) were determined. Moreover, the parathyroid gland, parathyroid lesions, recurrent laryngeal nerve lesions, total number of central lymph nodes, and metastatic central nodes were analyzed. Results Baseline characteristics of both groups were similar, except for patient age and thyroid capsule invasion. Despite a significant difference between the two groups in terms of transient recurrent nerve injury (P< 0.05), no significant differences were noted in surgical time, blood loss, postoperative blood loss, postoperative drainage volume, postoperative drainage tube removal time, postoperative leukocyte count, postoperative NEUT%, and postoperative hospital stay (P > 0.05). The percentages of patients with parathyroid disorders and permanent recurrent laryngeal neuropathy were comparable (P > 0.05); however, more lymph nodes were recovered via lobectomy with CND in TOETVA than in ETCB groups (P < 0.05). The number of lymph nodes on either side of the central area was not significantly different. Conclusion TOETVA and ETCB are safe treatments for PTC. TOETVA is superior in terms of lymph node dissection, with less prominent postoperative scarring. TOETVA is safer for CND owing to the lower incidence of recurrent laryngeal nerve injury.