The Improved Techniques of Holding the Lens in Endoscopic Thyroidectomy via Bilateral Areola Approach

Background: Inexperienced endoscope holder often greatly affect the time and quality of endoscopic thyroidectomy (ET) via bilateral areola approach. We summarized some techniques of holding the endoscopic lens to evaluate the value of the technique in ET.Methods: We retrospectively enrolled 200 eligible patients during two time peroids: 2015.6-2018.6 (Control group:inexperienced endoscope holder,n = 100) and 2019.9-2021.2 (Improved group:assistants who master the techniques of holding the endoscopic lens,n = 100). Surgery approach:unilateral lobectomy and isthmus resection plus ipsilateral cervical central lymph nodes dissection via bilateral areola approach of ET. Perioperative indicators included Volume of intraoperative blood loss,the time of three stages in the operation, the indwelling time of drainage tube and postoperative hospitalization time were compared. Postoperative complications were simultaneously compared involved temporary hoarseness, tetany, postoperative bleeding, postoperative infection and postoperative subcutaneous effusion.Results: The time of stage 1 (p < 0.001), stage 2 (p < 0.001) and stage 3 (p < 0.001) in the operation in improved group were significantly shorter than those in control group. The volume of intraoperative blood loss was smaller (p < 0.001), postoperative hospitalization time was shorter (p < 0.001) and the indwelling time of drainage tube was shorter (p < 0.001) for improved group. In terms of postoperative complications, the control group had more cases of temporary hoarseness (p = 0.002), tetany (p = 0.008) and postprocedure subcutaneous effusion (p = 0.009), but there was no difference in postoperative bleeding (p = 0.477) and infection (p = 1.000) between the two groups.Conclusions: The skills of holding the endoscopic lens which shorten the operation time and improve the quality of the operation are effective and suitable for novices.

Comparing quality of life between patients undergoing trans-areola endoscopic thyroid surgery and trans-oral endoscopic thyroid surgery

Background Compared with conventional open surgery, endoscopic thyroidectomy via the oral vestibular approach (ETVOA) and endoscopic thyroidectomy via the areola approach (ETAA) avoided scarring of the skin, which may help patients achieve a better quality of life (QOL). However, the benefit of the QOL from this technique has not been adequately investigated, therefore this study compared the QOL outcomes between ETVOA and ETAA. Methods 131 patients were enrolled in this study. ETAA surgery and ETVOA surgery were performed in 74 patients and 57 patients, respectively. These patients were followed up at 2 weeks, 4 weeks, and 8 weeks, and their QOL was evaluated using a thyroid surgery-specific questionnaire and a short-form health survey (SF-36). Results There were no differences in clinical characteristics such as gender, age, body mass index (BMI), and tumor size between the two groups. The volume of intraoperative blood loss, cost of hospitalization, and complications between the two procedures showed no differences. Compared with ETAA, ETVOA has a longer operation time, no drainage, and shorter hospital stay. In the QOL questionnaire, several parameters in ETVOA were better. The satisfaction scores of patients undergoing ETVOA were higher. In addition, the cosmetic satisfaction in patients who received ETOVA was significantly better than that of patients who underwent ETAA. The degree of neck movement disorder in patients with ETVOA was milder. Patients who received ETVOA had higher score on the SF-36. Conclusions The trans-oral endoscopic approach can acquire better cosmetic results and achieved high-level QOL.

Trans-Oral Endoscopic Thyroid Surgery and Trans-Areola Endoscopic Thyroid Surgery: Which Offers A Better Quality of Life?

Background: Endoscopic thyroidectomy via the oral vestibular approach (ETVOA) and endoscopic thyroidectomy via the areola approach (ETAA) are becoming more favored in China. Compared with conventional open surgery, both methods avoid the scarring on the neck, but only ETVOA obviates scarring of the skin, which may helps patients achieve a better quality of life (QOL). However, the benefit of the QOL from this technique has not been adequately investigated, therefore this study compared the QOL outcomes between ETVOA and ETAA. Methods: We enrolled 131 patients in this study. ETAA surgery and ETVOA surgery were performed in 74 patients and 57 patients, respectively. These patients were followed up at 2 weeks, 4 weeks, and 8 weeks, and their QOL was evaluated using a thyroid surgery-specific questionnaire and a short-form health survey (SF-36). Results: There were no differences in clinical characteristics such as gender, age, body mass index (BMI), and tumor size between the two groups. The volume of intraoperative blood loss, cost of hospitalization, and complications between the two procedures showed no differences. Compared with ETAA, ETVOA has a longer operation time, no drainage, and shorter hospital stay. In the QOL questionnaire, several parameters in ETVOA were better. The satisfaction scores of patients undergoing ETVOA were higher. In addition, the cosmetic satisfaction in patients who received ETOVA was significantly better than that of patients who underwent ETAA. The degree of neck movement disorder in patients with ETVOA was milder. Patients who received ETVOA had higher score on the SF-36. Conclusions: Compared with ETAA, ETVOA can acquire better cosmetic results and make patients quick return to normal life.Patients who underwent ETVOA achieved high-level QOL.