Comparative study on complications of endoscopic thyroidectomy <i>versus</i> conventional thyroidectomy _CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

LIU Weiwei ,  ZHOU Ming , ZHAO Ji , SUN Peng

Department of General Surgery, Shanghai Tongren Hospital, Shanghai 200336, P. R. China;

Corresponding?author：

ZHOU Ming, Email: 13651740411@126.com

Keywords：

thyroidectomy; endoscopic; complications

DOI：

10.7507/1007-9424.201708032

Video：

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Objective To explore complications of endoscopic thyroidectomy and conventional thyroidectomy and to analyze causes of them in order to reducing complications of endoscopic thyroidectomy. Methods A total of 1 112 patients with thyroid diseases from September 2008 to March 2017 in the Shanghai Tongren Hospital were collected, then were designed to endoscopic thyroidectomy group and conventional thyroidectomy group. The recurrent laryngeal nerve injury, hypoparathyroidism, postoperative bleeding, tracheoesophageal injury, poor healing of surgical wound, skin ecchymosis and subcutaneous effusion, neck discomfort, and CO₂ related complications were observed. Results ① There were 582 cases in the endoscopic thyroidectomy group and 530 cases in the conventional thyroidectomy group, the baselines such as the gender, age, most diameter of tumor, diseases type, operative mode, operative time, and intraoperative bleeding had no significant differences between the endoscopic thyroidectomy group and the conventional thyroidectomy group (P>0.05). ② All the operations were performed successfully, none of patients was converted to the open operation. The rates of the recurrent laryngeal nerve injury, hypoparathyroidism, postoperative bleeding, and tracheoesophageal injury had no significant differences in these two groups (P>0.05). The rates of the poor healing of surgical wound and neck discomfort were significantly lower and the rate of the skin ecchymosis and subcutaneous effusion was significantly higher in the endoscopic thyroidectomy group as compared with the conventional thyroidectomy group (P<0.05). There were 32 cases of CO₂ related complications in the endoscopic thyroidectomy group. Conclusion Results of this study show that endoscopic thyroidectomy is safe for thyroid diseases, it’s complications could be reduced by improving operation technique.

Citation： LIU Weiwei, ZHOU Ming, ZHAO Ji, SUN Peng. Comparative study on complications of endoscopic thyroidectomy versus conventional thyroidectomy . CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2018, 25(3): 323-327. doi: 10.7507/1007-9424.201708032 Copy

1.	仇明, 丁爾迅, 江道振, 等. 頸部無瘢痕內鏡甲狀腺切除 1 例. 中華普通外科雜志, 2002, 17(2): 127.
2.	王存川, 蘇超. 內鏡甲狀腺切除術的現狀及前景. 臨床外科雜志, 2005, 13(10): 605-606.
3.	Puntambekar S, Sharma V, Kumar S, et al. Management of large size MNGs and STNs using 3D endoscopic technique: a review of 10 cases. Indian J Surg, 2016, 78(2): 117-120.
4.	由田, 胡友主. 完全乳暈入路腔鏡甲狀腺手術后并發癥的研究進展. 腹腔鏡外科雜志, 2017, 22(4): 308-312.
5.	蘇磊, 桑劍鋒, 姚永忠, 等. 經胸乳入路腔鏡甲狀腺切除的手術技巧. 中國普外基礎與臨床雜志, 2013, 20(5): 512-516.
6.	Kandil EH, Noureldine SI, Yao L, et al. Robotic transaxillary thyroidectomy: an examination of the first one hundred cases. J Am Coll Surg, 2012, 214(4): 558-566.
7.	Park KN, Cho SH, Lee SW. Nationwide multicenter survey for current status of endoscopic thyroidectomy in Korea. Clin Exp Otorhinolaryngol, 2015, 8(2): 149-154.
8.	Choi JY, Lee KE, Chung KW, et al. Endoscopic thyroidectomy via bilateral axillo-breast approach (BABA): review of 512 cases in a single institute. Surg Endosc, 2012, 26(4): 948-955.
9.	關強, 王貴民, 王宏升. 胸骨前徑路與改良 Miccoli 腔鏡甲狀腺手術臨床研究. 中國普外基礎與臨床雜志, 2010, 17(3): 240-242.
10.	Yan H, Wang Y, Wang P, et al. " Scarless” (in the neck) endoscopic thyroidectomy (SET) with ipsilateral levels Ⅱ, Ⅲ, and Ⅳ dissection via breast approach for papillary thyroid carcinoma: a preliminary report. Surg Endosc, 2015, 29(8): 2158-2163.
11.	Dionigi G, Wu CW, Kim HY, et al. Safety of energy based devices for hemostasis in thyroid surgery. Gland Surg, 2016, 5(5): 490-494.
12.	He QQ, Zhu J, Zhuang DY, et al. Comparative study between robotic total thyroidectomy with central lymph node dissection via bilateral axillo-breast approach and conventional open procedure for papillary thyroid microcarcinoma. Chin Med J (Engl), 2016, 129(18): 2160-2166.
13.	Zhou J, Wu Z, Wang Y, et al. Endoscopic thyroidectomy for bilateral thyroid diseases: safety and effectiveness. J Craniofac Surg, 2012, 23(2): 565-570.
14.	Liao HJ, Dong C, Kong FJ, et al. The CUSUM analysis of the learning curve for endoscopic thyroidectomy by the breast approach. Surg Innov, 2014, 21(2): 221-228.
15.	Tori M. Hybrid-type endoscopic thyroidectomy (HET: Tori’s method) for differentiated thyroid carcinoma including invasion to the trachea. Surg Endosc, 2014, 28(3): 902-909.
16.	孫丕東, 沈永寬. 影像切口愈合的因素與防治措施. 中國醫學創新, 2008, 5(35): 40-41.
17.	Wang C, Feng Z, Li J, et al. Endoscopic thyroidectomy via areola approach: summary of 1 250 cases in a single institution.Surg Endosc, 2015, 29(1): 192-201.
18.	Jin X, Lu B, Cai X, et al. Total endoscopic thyroidectomy via bilateral breast and ipsilateral axillary approach: a clinical feasibility study. J Craniofac Surg, 2014, 25(3): 738-741.
19.	Park KN, Mok JO, Chung CH, et al. Does postthyroidectomy syndrome really exist following thyroidectomy? Prospective comparative analysis of open vs. endoscopic thyroidectomy. Clin Exp Otorhinolaryngol, 2015, 8(1): 76-80.
20.	Kang JB, Kim EY, Park YL, et al. A comparison of postoperative pain after conventional open thyroidectomy and single-incision, gasless, endoscopic transaxillary thyroidectomy: a single institute prospective study. Ann Surg Treat Res, 2017, 92(1): 9-14.
21.	Wang YC, Zhu JQ, Liu K, et al. Surgical outcomes comparison between endoscopic and conventional open thyroidectomy for benign thyroid nodules. J Craniofac Surg, 2015, 26(8): e714-e718.
22.	Bhargav PR, Amar V. Operative technique of endoscopic thyroidectomy: a narration of general principles.Indian J Surg, 2013, 75(3): 216-219.
23.	Youben F, Bo W, Chunlin Z, et al. Trans-areola single-site endoscopic thyroidectomy: pilot study of 35 cases. Surg Endosc, 2012, 26(4): 939-947.
24.	Duke WS, White JR, Waller JL, et al. Endoscopic thyroidectomy is safe in patients with a high body mass index. Thyroid, 2014, 24(7): 1146-1150.
25.	Zhang W, Dang C, Shan C, et al. Use of a mini-instrument in endoscopic thyroidectomy via a breast approach to improve cosmetic outcomes. Biosci Trends, 2014, 8(5): 280-285.
26.	Henry BM, Graves MJ, Vikse J, et al. The current state of intermittent intraoperative neural monitoring for prevention of recurrent laryngeal nerve injury during thyroidectomy: a PRISMA-compliant systematic review of overlapping meta-analyses. Langenbecks Arch Surg, 2017, 402(4): 663-673.
27.	Chang EHE, Kim HY, Koh YW, et al. Overview of robotic thyroidectomy. Gland Surg, 2017, 6(3): 218-228.

1. 仇明, 丁爾迅, 江道振, 等. 頸部無瘢痕內鏡甲狀腺切除 1 例. 中華普通外科雜志, 2002, 17(2): 127.
2. 王存川, 蘇超. 內鏡甲狀腺切除術的現狀及前景. 臨床外科雜志, 2005, 13(10): 605-606.
3. Puntambekar S, Sharma V, Kumar S, et al. Management of large size MNGs and STNs using 3D endoscopic technique: a review of 10 cases. Indian J Surg, 2016, 78(2): 117-120.
4. 由田, 胡友主. 完全乳暈入路腔鏡甲狀腺手術后并發癥的研究進展. 腹腔鏡外科雜志, 2017, 22(4): 308-312.
5. 蘇磊, 桑劍鋒, 姚永忠, 等. 經胸乳入路腔鏡甲狀腺切除的手術技巧. 中國普外基礎與臨床雜志, 2013, 20(5): 512-516.
6. Kandil EH, Noureldine SI, Yao L, et al. Robotic transaxillary thyroidectomy: an examination of the first one hundred cases. J Am Coll Surg, 2012, 214(4): 558-566.
7. Park KN, Cho SH, Lee SW. Nationwide multicenter survey for current status of endoscopic thyroidectomy in Korea. Clin Exp Otorhinolaryngol, 2015, 8(2): 149-154.
8. Choi JY, Lee KE, Chung KW, et al. Endoscopic thyroidectomy via bilateral axillo-breast approach (BABA): review of 512 cases in a single institute. Surg Endosc, 2012, 26(4): 948-955.
9. 關強, 王貴民, 王宏升. 胸骨前徑路與改良 Miccoli 腔鏡甲狀腺手術臨床研究. 中國普外基礎與臨床雜志, 2010, 17(3): 240-242.
10. Yan H, Wang Y, Wang P, et al. " Scarless” (in the neck) endoscopic thyroidectomy (SET) with ipsilateral levels Ⅱ, Ⅲ, and Ⅳ dissection via breast approach for papillary thyroid carcinoma: a preliminary report. Surg Endosc, 2015, 29(8): 2158-2163.
11. Dionigi G, Wu CW, Kim HY, et al. Safety of energy based devices for hemostasis in thyroid surgery. Gland Surg, 2016, 5(5): 490-494.
12. He QQ, Zhu J, Zhuang DY, et al. Comparative study between robotic total thyroidectomy with central lymph node dissection via bilateral axillo-breast approach and conventional open procedure for papillary thyroid microcarcinoma. Chin Med J (Engl), 2016, 129(18): 2160-2166.
13. Zhou J, Wu Z, Wang Y, et al. Endoscopic thyroidectomy for bilateral thyroid diseases: safety and effectiveness. J Craniofac Surg, 2012, 23(2): 565-570.
14. Liao HJ, Dong C, Kong FJ, et al. The CUSUM analysis of the learning curve for endoscopic thyroidectomy by the breast approach. Surg Innov, 2014, 21(2): 221-228.
15. Tori M. Hybrid-type endoscopic thyroidectomy (HET: Tori’s method) for differentiated thyroid carcinoma including invasion to the trachea. Surg Endosc, 2014, 28(3): 902-909.
16. 孫丕東, 沈永寬. 影像切口愈合的因素與防治措施. 中國醫學創新, 2008, 5(35): 40-41.
17. Wang C, Feng Z, Li J, et al. Endoscopic thyroidectomy via areola approach: summary of 1 250 cases in a single institution.Surg Endosc, 2015, 29(1): 192-201.
18. Jin X, Lu B, Cai X, et al. Total endoscopic thyroidectomy via bilateral breast and ipsilateral axillary approach: a clinical feasibility study. J Craniofac Surg, 2014, 25(3): 738-741.
19. Park KN, Mok JO, Chung CH, et al. Does postthyroidectomy syndrome really exist following thyroidectomy? Prospective comparative analysis of open vs. endoscopic thyroidectomy. Clin Exp Otorhinolaryngol, 2015, 8(1): 76-80.
20. Kang JB, Kim EY, Park YL, et al. A comparison of postoperative pain after conventional open thyroidectomy and single-incision, gasless, endoscopic transaxillary thyroidectomy: a single institute prospective study. Ann Surg Treat Res, 2017, 92(1): 9-14.
21. Wang YC, Zhu JQ, Liu K, et al. Surgical outcomes comparison between endoscopic and conventional open thyroidectomy for benign thyroid nodules. J Craniofac Surg, 2015, 26(8): e714-e718.
22. Bhargav PR, Amar V. Operative technique of endoscopic thyroidectomy: a narration of general principles.Indian J Surg, 2013, 75(3): 216-219.
23. Youben F, Bo W, Chunlin Z, et al. Trans-areola single-site endoscopic thyroidectomy: pilot study of 35 cases. Surg Endosc, 2012, 26(4): 939-947.
24. Duke WS, White JR, Waller JL, et al. Endoscopic thyroidectomy is safe in patients with a high body mass index. Thyroid, 2014, 24(7): 1146-1150.
25. Zhang W, Dang C, Shan C, et al. Use of a mini-instrument in endoscopic thyroidectomy via a breast approach to improve cosmetic outcomes. Biosci Trends, 2014, 8(5): 280-285.
26. Henry BM, Graves MJ, Vikse J, et al. The current state of intermittent intraoperative neural monitoring for prevention of recurrent laryngeal nerve injury during thyroidectomy: a PRISMA-compliant systematic review of overlapping meta-analyses. Langenbecks Arch Surg, 2017, 402(4): 663-673.
27. Chang EHE, Kim HY, Koh YW, et al. Overview of robotic thyroidectomy. Gland Surg, 2017, 6(3): 218-228.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Comparative study on complications of endoscopic thyroidectomy versus conventional thyroidectomy

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