Comparison of Outcomes and Cosmetic Satisfaction of Bilateral Trans- Axillary Endoscopic Total Thyroidectomy versus Conventional Open Total Thyroidectomy

Abstract

Objective: The purpose of the present study was to compare the outcomes and cosmetic satisfaction achieved by bilateral trans-axillary endoscopic total thyroidectomy to those of conventional open total thyroidectomy at Rajavithi Hospital.

Methods: A retrospective study was conducted on 11 patients who underwent bilateral trans-axillary endoscopic thyroidectomy and 20 patients who had conventional total thyroidectomy between April 2013 and April 2018. Bilateral trans-axillary endoscopic thyroidectomy was performed using a four-port technique, and ultrasonic devices were used for dissection. Demographic data, weight of thyroid gland, mean operative time, blood loss, hospital stay, complications and scar satisfaction in the two groups were compared.

Results: Bilateral trans-axillary endoscopic total thyroidectomy was successfully performed in all cases without conversion to the open technique. Operative time for the endoscopic group was longer than for that for open total thyroidectomy (293 ± 58 vs 165 ± 52 minutes, p < 0.001); however, operative blood loss (124 ± 18 vs. 231 ± 19 mL, p = 0.134) and duration of hospital stay (6.5 ± 1.7 vs. 6.9 ± 1.9 days, p = 0.582) were lower for the endoscopic technique, even though these findings were not statistically significant. Scar satisfaction in all parameters, such as wound color, size and overall satisfaction were better in the endoscopic group, p = 0.001. With the open technique, transient recurrent laryngeal nerve injury was found in 1 patient (5%) and transient hypocalcemia occurred in 4 cases (25%). There were no serious complications in the bilateral trans-axillary endoscopic total thyroidectomy group.

Conclusion: Bilateral trans-axillary endoscopic thyroidectomy is an appropriate option for total thyroidectomy; however, the surgeon should be familiar with laparoscopic operations, and suitable cases should be selected for this procedure.