Background: Endoscopic thyroidectomy for minimally invasive thyroid surgery has been widely applied in the past decade. The present study aimed to evaluate the effects of single-port access transaxillary totally endoscopic thyroidectomy on the postoperative outcomes and functional parameters, including quality of life and cosmetic result in patients with papillary thyroid carcinoma (PTC).
Patients and methods: Seventy-five patients with PTC who underwent endoscopic thyroidectomy via a single-port access transaxillary approach were included (experimental group). A total of 123 patients with PTC who were subjected to conventional open total thyroidectomy served as the control group. The health-related quality of life and cosmetic and satisfaction outcomes were assessed postoperatively.
Results: The mean operation time was significantly increased in the experimental group. The physiological functions and social functions in the two groups were remarkably augmented after 6 months of surgery. However, there was no significant difference in the scores of speech and taste between the two groups at the indicated time of 1 month and 6 months. In addition, the scores for appearance, satisfaction with appearance, role-physical, bodily pain, and general health in the experimental group were better than those in the control group at 1 month and 6 months after surgery.
Conclusion: The single-port access transaxillary totally endoscopic thyroidectomy is safe and feasible for the treatment of patients with PTC. The subjects who underwent this technique have a good perception of their general state of health and are likely to participate in social activities. It is worthy of being clinically used for patients with PTC.
Keywords: total thyroidectomy, transaxillary approach, papillary thyroid carcinoma, quality of life
Papillary thyroid carcinoma (PTC) is the most common malignancy of the endocrine system, accounting for ~80% of all thyroid malignancies.1 PTC is ranked the fifth leading malignancy in females and has a favorable prognosis in most cases.2 Conventional open thyroidectomy has been exercised worldwide for the treatment of endocrine neck surgery with low morbidity and mortality.3 The first endoscopic thyroidectomy was conducted by Huscher et al4 in 1997. With the improvement in minimally invasive surgery, various types of endoscopic thyroidectomy evolved considerably over the past 20 years. The newly developed endoscopic thyroidectomy has been demonstrated to achieve good results and advantages.5,6 The emergence of endoscopic thyroidectomy technologies provides a promising approach for the treatment of neck diseases. The recently identified endoscopic operative methods, such as axillary,7 breast,8 and anterior chest approaches,9 were successfully applied to thyroidectomy by many surgeons. The endoscopic thyroid surgery was initially appropriate only for benign thyroid diseases; owing to this, a complete thyroidectomy is not sufficiently conducted via endoscopic methods. However, there are several reasons for the clinical applications of endoscopic thyroidectomy: 1) the PTC has a relatively good prognosis;10 2) popularity of endoscopic thyroidectomy with reduced neck scarring and increased cosmetic effect; 3) enhancing cosmetic demand in more females; and 4) the introduction of transaxillary or axillary-breast gasless approach.11 The totally endoscopic thyroidectomy is gradually developed in thyroid malignancies. The indications for endoscopic thyroidectomy for the treatment of thyroid malignancies are increasingly expanding with the improvement in the techniques. As the experience of single-port access laparoscopic surgery is accumulating, it has been served as a less-invasive alternative to conventional laparoscopy. An increasing attention has been paid to the postoperative symptoms and functional outcomes in minimally invasive endoscopic thyroidectomy. The present study was conducted to assess the effects of single-port access transaxillary totally endoscopic thyroidectomy on the postoperative outcomes and functional parameters, including quality of life (QOL) and cosmetic result, in patients with PTC.