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Li X, Ding W, Zhang H. Surgical outcomes of endoscopic thyroidectomy approaches for thyroid cancer: a systematic review and network meta-analysis. Front Endocrinol (Lausanne) 2023; 14:1256209. [PMID: 38111707 PMCID: PMC10726028 DOI: 10.3389/fendo.2023.1256209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 11/01/2023] [Indexed: 12/20/2023] Open
Abstract
Objectives This network meta-analysis assesses the outcomes of seven endoscopic approaches, offering valuable insights for researchers and practitioners in choosing the best method for thyroid cancer patients. Methods A systematic literature search was conducted in the PubMed, Embase and Web of Science databases up to March 2023. The analysis included seven endoscopic approaches, with a focus on their respective outcomes through network meta-analysis. Results This meta-analysis included 44 studies involving 8,672 patients. The axillo-bilateral breast approach (ABBA) and unilateral axillo-breast approach (UABA) showed advantages in terms of reduced operative time compared to other approaches (MD = 19.66 minutes, 95% CI = -31.66 to 70.98; MD = 30.32 minutes, 95% CI = -1.45 to 62.09, respectively). The UABA and anterior chest approach (ACA) exhibited superiority in controlling intraoperative bleeding (MD = -3.37 mL, 95% CI = -22.58 to 15.85; MD = -13.77 mL, 95% CI = -28.85 1.31, respectively). UABA and ACA also showed advantages in reducing hospital stays (MD = -0.39 days, 95% CI = -1.48 to 0.71; MD = -0.26 days, 95% CI = -1.33 to 0.81, respectively). The transoral approach (OA) yielded results comparable to those of conventional open thyroidectomy (COT) and outperformed other endoscopic surgeries with regards to lymph node retrieval and metastatic lymph node assessment. For the stimulated serum thyroglobulin (TG) levels, no significant difference was observed between bilateral axillo-breast approach (BABA) and OA compared to COT. However, chest-breast approach (CBA) showed significantly lower levels than COT (MD=-0.40 ng/ml, 95% CI =-0.72 to -0.09). Patients in the gasless unilateral transaxillary approach (GUA) group experienced a significant improvement in cosmetic satisfaction (MD=-2.08, 95% CI =-3.35 to -0.82). Importantly, no significant difference was observed in the incidence of surgical complications between endoscopic thyroidectomy and COT. Conclusion Endoscopic thyroid surgery is a safe and effective choice for thyroid cancer patients. Different approaches have their advantages, allowing personalized selection based on the patient's needs. ABBA and UABA have shorter operative times, while UABA and ACA excel at controlling bleeding and shortening hospital stays. OA shows promise for lymph node assessment. These findings contribute to the growing evidence supporting endoscopic methods, expanding treatment options for thyroid cancer patients.
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Affiliation(s)
| | | | - Hong Zhang
- Department of Thyroid Surgery, The Second Hospital of Jilin University, Changchun, Jilin, China
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Chen W, Xie R, Zhang S, Zhou T, Xiong C, Huang D, Yu J, Zhong M. Clinical efficacy of gasless submental-transoral endoscopic thyroidectomy with Kirschner wire suspension for papillary thyroid carcinoma. Am J Transl Res 2023; 15:5110-5119. [PMID: 37692964 PMCID: PMC10492077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 07/24/2023] [Indexed: 09/12/2023]
Abstract
PURPOSE To analyze the clinical efficacy of gasless submental-transoral endoscopic thyroidectomy (ETE) with Kirschner wire suspension in patients with papillary thyroid carcinoma (PTC). METHODS Retrospectively, we enrolled 112 patients with PTC who received treatment in The Second Affiliated Hospital of Nanchang University between December 2020 and December 2021. Among them, 60 cases (laparoscopic group) received gasless submental-transoral ETE with Kirschner wire suspension, and the other 52 cases (open group) were treated by traditional thyroidectomy. Surgical indicators (operative time (OT), intraoperative blood loss (IBL), and postoperative drainage volume (DV)), number of central lymph node (CLN) dissected, length of hospital stay (LOS), Visual Analogue Scale (VAS) score, aesthetic satisfaction score, and complications were observed and compared between the two groups. RESULTS There was no significant difference between the two groups in OT (55.73±5.49 min vs. 55.00±7.79 min), IBL (20.67±7.75 mL vs. 23.08±6.24 mL), postoperative DV (33.17±15.09 mL vs. 39.52±19.22 mL), number of CLN dissected (5.54±2.75 vs. 5.43±3.15), LOS (3.63±0.69 d vs. 3.68±0.57 d), postoperative VAS score (3.19±1.07 points vs. 3.38±1.09 points), and total complication rate (3.85% vs. 8.33%; all P>0.05). However, the laparoscopic group exhibited a significantly higher aesthetic satisfaction score than the open group (7.10±1.46 points vs. 6.42±1.46 points; P<0.05). In addition, patients in both groups were followed up for at least 3 months, and no recurrence or metastasis was observed. CONCLUSIONS Gasless submental-transoral ETE with Kirschner wire suspension offers comparable curative effect as traditional thyroidectomy and safety, but it provides superior esthetic results, making it a viable treatment option for patients with PTC.
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Affiliation(s)
- Wanzhi Chen
- Department of Thyroid Surgery, The Second Affiliated Hospital of Nanchang UniversityNanchang 330006, Jiangxi, P. R. China
| | - Rong Xie
- Department of Thyroid Surgery, The Second Affiliated Hospital of Nanchang UniversityNanchang 330006, Jiangxi, P. R. China
| | - Shuyong Zhang
- Department of Thyroid Surgery, The Second Affiliated Hospital of Nanchang UniversityNanchang 330006, Jiangxi, P. R. China
| | - Tao Zhou
- Department of Thyroid Surgery, The Second Affiliated Hospital of Nanchang UniversityNanchang 330006, Jiangxi, P. R. China
| | - Chengfeng Xiong
- Department of Thyroid Surgery, The Second Affiliated Hospital of Nanchang UniversityNanchang 330006, Jiangxi, P. R. China
| | - Da Huang
- Department of Thyroid Surgery, The Second Affiliated Hospital of Nanchang UniversityNanchang 330006, Jiangxi, P. R. China
| | - Jichun Yu
- Department of Thyroid Surgery, The Second Affiliated Hospital of Nanchang UniversityNanchang 330006, Jiangxi, P. R. China
| | - Meijun Zhong
- The Second Affiliated Hospital of Nanchang UniversityNanchang 330006, Jiangxi, P. R. China
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Li J, Guo B, Wu B, Kang J, Deng X, Fan Y. Clinical efficacy and inflammatory reaction of submental endoscopic thyroidectomy versus conventional thyroidectomy: A prospective randomized study. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:1381-1386. [PMID: 37246091 DOI: 10.1016/j.ejso.2023.03.219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 03/03/2023] [Accepted: 03/16/2023] [Indexed: 05/30/2023]
Abstract
OBJECTIVES This prospective study aimed to explore the clinical efficacy and inflammatory reaction of submental endoscopic thyroidectomy versus conventional thyroidectomy. METHODS We prospectively recruited 45 patients (total 90 patients) who met the eligibility criteria to undergo conventional open thyroidectomy or submental endoscopic thyroidectomy from January 2021 to July 2022 in the Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine. These patients were evaluated using the following indices: number of lymph nodes dissected, complications, pain severity, inflammatory indicators, cosmetic satisfaction, and economic cost. All data were analyzed by the t-test or chi-squared test. RESULTS Ninety patients were enrolled. The two groups did not significantly differ regarding baseline characteristics. All patients who underwent thyroidectomy had a similar trauma index and increased level of inflammation. There were no significant differences between the open thyroidectomy and submental endoscopic thyroidectomy groups in the total number of lymph nodes dissected, number of positive lymph nodes, drainage volume, and complications. The Vancouver scar score and cosmetic satisfaction score were significantly better in the submental endoscopic thyroidectomy group than the open thyroidectomy group. The submental endoscopic thyroidectomy group had a significantly lower pain scores on postoperative days 1 and 2, less downtime, and cheaper medical and esthetic costs than the open thyroidectomy group. CONCLUSION Compared with conventional open thyroidectomy, submental endoscopic thyroidectomy did not increase the degree of trauma, had superior clinical efficacy, caused less pain, required a shorter downtime, achieved a better cosmetic effect, and was associated with lower healthcare costs.
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Affiliation(s)
- Jiamin Li
- Department of General Surgery, Thyroid and Parathyroid Center, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, China
| | - Bomin Guo
- Department of General Surgery, Thyroid and Parathyroid Center, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, China
| | - Bo Wu
- Department of General Surgery, Thyroid and Parathyroid Center, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, China.
| | - Jie Kang
- Department of General Surgery, Thyroid and Parathyroid Center, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, China
| | - Xianzhao Deng
- Department of General Surgery, Thyroid and Parathyroid Center, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, China
| | - Youben Fan
- Department of General Surgery, Thyroid and Parathyroid Center, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, China
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Jiang J, He G, Chu J, Li J, Lu X, Jiang X, Xie L, Gao L, Zhang D. Gasless submental-transoral combined approach endoscopic thyroidectomy: a new surgical technique. Front Oncol 2023; 13:1115927. [PMID: 37324008 PMCID: PMC10264817 DOI: 10.3389/fonc.2023.1115927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 04/20/2023] [Indexed: 06/17/2023] Open
Abstract
Background The development of transoral endoscopic vestibular approach thyroidectomy (TOETVA) has been limited by inherent defects, such as mental nerve injury and carbon dioxide (CO2)-related complications. Herein, we proposed a new technique without CO2 called gasless submental-transoral combined approach endoscopic thyroidectomy (STET) to solve the problems in TOETVA. Methods We reviewed 75 patients who successfully underwent gasless STET using novel instruments at our institution from November 2020 to November 2021. A main incision of approximately 2 cm was made in the natural submental crease line and then combined with two vestibule incisions to complete the procedure. Demographic data, surgical technique and perioperative outcomes were retrospectively recorded. Results Thirteen male and sixty-two female patients with a mean age of 34.0 ± 8.1 years were enrolled in this study. Sixty-eight patients had papillary thyroid carcinomas and seven had benign nodules. We successfully performed all gasless STET without conversion to open surgery. The average postoperative hospital stay was 4.2 ± 1.8 days. One transient recurrent laryngeal nerve injury and two transient hypoparathyroidisms were observed. Three patients complained of slight lower lip numbness on the first postoperative day. One case of lymphatic fistula, subcutaneous effusion, and incision swelling occurred each, all of which were conservatively cured. One patient developed a recurrence six months after surgery. Conclusions Gasless STET using our own designed suspension system is technically safe and feasible with reasonable operative and oncologic results.
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Chen H, Deng L, Xu K, Gong Z, Zhu X. Clinical application of transoral and submental thyroidectomy (TOaST): a series of 54 human cases. Langenbecks Arch Surg 2022; 407:3039-3044. [PMID: 36031657 PMCID: PMC9640426 DOI: 10.1007/s00423-022-02663-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 08/21/2022] [Indexed: 11/30/2022]
Abstract
Objective A new endoscopic thyroidectomy approach—transoral and submental endoscopic thyroidectomy (TOaST)—was applied in clinical practice and considered an improved approach for endoscopic thyroid surgery via the oral approach. This paper discusses the feasibility and effectiveness of this surgical method. Methods A retrospective analysis was performed on the clinical data of 54 patients who had undergone TOaST in the thyroid disease center of the First Affiliated Hospital of Nanchang University between December 2020 and December 2021. The surgical data and techniques, complications, and cosmetic outcomes of these patients were studied. Results Among the total 54 patients, 23 underwent unilateral subtotal thyroidectomy, 3 patients underwent bilateral subtotal thyroidectomy, 27 with unilateral thyroid cancer underwent affected thyroid + isthmus + central lymph node resection, and only 1 patient underwent total thyroidectomy. The mean operative time was 88.06 ± 12.03 min (range: 65–135 min), the mean intraoperative blood loss was 8.61 ± 4.60 ml (range: 5–20 ml), the mean postoperative drainage volume was 49.96 ± 9.88 ml (range: 30–60 ml), the mean drainage time was 36.61 ± 2.65 h (range: 32–50 h), and the mean length of hospital stay was 46.63 ± 3.28 h (range 45–70 h). One patient experienced transient recurrent laryngeal nerve injury, and another patient experienced transient parathyroid dysfunction; there was no superior laryngeal nerve injury and other complications, such as postoperative subcutaneous hematoma, hypercapnia, mental nerve injury, tracheoesophageal injury, infection, or lymphatic leakage. Conclusion TOaST cannot only achieve a good therapeutic effect but also avoid mental nerve injury, reduce the discomfort of the patient’s jaw, obtain a good cosmetic effect, and facilitate the operation of the operator. It is an endoscopic thyroidectomy technique with a certain clinical value. Supplementary Information The online version contains supplementary material available at 10.1007/s00423-022-02663-w.
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Affiliation(s)
- Hang Chen
- Department of Day Ward, The First Affiliated Hospital of Nanchang University, Nanchang, 330006, Jiangxi, China
| | - Lijuan Deng
- The Nephrology Department, The First Affiliated Hospital of Nanchang University, Nanchang, 330006, Jiangxi, China
| | - Keyi Xu
- Department of Day Ward, The First Affiliated Hospital of Nanchang University, Nanchang, 330006, Jiangxi, China
| | - Zhixian Gong
- Department of Day Ward, The First Affiliated Hospital of Nanchang University, Nanchang, 330006, Jiangxi, China
| | - Xiaoping Zhu
- Department of Day Ward, The First Affiliated Hospital of Nanchang University, Nanchang, 330006, Jiangxi, China.
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Piromchai P. Comparison of Quality of Life between Patients Undergoing Submental Endoscopic Thyroidectomy and Conventional Thyroidectomy: A Prospective Controlled Clinical Trial. J Clin Med 2022; 11:jcm11164802. [PMID: 36013041 PMCID: PMC9409857 DOI: 10.3390/jcm11164802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 08/10/2022] [Accepted: 08/15/2022] [Indexed: 11/16/2022] Open
Abstract
The objectives of this study were to compare the surgical outcomes and quality of life between patients undergoing submental endoscopic thyroidectomy and those undergoing conventional thyroidectomy. The surgical outcomes and quality of life were recorded. Forty-eight patients were included in the study. Their ages ranged from 20 to 60 years. All patients underwent lobectomy, isthmectomy, or the combination of lobectomy and isthmectomy. Most histological diagnoses were benign (85.42%). The submental endoscopic thyroidectomy group showed better scores in the energy/fatigue, emotional wellbeing, and general health domains (p = 0.006, 0.041, and 0.004, respectively). There were no statistically significant differences in surgical outcomes between the submental endoscopic thyroidectomy and conventional thyroidectomy groups (p > 0.05). Submental endoscopic thyroidectomy is feasible, and permits a better quality of life in terms of the energy/fatigue, emotional wellbeing, and general health domains.
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Affiliation(s)
- Patorn Piromchai
- Department of Otorhinolaryngology, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
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Sun P, Zhan J, Chong TH, Li J, Wang C. Endoscopic central lymph node dissection of thyroid cancer via chest-breast approach: results, indications, and strategies. Surg Endosc 2022; 36:4239-4247. [PMID: 35169879 DOI: 10.1007/s00464-021-08758-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 09/27/2021] [Indexed: 01/29/2023]
Abstract
BACKGROUND Surgery for thyroid cancer via endoscopic approach was still controversial. Herein, we report the indications, strategies for operative techniques, as well as results for endoscopic central lymph node dissection of thyroid cancer via chest-breast approach (ETCB-CLND). METHODS A retrospective analysis was conducted on the cases of DTC, whom underwent ETCB-CLND from January 2013 to June 2020. Three hundred and twenty-three cases underwent ETCB-CLND (endoscopic group) and 267 cases underwent open surgery (open group). General characteristic, surgical results, thyroglobulin (Tg), radioactive iodine uptake (RAIU), radioactive technetium uptake (RATU), radionuclide imaging of the thyroid residual area (RITRA), and radionuclide imaging of suspicious lymph nodes metastasis (RISLNM) were analyzed and compared between the two groups. RESULTS The age of the endoscopic group were lower than that of the open group. The operation time of lobectomy in endoscopic group were longer than that in open group. The gender distribution (P = 0.831), operation time of total thyroidectomy (P = 0.311), intraoperative blood loss (P = 0.672), postoperative hospital stay (P = 0.852), tumor size (P = 0.259), number of cases of lymph node metastasis (P = 0.618), number of dissected lymph nodes (P = 0.681), number of metastatic lymph nodes (P = 0.723), and complications (P = 0.749) did not differ significantly between groups, nor did the surgical range (P = 0.661), Tg at 1 month (P = 0.61) and 1 year (P = 0.67) after surgery, before (P = 0.589) and after (P = 0.593) radioiodine therapy, RAIU-2 h/24 h (P = 0.906/0.582), RATU (P = 0.532), (99mTc 15 min:P = 0.503; 131I 24 h:P = 0.377; 131I 3d:P = 0.919), RISLNM (none: P = 0.887; central: P = 0.630; lateral: P = 0.659). CONCLUSION The rational and normative application of the endoscopic technique in central lymph node dissection of DTC is safe, feasible, and consistent with the principle of radical tumor cure for selected cases by well-trained surgeons.
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Affiliation(s)
- Peng Sun
- Department of Thyroid Surgery, Jinan University First Affiliated Hospital, No. 613 Huangpu Road West, Guangzhou, Guangdong, People's Republic of China.
| | - Jialin Zhan
- Department of Dermatology and STD, Jinan University First Affiliated Hospital, Guangzhou, China
| | - Tsz Hong Chong
- Department of Thyroid Surgery, Jinan University First Affiliated Hospital, No. 613 Huangpu Road West, Guangzhou, Guangdong, People's Republic of China
| | - Jinyi Li
- Department of Thyroid Surgery, Jinan University First Affiliated Hospital, No. 613 Huangpu Road West, Guangzhou, Guangdong, People's Republic of China.
| | - Cunchuan Wang
- Department of General Surgery, Jinan University First Affiliated Hospital, Guangzhou, China
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Alnehlaoui F, Guraya SY. Transoral and submental thyroidectomy using intraoperative nerve stimulation and indocyanin green fluorescence imaging. BMJ Case Rep 2021; 14:e243306. [PMID: 34426423 PMCID: PMC8383884 DOI: 10.1136/bcr-2021-243306] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2021] [Indexed: 11/04/2022] Open
Abstract
There is a recent proliferation of clinical studies about the minimally invasive scarless thyroid surgery. The transoral endoscopic thyroidectomy vestibular approach (TOETVA) carries a great potential for being scarless surgery via a short dissection flap. However, TOETVA has limitations in extracting larger thyroid tumours via the transoral vestibular incision and due to its potential damage to the branches of the mental nerve. The rapidly evolving surgical innovations have now introduced transoral and submental thyroidectomy (TOaST) approach that allows extraction of large thyroid tumours with less flap dissection and minimal postoperative pain. We present a 39-year-old man with a large multinodular goitre. The patient was euthyroid with moderate to severe compression symptoms of difficulty in breathing and swallowing. We performed a TOaST procedure using intraoperative neuromonitoring and indocyanin green fluorescence imaging with an uneventful recovery. This is a first case report from the middle east region that will pave the way to large clinical trials to determine the efficacy and safety of TOaST.
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Affiliation(s)
| | - Salman Yousuf Guraya
- Clinical Sciences Department, College of Medicine, University of Sharjah, Sharjah, UAE
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