Prophylactic antibiotics may not be necessary for transoral endoscopic thyroidectomy

Current Practices in Antibiotic Prophylaxis for Transoral Endoscopic Thyroid and Parathyroid Surgery: A Comparative Study

Background and Objectives: The transoral endoscopic thyroidectomy-vestibular approach (TOETVA) and parathyroidectomy-vestibular approach (TOEPVA) are scar-free alternatives to conventional surgery but are classified as clean-contaminated due to the oral incision, raising concerns about surgical site infections (SSIs). This study evaluates whether perioperative antibiotic prophylaxis (pABX) alone is sufficient compared to extended antibiotic prophylaxis (eABX) in preventing SSIs in TOET/PVA, particularly considering the surgical learning curve. Materials and Methods: A retrospective study analyzed 162 patients undergoing TOET/PVA at a single center from January 2018 to June 2024. Patients were divided into two groups: 82 received eABX (intravenous cefazolin preoperatively plus 7 days of oral amoxicillin/clavulanate), and 80 received pABX alone (intravenous cefazolin). The inclusion criteria included complete postoperative hemogram and C-reactive protein (CRP) records; exclusions comprised other surgical approaches or missing data. Outcomes included postoperative white blood cell (WBC) count, CRP levels, and complications (seroma, cellulitis, and flap perforation), defined using Centers for Disease Control and Prevention (CDC) guidelines. The statistical analysis comprised t-tests, chi-square tests, and logistic regression, adjusting for confounders like age and sex. Results: The postoperative WBC and CRP levels were significantly higher in the pABX group (p = 0.001), but all values remained within the laboratory normal limits. Complications were observed in 14 patients: seroma in 11, cellulitis in 2, and flap perforation in 1. Complications occurred more frequently in the eABX group but without statistical significance (p = 0.103). The duration of surgery was longer in the eABX group (117.93 ± 52.35 vs. 72.44 ± 22.54 min, p = 0.001) and was an independent predictor of complications (OR = 1.018, 95% CI: 1.006-1.031, p = 0.004). Conclusions: Perioperative antibiotic prophylaxis alone does not increase the risk of SSIs compared to extended prophylaxis in TOETVA. However, eABX may be prudent during the learning curve due to longer operative times and higher complication risks. Future prospective, randomized trials are needed to standardize prophylaxis regimens.

Antibiotic Use Can be De-escalated During Transoral Endoscopic Thyroidectomy: A Bacterial Culture-Based Study

Objective: To explore the possibility of reducing the use of antibiotics after transoral endoscopic thyroidectomy vestibular approach (TOETVA). Method: A retrospective study was conducted on patients with thyroid tumors who were diagnosed and underwent surgical treatment at our hospital from 2022 to 2024. Patients diagnosed with T1-stage differentiated thyroid cancer or a benign retrosternal goiter <4 cm with cosmetic needs were included in the current study. Drainage fluid was cultured on the first postoperative day. The differences in infection rates, bacterial culture results, and antibiotic use between patients with clean incisions and those with clean-contaminated incisions were compared. Results: There were no signs of infection in the postoperative drainage fluid or delayed healing due to surgical cavity infection. There was no significant difference in the incidence of postoperative infection or the results of bacterial culture between clean and clean-contaminated incisions or between the groups with and without antibiotic use for clean-contaminated incisions. The proportion of pathogenic bacteria in clean-contaminated incisions was significantly greater than that in clean incisions, while bacteria cultured in clean incisions were mostly common colonizing bacteria. Conclusion: Pathogenic bacteria may indeed exist in the operative cavity of the TOETVA regardless of whether antibiotics are used during the perioperative period. With adequate drainage, the absence of the routine administration of antibiotics or only preventive antibiotics during the perioperative period does not increase the infection rate.

Modern Surgical Techniques of Thyroidectomy and Advances in the Prevention and Treatment of Perioperative Complications

Thyroid cancer is the most common cancer of the endocrine system, and, in recent years, there has been a phenomenon of overdiagnosis followed by subsequent overtreatment. This results in an increasing number of thyroidectomy complications being faced in clinical practice. In this paper, we present the current state of knowledge and the latest findings in the fields of modern surgical techniques, thermal ablation, the identification and assessment of parathyroid function, recurrent laryngeal nerve monitoring and treatment and perioperative bleeding. We reviewed 485 papers, from which we selected 125 papers that are the most relevant. The main merit of this article is its comprehensive view of the subject under discussion-both general, concerning the selection of the appropriate method of surgery, and particular, concerning the selection of the appropriate method of prevention or treatment of selected perioperative complications.