Transoral Thyroidectomy Found Feasible, Safe Compared to Open

Posted on November 3, 2022

The study covered in this summary was published in Research Square as a preprint and has not yet been peer reviewed.

Key Takeaways

For selected patients requiring total thyroidectomy, the transoral endoscopic thyroidectomy via vestibular approach (TOETVA) is safe, feasible, and provides better cosmetic effects and similar surgical outcomes compared with conventional open surgery.

Why This Matters

TOETVA is becoming increasingly popular and is favored by many thyroid surgeons worldwide, but until now, there had not been a large-sample retrospective study comparing TOETVA with open thyroidectomy (OT).

Study Design

Retrospective review of 780 consecutive patients with papillary thyroid cancer who had undergone total thyroidectomy either with TOETVA (n = 107) or OT (n = 673) between April 2016 and October 2021 at a single institution.
Propensity score matching for patient characteristics yielded 101 patients in each surgical group.

Key Results

No patient required a second surgery, but one patient in the TOETVA group was converted to OT due to tumor invasion into tracheal cartilage.
Compared with OT, the TOETVA group had significantly longer operative time (223.2 vs 95.9 minutes; P < .001) and greater blood loss (18.7 vs 14.2 mL; P < .001).
There was no significant difference in the attenuation or disappearance of recurrent laryngeal nerve signal (5.9% vs 8.9% and 2.0% vs 1.0%; P = .633), rate of parathyroid auto-transplantation (46.5% vs 41.6%; P = .479) and bilateral lymph node dissection (89.1% vs 87.1%; P = .664), positivity of lymph node metastasis (51.5% vs 49.5%; P = .778), number of dissected lymph nodes (10.8 vs 11.4; P = .630), and positive lymph nodes (3.6 vs 3.3; P = .744).
Postoperatively, total drainage amount was greater (186.7 vs 142.1 mL; P < .001) and white blood cell count (11.27 × 10⁹/L vs 9.04 ×10⁹/L; P < .001) and C-reactive protein (16.0 vs 7.7 mg/L; P < .001) were higher in the TOETVA than the OT group.
There was no significant difference between groups in postoperative levels of blood calcium (2.01 vs 2.03 mmol/L; P = .477) and parathyroid hormone (PTH) (18.8 vs 21.2 ng/mL; P = .276), rate of PTH < 15 ng/mL (45.5% vs 38.6%; P = .318), visual analog scale score (1.87 vs 1.88; P = .928), and duration of hospital stay (4.0 vs 4.1 days; P = .525).
In the TOETVA group, transient recurrent laryngeal nerve palsy or hypoparathyroidism occurred in 2 (2.0%) and 23 (22.8%) patients, respectively, all of whom recovered within 6 months.
Over at least 3 months’ follow-up of 84 TOETVA and 87 OT patients, cosmetic satisfaction and quality of life were significantly better and scar self-consciousness was lower (all P < .001) in the TOETVA compared with the OT group.
At 3 months post-procedure, mean thyroglobulin (Tg) levels without thyroid-stimulating hormone (TSH) stimulation and Tg antibody levels in the TOETVA group were 0.19 and 44.18 IU/mL, respectively, and were not different from the OT group (0.28 µg/L, P = .476 and 32.5 IU/mL, P = .226, respectively).
There was no significant difference in mean TSH-stimulated Tg (sTg) level before radioactive iodine therapy (1.24 vs 1.67 µg/L; P = .157) and proportion of sTg level < 1 (57.1% vs 61.5%; P = .816).
No patient in the TOETVA group had recurrence.

Limitations

Small sample size.
Short follow-up.
Selection bias of surgical methods.

Disclosures

This is a summary of the preprint research study “Is transoral endoscopic thyroidectomy via vestibular approach safe for total thyroidectomy compared to open thyroidectomy? A propensity-score matched cohort study of 101 matched patient pairs with papillary thyroid carcinoma,” by Yujun Li of Zhejiang University School of Medicine, China, and colleagues. The study has not yet been peer reviewed.

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