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Purpose: Our study aimed to compare the effectiveness and complications of the transoral endoscopic thyroidectomy submental vestibular approach (TOETSMVA) versus the transoral endoscopic thyroidectomy vestibular approach (TOETVA) or conventional open thyroidectomy (COT) in patients with early-stage papillary thyroid carcinoma (PTC). Methods: We searched online databases up to January 2024. The outcomes were analyzed using RevMan 5.4 and inverse variance. Results: Seven studies (two RCTs and five retrospective cohort studies) were included. We established higher significance differences for TOETSMVA in comparison with TOETVA in terms of all primary outcomes; operation time, hospital stay, number of resected lymph nodes [MD -21.05, 95% CI= -30.98, -11.12; p < 0.0001], [MD -1.76, 95% CI= -2.21, -1.32, p < 0.00001], [MD -2.99, 95% CI= -19.75, 13.76, p < 0.73], [MD -0.83, 95% CI = -1.19 to -0.47; p < 0.00001], respectively, except the drainage volume, it showed no difference [MD -2.99, 95% CI= -19.75, 13.76, p < 0.73]. In secondary outcomes, it was favored only in mandibular numbness and return to normal diet outcomes. Additionally, TOETSMVA compared with COT showed a significant difference in drainage volume, pain, cosmetic effect, and satisfaction score. Conclusions: TOETSMVA showed a significant improvement compared to the TOETVA in operation time, hospital stay, number of resected lymph nodes, mandibular numbness, and return to normal diet but did not show a difference in drainage volume. However, TOETSMVA was better in cosmetic effect, drainage volume, satisfaction, and pain scores compared with COT. Further RCTs with larger sample size, multicentral, and longer follow-up are necessary to evaluate the limitations. [ABSTRACT FROM AUTHOR]

Abstract Background The endoscopic thyroidectomy areola approach (ETAA) has been widely applied for papillary thyroid carcinoma (PTC), but leaves scars and is not truly minimally invasive. The oral vestibular approach (ETOVA) leaves no scars and is even more minimally invasive. However, there have been few comparative studies of ETAA and ETOVA for PTC. The purpose of our research was to compare two PTC treatment methods in terms of feasibility, safety, efficacy, and cosmetic results. Methods A total of 129 patients with PTC underwent thyroidectomy combined with central lymph node dissection by the same surgeon. Among them, 79 patients underwent the ETOVA, and the others underwent the ETAA. We compared the two groups in terms of operative outcomes, postoperative complications, and cosmetic results. Results No significant differences were found in the clinical characteristics between the ETOVA and ETAA groups. There were no significant differences in the number of removed lymph nodes (P = 0.279) or the number of positive lymph nodes (P = 0.569), but the ETOVA group had a higher number of removed lymph nodes. There was also no significant difference in blood loss volume(P = 0.180), postoperative drainage volume (P = 0.063), length of hospital stay (P = 0.182), transient RLN injury rate (P = 1.000), permanent RLN injury rate (P = 1.000), or recurrence rate (P = 1.000). The ETOVA was a longer operation than the ETAA was (P

Objective: This study compares endoscopic thyroidectomy by gasless unilateral axillary approach (ETGUA) and sternocleidomastoid leading-edge approach (SLEA) with conventional open thyroidectomy (COT) in hemithyroidectomy. The main focus is on the protection of neck muscles (sternocleidomastoid, omohyoid, sternothyroid) and the postoperative function of voice and swallowing yielded through these common approaches. Methods: A total of 302 patients who underwent hemithyroidectomy were enrolled and divided into three groups: ETGUA (n = 101), SLEA (n = 100), and COT (n = 101). Ultrasound was used to measure the thickness of bilateral neck muscles, including the sternocleidomastoid, omohyoid, and sternothyroid. The changes in thickness on the surgical side compared to the non-surgical side. Analyzed factors included muscle thickness changes, Swallowing Impairment Score (SIS), Voice Handicap Index (VHI), Scar Cosmesis Assessment and Rating (SCAR), Neck Injury Index (NII), surgery duration, drainage volume, hospitalization, and number of lymph nodes. Results: The clinical characteristics among the three groups were consistent except for differences in sex, age, and BMI. Metrics such as sternocleidomastoid muscle, NII, hypocalcemia, postoperative PTH, transient hoarseness, and number of lymph nodes showed no significant differences among the three groups. However, significant differences were found in the duration of surgery, drainage volume, hospitalization period omohyoid muscle, Sternohyoid muscle, VHI, SIS, and SCAR (all p

Background: Extrathyroid implantation or dissemination of thyroid tissue secondary to a thyroid procedure is rare. Most of these belonged to thyroid carcinoma with metastatic potential and uncommon for benign pathologies. Methods: We report the case of a 31‐year‐old female who was identified to have multiple subcutaneous implantation of thyroid tissue 5 years after transoral endoscopic thyroidectomy vestibular approach. A comprehensive literature search on implantation of thyroid tissue secondary to thyroid procedures was performed. Results: Accidental tearing of the capsule during previous surgery may lead to the subcutaneous implantation. Through literature review, a total 29 articles with 47 patients were identified. 33.3% were benign lesions, and implantation was mostly secondary to fine needle aspiration biopsy (46.5%). Conclusions: Subcutaneous or port site implantation after endoscopic thyroid surgery may occur in benign thyroid pathologies and therefore, oncologic principles must be strictly followed during surgery regardless of its histopathological nature. [ABSTRACT FROM AUTHOR]

Objective: We developed a novel method for thyroidectomy using a single‐incision oral vestibular approach. To assess its advantages and disadvantages, we compared the perioperative parameters of this approach with those of transoral three‐incision thyroidectomy and trans‐areolar thyroidectomy. Methods: In a study of 136 papillary thyroid carcinoma patients (2016–2018), precise thyroidectomy and neck dissection were conducted. Among them, 52 chose single‐incision oral vestibular approach, 33 chose three‐incision variant, and 51 underwent trans‐areolar thyroidectomy. Perioperative aspects of the transoral single‐incision group were compared with those of transoral three‐incision group, and transthoracic group. Results: In the cohort, meticulous tumor level VI lymph node dissection was performed, achieving intended resection extent with one case requiring a switch from transoral to transthoracic approach. No nerve palsy occurred in the transoral group. Thyroidectomy duration varied significantly across groups. Transoral single‐incision had a shorter duration than transoral three‐incision and longer than transthoracic. Minor differences were observed in blood loss and drainage. Perioperative factors like hematoma, infection, hypocalcemia, et al., remained consistent. Notably, no tumor recurrence was observed in this study. Conclusions: This new transoral video‐assisted neck surgery (TOVANS) method for thyroidectomy without gas insufflation approach did not increase the surgical complexity compared with the transoral vestibular three‐incision thyroidectomy and the trans‐areolar thyroidectomy. Level of Evidence: 3 Laryngoscope, 134:2976–2984, 2024 [ABSTRACT FROM AUTHOR]

This study compares endoscopic thyroidectomy by gasless unilateral axillary approach (ETGUA) and sternocleidomastoid leading-edge approach (SLEA) with conventional open thyroidectomy (COT) in hemithyroidectomy. The main focus is on the protection of neck muscles (sternocleidomastoid, omohyoid, sternothyroid) and the postoperative function of voice and swallowing yielded through these common approaches. A total of 302 patients who underwent hemithyroidectomy were enrolled and divided into three groups: ETGUA (n = 101), SLEA (n = 100), and COT (n = 101). Ultrasound was used to measure the thickness of bilateral neck muscles, including the sternocleidomastoid, omohyoid, and sternothyroid. The changes in thickness on the surgical side compared to the non-surgical side. Analyzed factors included muscle thickness changes, Swallowing Impairment Score (SIS), Voice Handicap Index (VHI), Scar Cosmesis Assessment and Rating (SCAR), Neck Injury Index (NII), surgery duration, drainage volume, hospitalization, and number of lymph nodes. The clinical characteristics among the three groups were consistent except for differences in sex, age, and BMI. Metrics such as sternocleidomastoid muscle, NII, hypocalcemia, postoperative PTH, transient hoarseness, and number of lymph nodes showed no significant differences among the three groups. However, significant differences were found in the duration of surgery, drainage volume, hospitalization period omohyoid muscle, Sternohyoid muscle, VHI, SIS, and SCAR (all p < 0.001). In comparison to COT, ETGUA and SLEA demonstrate superiority in protecting neck muscles and preserving voice and swallowing function without compromising surgical safety or radicality. [ABSTRACT FROM AUTHOR]

Objective(s): Endoscopic thyroidectomy, such as axillary, areola and transoral approaches, offer the advantage of a good cosmetic outcome, but it requires a wider dissection field compared to open thyroidectomy. Recently, chest-collarbone approach thyroidectomy has been widely developed in China because of its shorter anatomical route compared to other endoscopic approaches. This study retrospectively evaluated endoscopic thyroidectomy via chest-collarbone approach in patients with thyroid nodules to determine its feasibility. Methods: A total of 46 patients with thyroid disease who underwent endoscopic thyroidectomy between January 2022 and December 2022 were enrolled in the study and randomly matched to patients with thyroid disease who underwent open thyroidectomy at the same time based on nodule size and pathology. Postoperative bleeding, hoarseness situation, hospital stay, postoperative drainage volume, laryngeal nerve palsy, hypoparathyroidism and wound infection were assessed in both groups. Results: Forty-four patients underwent endoscopic thyroidectomy successfully and two patients changed to open thyroidectomy. The amount of postoperative drainage for the endoscopic thyroidectomy group was 102.78 ± 28.04 mL, and which was 71.91 ± 19.20 for open thyroidectomy group (p

Summary: Endoscopic thyroidectomy (ET), a surgical procedure widely accepted by surgeons, has been proven to be feasible. The aim of this systematic review is to evaluate the effectiveness and safety of ET compared to conventional open thyroidectomy (COT) in the treatment of papillary thyroid microcarcinoma (PTMC) through a meta-analysis. Medical literature databases, including PubMed, Embase, Cochrane Library, CBM,CNKI, Wanfang, and VIP, were systematically searched for relevant studies on ET and COT for the treatment of PTMC. The search period was from January 2000 to June 2023. Two researchers independently performed literature screening and data extraction according to the inclusion and exclusion criteria, and the Newcastle–Ottawa Scale (NOS) was used to assess the quality of the included studies. Meta-analysis was conducted using Revman 5.3 software. Six studies were eventually included, involving a total of 440 patients with PTMC. The meta-analysis results demonstrated that the ET group had shorter incision length (MD = −2.96, 95 % CI: −4.27 to −1.65, P 0.05), lymph node dissection (MD = 1.03, 95 % CI: −1.47 to 3.54, P = 0.42 > 0.05), postoperative hospital stay (MD = −0.96, 95 % CI: −2.00 to 0.08, P = 0.07 > 0.05), and transient recurrent laryngeal nerve paralysis (OR = 3.32, 95 % CI: 0.65 to 16.90, P = 0.15 > 0.05). Compared with COT, ET has the advantages of shorter incision length, less intraoperative blood loss, better prognosis and comparable safety, making it a worthy choice for clinical application.

Horner syndrome (HS) is a rare complication of thyroid surgery. However, the relationship between the occurrence of HS and thyroid upper pole injury is still not completely clear, and there are only few reports.

Abstract Background Endoscopic thyroidectomy has been preliminarily proven effective and safe for thyroid diseases. The cosmetic outcomes and life quality are critical contents of postoperative assessment. This review will primarily focus on the assessment methods and results related to cosmetic outcomes, sensory alteration of surgical area, and quality of life following endoscopic thyroidectomy. Methods A comprehensive search of published articles within the last decade was conducted using the terms “endoscopic/robotic thyroidectomy,” “patient satisfaction scores,” “questionnaire,” “quality of life,” and “cosmetic” in PubMed. Results Assessment methods for postoperative cosmetic satisfaction and sensory alterations encompassed verbal/visual analog scales, scar evaluations, Semmes–Weinstein monofilament tests, and more. The evaluation of postoperative quality of life in endoscopic thyroidectomy involved tools such as SF-36, SF-12, thyroid-specific questionnaires, thyroid cancer-specific quality of life questionnaires (THYCA-QOL), as well as assessments related to voice and swallow function. The cosmetic results of endoscopic thyroidectomy generally surpassed those of open thyroidectomy, while the quality of life in endoscopic procedures was either superior or equivalent to that in open thyroidectomy, especially with respect to general health, role emotion, and vitality. Conclusions Assessments of cosmetic outcomes and sensory alterations following endoscopic thyroidectomy predominantly relied on patients’ subjective feelings. The objective and subjective perspectives of scar assessments remain underutilized. In addition, postoperative laryngoscopy and voice function assessments in endoscopic thyroidectomy procedures require more attention.

Background: The extent of postoperative pain following transoral thyroidectomy is not well-understood and remains a subject of debate. This study aims to analyze and compare postoperative pain levels between patients undergoing transoral and conventional transcervical thyroidectomy. Methods: A prospective evaluation on postoperative pain was conducted in 310 patients undergoing conventional thyroidectomy and 194 undergoing transoral thyroidectomy. Pain levels were evaluated using the numerical rating scale (NRS, ranging from 0 to 10) through preoperative and postoperative questionnaires at specified time points: 1, 3, and 6 days, and 1 and 3 months following surgery. Propensity score-matched analysis was carried out based on six covariates: sex, age, body mass index, extent of thyroidectomy, tumor size, and central neck dissection. Results: After propensity score matching based on the six covariates, 121 patient pairs were identified from each group. Within this matched cohort, postoperative pain scores significantly worsened 1 day after surgery but showed progressive recovery up to 3 months post-surgery in both groups. The transoral group exhibited higher postoperative pain scores than the conventional group from day 1 (4.43 ± 2.6 vs. 3.11 ± 2.5, p < 0.001) to day 6 (1.76 ± 1.9 vs. 1.13 ± 1.6, p = 0.016) post-surgery, with no significant difference noted at 1 month. Among transoral procedures, pain scores were significantly higher for the endoscopic approach compared to the robotic approach on days 1 (5.52 ± 2.3 vs. 4.29 ± 2.3, p = 0.028) and 3 (3.52 ± 2.5 vs. 2.64 ± 2.0, p = 0.047) post-surgery. Conclusions: Postoperative pain was significantly higher in transoral thyroidectomy compared to conventional thyroidectomy up to 6 days post-surgery. Within the transoral group, the robotic procedure resulted in lower pain levels than the endoscopic approach during the early postoperative period. [ABSTRACT FROM AUTHOR]

Endoscopic thyroidectomy (ET), a surgical procedure widely accepted by surgeons, has been proven to be feasible. The aim of this systematic review is to evaluate the effectiveness and safety of ET compared to conventional open thyroidectomy (COT) in the treatment of papillary thyroid microcarcinoma (PTMC) through a meta-analysis. Medical literature databases, including PubMed, Embase, Cochrane Library, CBM,CNKI, Wanfang, and VIP, were systematically searched for relevant studies on ET and COT for the treatment of PTMC. The search period was from January 2000 to June 2023. Two researchers independently performed literature screening and data extraction according to the inclusion and exclusion criteria, and the Newcastle–Ottawa Scale (NOS) was used to assess the quality of the included studies. Meta-analysis was conducted using Revman 5.3 software. Six studies were eventually included, involving a total of 440 patients with PTMC. The meta-analysis results demonstrated that the ET group had shorter incision length (MD = −2.96, 95 % CI: −4.27 to −1.65, P < 0.05) and less intraoperative blood loss (MD = −18.06, 95 % CI: −32.76 to −3.37, P = 0.02 < 0.05). There was no statistically significant difference between the two groups in terms of operative time (MD = −0.83, 95 % CI: −19.64 to 17.98, P = 0.93 > 0.05), lymph node dissection (MD = 1.03, 95 % CI: −1.47 to 3.54, P = 0.42 > 0.05), postoperative hospital stay (MD = −0.96, 95 % CI: −2.00 to 0.08, P = 0.07 > 0.05), and transient recurrent laryngeal nerve paralysis (OR = 3.32, 95 % CI: 0.65 to 16.90, P = 0.15 > 0.05). Compared with COT, ET has the advantages of shorter incision length, less intraoperative blood loss, better prognosis and comparable safety, making it a worthy choice for clinical application. [ABSTRACT FROM AUTHOR]

Background: Endoscopic thyroidectomy has been preliminarily proven effective and safe for thyroid diseases. The cosmetic outcomes and life quality are critical contents of postoperative assessment. This review will primarily focus on the assessment methods and results related to cosmetic outcomes, sensory alteration of surgical area, and quality of life following endoscopic thyroidectomy. Methods: A comprehensive search of published articles within the last decade was conducted using the terms "endoscopic/robotic thyroidectomy," "patient satisfaction scores," "questionnaire," "quality of life," and "cosmetic" in PubMed. Results: Assessment methods for postoperative cosmetic satisfaction and sensory alterations encompassed verbal/visual analog scales, scar evaluations, Semmes–Weinstein monofilament tests, and more. The evaluation of postoperative quality of life in endoscopic thyroidectomy involved tools such as SF-36, SF-12, thyroid-specific questionnaires, thyroid cancer-specific quality of life questionnaires (THYCA-QOL), as well as assessments related to voice and swallow function. The cosmetic results of endoscopic thyroidectomy generally surpassed those of open thyroidectomy, while the quality of life in endoscopic procedures was either superior or equivalent to that in open thyroidectomy, especially with respect to general health, role emotion, and vitality. Conclusions: Assessments of cosmetic outcomes and sensory alterations following endoscopic thyroidectomy predominantly relied on patients' subjective feelings. The objective and subjective perspectives of scar assessments remain underutilized. In addition, postoperative laryngoscopy and voice function assessments in endoscopic thyroidectomy procedures require more attention. [ABSTRACT FROM AUTHOR]

Transoral endoscopic thyroidectomy with vestibular approach (TOETVA) is a scarless thyroid surgery used as an alternative to open conventional surgery. Our aim was to investigate possible risk factors for complications and conversion during TOETVA. The study was conducted internationally by centres from Turkiye, the Republic of Korea, Italy, and Peru. A total of 406 patients who underwent TOETVA and were ≥ 18 years of age were included in the study. Demographic, pre-, intra-, and postoperative data were collected and compared between the groups with/without complication/conversion to identify possible predictors of complication/conversion. Subsequently, patients with complication/conversion were matched by the hospital, age, sex, and American Society of Anesthesiologists classification score using a propensity score (PSM) of 1:3 to eliminate confounding differences. Results were reported for the un-matched and matched groups. Complications occurred in 11 (2.7%) patients. High body mass index (26.4 ± 3.4 vs. 23.3 ± 3.7, p = 0.007), larger tumor size (1.7 ± 1.3 cm. vs. 1.1 ± 1.0 cm, p = 0.012), larger thyroid volume (20.0 ± 9.2 vs. 12.8 ± 8.5, p = 0.007) and long operation time (127.8 ± 45.0 min. vs. 97.7 ± 38.5 min., p = 0.008) were significantly associated with complications in un-matched analyses. Older age (42.7 ± 8.0 vs. 34.9 ± 9.2, p = 0.023), high BMI (26.7 ± 3.2 vs. 23.3 ± 3.7, p = 0.012), and longer operation time (160.1 ± 54.1 min. vs. 97.4 ± 37.8, p = 0.001) were significantly related to conversion in un-matched analyses. However, significance was lost after PSM for both complication and conversion. The data from this study conducted on TOETVA cases do not suggest a risk factor for complications and conversion with PSM. [ABSTRACT FROM AUTHOR]

Background: Preserving parathyroid glands in situ is crucial to avoid surgical hypoparathyroidism, but it is also one of the greatest challenges during thyroid surgery. Magnified endoscopic imaging has been proposed as a way to improve parathyroid preservation. Methods: 2,603 consecutive patients who underwent thyroid surgery at the First People’s Hospital of Zunyi from January 2018 to July 2022 were screened. 1,355 patients were eligible, including 965 endoscopic and 390 open cases. Parathyroid hormone (PTH) loss levels and severe parathyroid injury rates were compared between endoscopic and open cases. Meanwhile, factors that contribute to parathyroid injuries were assessed, including surgical extent, tumor size, carbon nanoparticle guidance, and surgical proficiency. Results: PTH loss levels were similar between endoscopic and open cases (P = 0.440). The incidence of severe parathyroid injuries was also comparable (7.8% for endoscopic vs. 6.9% for open, P = 0.592). The endoscopic group had higher rates of autologous parathyroid transplantation (39.5% vs. 24.4%, P = 0.000), while accidental parathyroidectomy rates were similar (11.4% vs. 10.8%, P = 0.739). Among patients who received the same extent of thyroid surgeries, no significant difference was found in PTH loss levels and severe parathyroid injury rates, except for a higher risk of severe parathyroid injuries in endoscopic bilateral thyroidectomy (18.52% vs. 11.52%, P = 0.033). Conclusions: Despite the magnified endoscopic imaging facilitating the identification of parathyroid tissues, endoscopic approaches are not superior to open ones for the in-situ preservation of parathyroid glands. For a bilateral thyroidectomy, open approaches are safer for parathyroid preservation.

The incidence of thyroid tumors has been increasing recent years, the importance of quality of life has been more concerned in addition to radical treatment. Traditional open surgery has been unable to meet the needs of all patients. In recent years, the continuous innovation and vigorous development of minimally invasive techniques, including endoscopy, ablation, and robotics, have expanded the range of available surgical options. In this review, we summarized the advancements in minimally invasive surgery for thyroid tumors, focusing on how to select the most appropriate surgical approach based on the patient's condition and develop personalized treatment plans.

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. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the feasibility, safety, and oncologic outcomes associated with endoscopic thyroidectomy via the areolar approach (ETAA), compared with conventional open thyroidectomy (COT) for the treatment of stage T1 papillary thyroid carcinoma (PTC). Methods: Between January 2021 and June 2022, a total of 1204 patients diagnosed with PTC underwent screening, out of which 138 patients were selected for inclusion in the study population after propensity score matching (92 patients in the ETAA group and 46 patients in the COT group). The study included the collection and analysis of clinicopathologic characteristics, intraoperative outcomes, postoperative outcomes, complications, and followup data using R software. Results: The operative time for the ETAA group was longer than that for the COT group (160.42 ± 32.21 min vs. 121.93 ± 29.78 min, p < 0.0001). However, there were no significant differences between the two groups in terms of intraoperative blood loss, the extent of surgical resection, the number of dissected lymph nodes, the number of metastatic lymph nodes, and the rate of parathyroid autotransplantation. Postoperative drainage and C-reactive protein levels were higher in the ETAA group than in the COT group, but there were no significant differences in 24-hour visual analogue scale scores, white blood cell counts, drainage duration, or postoperative hospital stay. Complication rates were similar between the two groups, and no permanent recurrent laryngeal nerve palsy or hypoparathyroidism was observed. Patients who underwent ETAA reported greater cosmetic satisfaction and quality of life than those who underwent COT. During the follow-up phase, only one patient in the COT group developed lateral cervical lymph node involvement requiring reoperation. Conclusion: ETAA is a safe and feasible surgical method for patients with stage T1 PTC, providing results similar to COT in terms of oncologic completeness, while avoiding neck scars, with excellent cosmetic effects. [ABSTRACT FROM AUTHOR]

Background: In a previous study, we proposed a novel anatomy-based five-settlement method for transaxillary endoscopic thyroidectomy (fs-TAT) for patients with papillary thyroid carcinoma. The safety of this new method has been reported in a retrospective study of a single cohort. The safety and short-term oncological outcome of this method was confirmed by comparing it with conventional open surgery (COT) in patients with papillary thyroid microcarcinoma. Methods: The medical records of patients who underwent fs-TAT or COT by a single surgeon from February 2019 to December 2021 were reviewed retrospectively. All patients were diagnosed with papillary thyroid microcarcinoma and underwent lobectomy and ipsilateral central compartment neck dissection. Propensity score matching was used to compare the technical safety and short-term oncologic outcomes of fs-TAT and COT for the purpose of reducing potential selection bias. Reporting was consistent with the STROCSS 2021 guidelines. Result: After propensity score matching, 460 (fs-TAT: 230; COT: 230) patients remained in the study population. There were no significant differences in sex, age, tumor size, Hashimoto's thyroiditis, or tumor multifocality between the groups. The operative time was longer [104.5 (90.3, 120.0) vs. 62.0 (52.0, 76.0), P < 0.001] and the total postoperative drainage volume [135(90, 210) vs. 75 (55, 115), P < 0.001] was greater in the fs-TAT group than in the COT group. However, intraoperative bleeding [3.0 (2.0, 5.0) vs. 5.0 (5.0, 7.5), P < 0.001] was greater, and the median number of lymph nodes yielded [5.0 (2.3, 8.0) vs. 7.0 (5.0, 11.0), P < 0.001] was greater in the COT group than in the fs-TAT group. The groups exhibited no significant difference in the rate of complications (fs-TAT: 2.2% vs. COT: 2.6%, P = 0.856), rate of positive lymph nodes (fs-TAT: 32.2% vs. COT: 36.5%, P = 0.377), length of postoperative hospital stay (3 days vs. 3 days, P = 0.305) or total medical costs (26,936 vs. 26,549, P = 0.144). Conclusion: Compared to conventional open surgery, fs-TAT offered excellent safety and acceptable short-term oncological outcomes in a selected cohort of patients with papillary thyroid microcarcinoma. [ABSTRACT FROM AUTHOR]

Background: Conventional thyroidectomy leaves an eye-catching scar in the anterior neck region. Endoscopic thyroidectomy may achieve a better esthetic effect and improve quality of life postoperatively. The aim of this study was to undertake a complete review of a large cohort of the patients undergoing gasless endoscopic thyroidectomy (GET) via anterior chest approach (ACA) with a long-term follow-up period, and evaluate the results and limits of this procedure. Methods: Between 2003 and 2022, 1413 patients undergoing GET via ACA in our department were included. The demographic, clinicopathological characteristics, oncologic and esthetic outcomes were summarized and analyzed. Results: The indication for surgery was papillary thyroid carcinoma in 686 (48.5%) patients and benign thyroid diseases in 727 (51.5%) patients. Among them, 802 (56.8%) patients took hemithyroidectomy, and 611 (43.2%) patients did sub-total/total thyroidectomy. Meanwhile, 598 (42.3%) ones had central neck dissection, while 88 (6.2%) lateral neck dissection. The most common complication was transient hypoparathyroidism with an incidence of 2.9%. During the follow-up period of 2 to 232 months, three patients were confirmed locoregional recurrence. Most of the patients were satisfied with the cosmetic results. Conclusion: Gasless endoscopic thyroidectomy via anterior chest approach is a safe and feasible procedure, which could achieve excellent oncologic and esthetic outcomes. [ABSTRACT FROM AUTHOR]

Introduction: Although transoral endoscopic thyroidectomy (TOETVA) is widely utilized in clinical practice, some problems and restrictions still remain. Our study compared the perioperative features and early surgical efficacy of TOETVA and a modified transoral and submental endoscopic thyroidectomy (TOaST) in early stage papillary thyroid carcinoma (PTC). Methods: The clinical data of PTC patients who underwent endoscopic thyroidectomy, including 42 modified TOaST patients and 114 traditional TOETVA patients, were retrospectively collected. Propensity score matching was employed to reduce patient selection bias. The perioperative features and early surgical efficacy data of two groups were compared. Results: The operation time of the TOaST group was significantly shorter than that of the TOETVA group (150.00 ± 35.47 min vs. 168.75 ± 44.49 min; P = 0.030). Furthermore, the TOaST group required shorter days for a normal diet (3.38 ± 0.93 days vs. 4.04 ± 1.03 days; P = 0.000) and a shorter hospital stay than the TOETVA group (5.85 ± 2.17 days vs. 6.12 ± 2.01 days; P = 0.003). There was no statistical difference in complications between the two groups, but the probability of numbness of the lower lip and chin in the TOaST group was lower than that in the TOETVA group(5.12% vs. 13.04%, P = 0.321). The symptoms of mandibular numbness and hoarseness of most patients were relieved in both groups 6 months after surgery, and no abnormalities and recurrence were found in the thyroid ultrasound. All the patients were satisfied with the appearance of their surgical incision. Conclusion: In early stage PTC patients, TOaST had the same surgical effectiveness as traditional TOETVA but can minimize the probability of mandibular numbness and improve the perioperative quality of life. [ABSTRACT FROM AUTHOR]

Objective: ：The safety of endoscopic thyroidectomy in patients with Hashimoto's thyroiditis (HT) is a matter of concern. This study aimed to assess the effect of concomitant HT on the feasibility of endoscopic thyroidectomy in patients with papillary thyroid carcinoma (PTC). Methods: This study is an observational, retrospective study. All patients were histopathologically diagnosed with HT. The study group consisted of 44 patients (40 %) with PTC who also had HT, whereas the remaining 66 patients (60%) without HT were assigned to the control group. The number of dissected lymph nodes, mean operation time, thyroid volume, blood loss, TSH level, and postoperative complications were recorded and statistically analysed. Results: One patient underwent conversion to open thyroidectomy because of recurrent laryngeal nerve (RLN) transection. Another patient required reoperation owing to postoperative haemorrhage. Statistically significant differences were observed in mean operation time (105.4 ± 10.7 vs 98.2 ± 7.4 min, P = 0.0001),mean thyroid lobe volume (12.2 ± 5.8 vs 9.6 ± 3.5 mL [mL], P = 0.0041), TSH level(4.1 ± 1.5 mIU/L vs 3.4 ± 0.9 mIU/L, P ＝ 0.0028), and the number of dissected lymph nodes between groups (4.1 ± 1.5 vs 3.4 ± 0.9,P = 0.0028). The estimated mean blood loss (31.5 ± 6.8 vs 29.5 ± 3.9 mL, P = 0.0529) and rate of complications (15.9% vs 10.6%, P = 0.4136) did not show statistically significant differences between groups. Conclusion: The coexistence of PTC and HT increases the operation time and difficulties in endoscopic thyroidectomy but does not affect postoperative outcomes. Endoscopic thyroidectomy can be safely performed with acceptable complication rates.

Background: Our objective was to assess the viability and oncological security of a gasless, transaxillary single-incision endoscopic procedure for performing total thyroidectomy and bilateral central neck dissection (TT + BCND). This study focused on patients diagnosed with bilateral papillary thyroid microcarcinoma (PTMC). Method: Between April 2020 and November 2021, 22 patients with bilateral PTMC underwent single-incision, gasless, transaxillary endoscopic TT + BCND. The patients’ clinicopathologic characteristics, surgical completeness and complications were analyzed. Result: Single-incision, gasless, transaxillary endoscopic TT + BCND was successful performed in all patients. The median (IQR) total surgical time was 143 (85–160) min. Only two patients experienced transient unilateral RLN palsy or transient hypocalcemia. All these complications resolved within 1 month after surgery. The median duration of hospital stay after surgery was 4 (3–4.5) days. The median hospitalization expense for these patients was 3848 (3781–4145) USD. The median number of lymph node yielded was 10.5 (8–15). The cosmetic outcomes were well-received by all individuals. Conclusion: In certain cases, gasless, transaxillary endoscopic TT + BCND procedure performed through a single incision proved to be a secure alternative for managing bilateral PTMC.

Abstract Purpose To investigate the mechanisms of recurrent laryngeal nerve (RLN) injury during endoscopic thyroidectomy via breast approach (ET‐BA) in patients with papillary thyroid carcinoma (PTC). Methods The records of 416 PTC patients who underwent ET‐BA with intraoperative neural monitoring (IONM) from May 2015 to May 2021 in Beijing Friendship Hospital affiliated to Capital Medical University were retrospectively analyzed. Results All patients were women. Mean age was 37.80 (7.87) years. The ET‐BA was performed in 416 patients. Overall incidence of RLN injury was 4.3% (18 patients). Injury was transient in 13 patients (3.1%) and permanent in five (1.2%). Macroscopic physical changes were apparent in the injured nerve in five patients (27.8%) and postoperative hoarseness or cough after drinking water were present in 11 (61.1%). Two RLN injuries occurred during nerve identification at the RLN laryngeal entry point into the surgical field, 15 during early nerve dissection somewhere between the first 0.5 and 2 cm of the nerve's course through the surgical field, and one occurred distal to 2 cm. The percentage of patients with separation, transection, traction and thermal mechanisms of injury was 27.8%, 22.2%, 22.2%, and 16.7%, respectively. The mechanism of injury was unknown in 11.1%. Conclusions RLN injury may still occur during ET‐BA despite endoscopic magnification and early nerve identification even when IONM is used. Separation, transection, and traction injuries were the most frequent causes of injury.

Introduction: Recently, endoscopic thyroidectomy has been developed and applied to thyroid surgery to achieve minimized neck scar formation and enhanced aesthetic outcomes. Our scientometric research in this paper offers a thorough overview of endoscopic thyroidectomy from 2013 to 2022. Methods: All pertinent articles on endoscopic thyroidectomy were obtained from the Web of Science Core Collection Database. The data on the number of citations and publications, most prolific countries and institutions, significant authors and journals, top themes, and keywords were analyzed by Biblioshiny, CiteSpace, and VOSviewer. Results: There were 758 publications, all of that were found from 2013 to 2022. The output of the annual publication showed an upward trend. A series of cases report by Anuwong et al. published in 2016 received the most citations. The country with the most articles published articles was South Korea, and the two countries with the most collaboration were South Korea and the United States. The most productive journal was Surgical Endoscopy and Other Interventional Techniques. Dionigi G, Kim HY, and Anuwong A were the writers with the most articles published, the highest hand g-indices, and the strongest link strength, respectively. The keywords "endoscopic thyroidectomy", "surgical", "thyroidectomy", "robotic thyroidectomy", "experience", and others were most used. Conclusion: The innovative surgical technique, transoral endoscopic thyroidectomy vestibular approach (TOETVA), leaves no scars and produces optimal cosmetic results. However, the long-term oncologic results for thyroid cancer performed with this approach are still missing. This scientometric analysis can offer valuable insights into the present research standing and key focal points in this domain, enabling researchers to gain a precise understanding of the state-of-the-art research in this area. [ABSTRACT FROM AUTHOR]

The objective of this study was to compare phonetic outcomes of TOETVA with those of conventional transcervical thyroidectomy(OPEN). Retrospective chart review of total 61 patients who received thyroidectomy through OPEN (n = 34) or TOETVA (n = 27) approach in single tertiary center were enrolled. There were significant differences in F0 between the two groups and there were significant changes from different time points within each group in jitter for vowel /i/. Aerodynamically, there were significant differences in mean sound pressure level for vowel /a/ and mean sound pressure level, mean air pressure, and aerodynamic resistance for syllable /pa/ between the two groups. In subjective VHI evaluations, there were no significant differences between the two groups. This study is significant in that it has investigated voices of patients with TOETVA. Results of this study are expected to be useful for voice evaluation, treatment, and prevention in the future. 3 [ABSTRACT FROM AUTHOR]

Background: Minimally invasive and endoscopic surgical techniques have surpassed the conventional open thyroidectomy for the treatment of thyroid nodules. Trans-axillary, Unilateral Axillo-Breast Approach (UABA), Bilateral Axillo-Breast Approach, and Trans-Oral Endoscopic Thyroidectomy Vestibular Approach (TOETVA) are the most common endoscopic procedures performed currently. This article highlights our experiences with UABA and TOETVA over a period of 6 years. Materials and Methods: Between January 2015 and December 2020, we retrospectively analyzed our experience in Endoscopic thyroidectomy with 119 patients using UABA (n = 72) and TOETVA (n = 47) in our tertiary care teaching hospital. Both approaches used the standard three-port technique. Real time angiography was performed intraoperatively using Indocyanine Green dye to delineate the vessels in all patients. Results: The mean operative time for UABA and TOETVA was 90 and 110 minutes, respectively. Estimated blood loss was 18 mL in the former and 20 mL in the latter. Temporary Recurrent Laryngeal Nerve palsy and Hypoparathyroidism were minimal with TOETVA (5 patients versus 4 patients and 7 patients versus 2 patients). Shorter duration of hospital stay was observed with UABA (3 days versus 5 days). Cosmetic satisfaction was better with TOETVA. Conclusion: Based on our 6-year experience, we propose "JJ Hospital Criteria," which we currently follow to decide which surgical approach will yield best results. UABA and TOETVA are safe, feasible, and give exceptional cosmetic satisfaction. Both approaches should be seen as complementary rather than competitive. [ABSTRACT FROM AUTHOR]

Objective: We had previously reported endoscopic central and lateral neck dissection via breast combined with an oral approach for papillary thyroid cancer treatment. In this study, we optimized the procedure with Wu's seven steps to make the procedure quicker and easier. Methods: Wu's seven steps for endoscopic central and lateral neck dissection via breast combined with oral approach for papillary thyroid cancer are: (1) establish the working space, (2) isolate the sternocleidomastoid and internal jugular vein, (3) dissect the thyroid via breast approach, (4) dissect the central lymph nodes via oral approach, (5) dissect the inferior board of level IV via oral approach, (6) remove the tissues of levels IV, III, and II via breast approach, and (7) wash the working space and place drainage tubes. Twelve patients were assigned to the Wu's seven steps group, and 13 patients were assigned to the contrast group. The operative procedure of the contrast group was the same as Wu's seven steps except for a few key differences, such as that the central lymph nodes were dissected via breast approach first and the internal jugular vein(IJV) was dissected from the cricoid cartilage down to the venous angle. Results: The Wu's seven steps group had a short operation time and few injuries of the internal jugular vein. There were no statistical differences in other clinicopathological features or surgical complications. Conclusion: It appears that Wu's seven steps for endoscopic central and lateral neck dissection via breast combined with oral approach for papillary thyroid cancer are effective and safe. [ABSTRACT FROM AUTHOR]

Background: Scarless endoscopic thyroidectomy (ET) is increasingly accepted by the growing amount of surgeons. The target of this study is to assess the efficacy and summarise the experiences of total areola approach for ET (TAAET). Subjects and Methods: TAAET was performed on 529 patients between January 2016 and October 2021. All operated patients were divided into two groups according to the chronological order. Demographic data, perioperative data and post-operative complications were collected to assess the effectiveness of TAAET. Results: Five hundred and twenty-eight patients were successfully treated with TAAET, while 1 case was converted to open surgery due to bleeding. The surgical approach consists of lobectomy or total thyroidectomy with or without central lymph node dissection. The post-operative pathology of 433 (81.9%) patients was diagnosed with T1 ~2N0M0. The average number of unilateral lymph node dissection was 7.72 ± 2.44 while the bilateral lymph node was 10.70 ± 3.72. In terms of complications, 38 cases had transient hoarseness, 28 cases had tetany and numbness, 3 cases had post-operative bleeding, 1 case had infection and 33 cases had subcutaneous fluid. There were statistically significant differences between the two groups with respect to transient hoarseness (P < 0.001), tetany and numbness (P = 0.005), intraoperative blood loss (P = 0.003) and operation time for malignant tumour (P < 0.001) because of the accumulation of surgical experience and the maturation of technology. Conclusions: TAAET which conforms to the anatomical pathway of open thyroidectomy is a safe, effective and feasible technique and is highly suitable for novices.

Although squamous metaplasia is a well-known occurrence in papillary thyroid carcinoma (PTC), it is extremely uncommon to diagnose a PTC with squamous differentiation (PTC-SD), especially in a non-elderly patient, thus raising a diagnostic challenge when considering its broad histopathological differential diagnosis. Endoscopic thyroidectomy via axillo-bilateral breast approach (ABBA) has been recently validated as an appropriate surgical alternative to conventional thyroidectomy for treating PTC in the selected patients. Hereby, we report a rare case of PTC-SD diagnosed in a solitary thyroid nodule (STN) in a 30-year-old man with a family history of thyroid cancer who was operated using the endoscopic ABBA. In fact, detection of the squamous cell carcinoma component may not be feasible through fine needle aspiration cytology or frozen section examinations, while permanent paraffin sections and immunohistochemistry (if required) usually allows for its identification. Due to their diverse clinical and biological behaviors, it is important to differentiate PTC-SD from other conditions in which a thyroid specimen contains a squamous epithelium. PTCSD patients with favorable clinicopathological criteria as young age and localized disease can be fortunate candidates for the minimally invasive thyroidectomy approaches as endoscopic ABBA.

Objective: To compare the effects of transoral endoscopic thyroidectomy vestibular approach (TOETVA) and via areola of breasts approach endoscopic thyroidectomy (ETE) on visual pain simulation (VAS) score, trauma-immune index and aesthetic degree of thyroid micropapillary carcinoma. Methods: The clinical data of 100 patients with thyroid micropapillary carcinoma who were received in our hospital from March 2020 to December 2021 were analyzed retrospectively. The patients were divided into group A (n=47, treated with ETE) and group B (n=53, treated with TOETVA) according to different approaches. Perioperative indexes, trauma-immune indexes, aesthetic degree and complication rate were compared in the two groups. Results: There were no differences between the two groups in the intraoperative blood loss, the number of central lymph nodes dissected and postoperative hospital stay (P>0.05). The operation time in the group B was longer than that in the group A, and the VAS score of the neck on the first day after operation was lower than that in the group A (P<0.05). CD8+, interleukin-6 (IL-6), C-reactive protein (CRP) and cortisol (Cor) increased in the two groups at 3 d after operation, but the group B was lower than the group A (P<0.05). CD4+ decreased in the two groups at 3 d after operation, but the group B was higher than the group A (P<0.05). The scores of Vancouver scar scale (VSS) and Patient and observer scar assessment scale (POSAS) in the group B were lower than those in the group A (P<0.05). There was no significant difference in the incidence of complications in the two groups(P>0.05). Conclusion: Compared with ETE, TOETVA can achieve a comparable surgical effect in the treatment of thyroid micropapillary carcinoma, and TOETVA can better reduce postoperative pain, postoperative trauma, and improve aesthetics. [ABSTRACT FROM AUTHOR]

The identification of a lower boundary for the central lymph node (CLN) of the neck in total endoscopic thyroidectomy via the areola approach (ETA) is important for its radical dissection. We found that resection of the suprasternal fossa fat (SFF) was beneficial for exposing the lower boundary and preventing suprasternal swelling after the operation. This retrospective analysis included 470 papillary thyroid carcinoma (PTC) cases, with some treated by unilateral lobectomy, some by central lymph node dissection (CLND) through ETA (n = 193), and the others by conventional open thyroidectomy (COT, n = 277). The main observation indicators included the total number of CLNs, CLND operative time, visualization of the upper pole of the thymus before removing the CLN, and postoperative suprasternal swelling. The SFF retention group and COT group had a similar percentage of women (78.65% vs. 79.42%, P = 0.876) lower than that in the SFF resection group (95.19%, P < 0.001). The percentage of the visualized upper pole of the thymus before CLN removal was notably higher in the SFF resection group than that in the SFF retention group (63.46 vs. 29.21%, P < 0.001) but notably lower than that in the COT group (63.46% vs. 100%, P < 0.001). A total of 43.82% and 23.1% of patients in the SFF retention and COT groups showed suprasternal swelling, respectively. No patient exhibited such swelling in the SFF resection group (23.1% vs. 0, P < 0.001). Resection of SFF in ETA easily identified the lower boundary for CLND and prevented suprasternal fossa swelling. [ABSTRACT FROM AUTHOR]

Background: Patients undergoing conventional endoscopic thyroidectomy via the axillary approach, which is commonly used clinically, suffered from a range of postoperative complications. This study aimed to prevent postoperative complications and evaluate patients' satisfaction with cosmetic outcomes in endoscopic thyroidectomy via the axillary with the use of "Elastic Stretch Cavity Building" System. Methods: In this retrospective case series study, the clinical data of patients who were admitted to the Thyroid Surgery Department of Ningbo Medical Centre Lihuili Hospital between December 2020 and December 2021 for endoscopic thyroidectomy via the axillary approach under the "Elastic Stretch Cavity Building" System. Results: A total of 67 patients were included, all surgeries were successfully completed. The operation time was 75.61 ± 13.67 minutes; the postoperative drainage volume was 109.97 ± 37.54 ml; the average postoperative hospital stay was 4 (2-6) days. There was no skin ecchymosis, effusion or infection, hypocalcemia, convulsions, upper extremity dyskinesia, and temporary hoarseness after the surgery. The patients were satisfied with the cosmetic effects, and the cosmetic score was 4 (3-4). Conclusion: The "Elastic Stretch Cavity Building" System in endoscopic thyroid surgery via the axillary approach might reduce the risks of complications and achieve satisfactory results with the cosmetic outcomes. [ABSTRACT FROM AUTHOR]

Background: Endoscopic thyroidectomy (ET) via gasless unilateral axillary (GUA) approach has been widely implemented worldwide. Based on our concept of mesothyroid excision in open surgery, we proposed a novel anatomy-based fivesettlement method in ET via the GUA approach. This preliminary report aimed to explore the efficacy and safety of this method in patients with papillary thyroid carcinoma (PTC). Methods: PTC patients who underwent endoscopic ET and unilateral central compartment neck dissection (CCND) via GUA approach with the fivesettlement method at the Department of General Surgery, Nanfang Hospital, Southern Medical University from March 2020 to December 2021 were retrospectively collected. The data included general clinicopathological characteristics, surgical information (including duration, complication, and clinicopathological features), and hospital stay information, and other medical records were documented. Results: In total, 521 patients underwent lobectomy and CCND under the GUA approach with the five-settlement method. The mean number of lymph nodes yielded (LNY) and positive lymph nodes (PLN) was 5.7 ± 4.3 (range, 1-30) and 1.0 ± 1.8 (range, 0-12), respectively. The incidence of transient recurrent laryngeal nerve injury was 1.1%. Chyle leakage and Horner's syndrome respectively occurred in one patient (0.2%). Five (0.9%) patients developed a hematoma. No severe complications or conversion to open surgery have occurred. Conclusion: The five-settlement method could be implemented safely and efficiently in ET+CCND via the GUA approach in selected PTC patients. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the oncologic safety and surgical outcomes of endoscopic thyroidectomy (ET) performed via different surgical approaches for papillary thyroid carcinoma (PTC). Methods: We reviewed the medical records of PTC patients who underwent ET between May 2015 and May 2021, at the Department of General Surgery, Beijing Friendship Hospital (affiliated with Capital Medical University). The patients were divided into three groups: the ET via breast approach (ETBA) group, the transoral ET vestibular approach (TOETVA) group, and the ET via transaxillary approach (ETTA) group. We evaluated the safety and surgical outcomes of each of these ET approaches. Results: A total of 490 patients were included in the analysis: 416 in the ETBA group, 57 in the TOETVA group, and 17 in the ETTA group. There were no significant differences among the groups in clinicopathologic characteristics or surgical procedures, or in the incidences of complications such as hematoma, subcutaneous emphysema, infection, and chyle. The incidences of transient and permanent recurrent laryngeal nerve (RLN) injury were 1.4% and 4.3%, respectively, with no significant difference among the three groups. The incidences of transient and permanent postoperative hypoparathyroidism were 13.7% and 1.4%, respectively. The incidence of transient hypoparathyroidism in the TOETVA group was 1.7%, which was significantly lower than that in the ETBA group. The postoperative 1-, 3- and 5-year rates of disease-free survival were 99.5%, 96.8%, and 95.9%, respectively. Univariate and multivariate analyses showed that ET was not a significant risk factor for recurrence or metastasis (p = 0.83 and p = 0.49, respectively), regardless of the surgical approach. Conclusions: TOETVA may be associated with a lower incidence of temporary hypoparathyroidism than ETBA. Apart from this difference, ETBA, ETTA and TOETVA showed comparable oncologic safety and surgical outcomes. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the mechanisms of recurrent laryngeal nerve (RLN) injury during endoscopic thyroidectomy via breast approach (ET‐BA) in patients with papillary thyroid carcinoma (PTC). Methods: The records of 416 PTC patients who underwent ET‐BA with intraoperative neural monitoring (IONM) from May 2015 to May 2021 in Beijing Friendship Hospital affiliated to Capital Medical University were retrospectively analyzed. Results: All patients were women. Mean age was 37.80 (7.87) years. The ET‐BA was performed in 416 patients. Overall incidence of RLN injury was 4.3% (18 patients). Injury was transient in 13 patients (3.1%) and permanent in five (1.2%). Macroscopic physical changes were apparent in the injured nerve in five patients (27.8%) and postoperative hoarseness or cough after drinking water were present in 11 (61.1%). Two RLN injuries occurred during nerve identification at the RLN laryngeal entry point into the surgical field, 15 during early nerve dissection somewhere between the first 0.5 and 2 cm of the nerve's course through the surgical field, and one occurred distal to 2 cm. The percentage of patients with separation, transection, traction and thermal mechanisms of injury was 27.8%, 22.2%, 22.2%, and 16.7%, respectively. The mechanism of injury was unknown in 11.1%. Conclusions: RLN injury may still occur during ET‐BA despite endoscopic magnification and early nerve identification even when IONM is used. Separation, transection, and traction injuries were the most frequent causes of injury. [ABSTRACT FROM AUTHOR]

Hemithyroidectomy plus prophylactic central neck dissection (pCND) has been adopted as a de-escalating surgical strategy for low-risk papillary thyroid cancer (PTC). This study aimed to evaluate and compare the outcomes of these two different endoscopic approaches in the treatment of PTC with hemithyroidectomy plus pCND. This retrospective study reviewed medical records of 545 patients receiving breast approach (ETBA) (n = 263) or gasless transaxillary approach (ETGTA) (n = 282) in treating PTC. Demographics and outcomes were compared between the two groups. Preoperatively, the two groups were similar in demographics. Regarding surgical outcomes, no differences were found in terms of intraoperative bleeding, total amount of drainage, duration of drainage, postoperative pain, hospital stay, vocal cord palsy, hypoparathyroidism, hemorrhage, wound infection, chyle leakage, or subcutaneous ecchymosis. Conversely, ETBA recorded fewer skin paresthesia (1.5% vs. 5.0%, respectively) but longer operative times (138.1 ± 27.0 vs. 130.9 ± 30.8 min,) and more swallowing disturbances (3.4% vs. 0.7%) compared to ETGTA (p < 0.05). No difference in scar cosmetic results, but ETBA had lower neck assessment score than ETGTA (2.6 ± 1.2 vs. 3.2 ± 2.0, p < 0.05). For low-risk PTC, endoscopic hemithyroidectomy plus pCND using either ETBA or ETGTA is both feasible and safe. Although the two approaches are comparable in terms of most surgical and oncological outcomes, ETBA is superior to ETGTA in terms of neck cosmetic results and skin paresthesia but is associated with more swallowing disturbances and requires a longer operative time. [ABSTRACT FROM AUTHOR]

Purpose Thermal ablation (TA) is a minimally invasive treatment method for symptomatic benign thyroid nodules (BTNs). This study aimed to evaluate the value of TA by comparing the efficacy, safety, and patient satisfaction with conventional/open thyroidectomy (ConT) and endoscopic thyroidectomy (ET) for symptomatic BTNs. Methods Patients with symptomatic BTNs who underwent ConT, ET, or TA therapy between January 2018 and January 2020 were included. Pre-operation data of the two comparisons (TA vs. ConT and TA vs. ET) was balanced using propensity score matching. The technique efficacy (volume reduction ratio ≥50%), nodule disappearance, and regrowth rate were calculated after ablation. The operation and hospitalization time, medical cost, complications, post-operative symptoms, and cosmetic scores were recorded and compared. Patient satisfaction was evaluated using a telephone survey. Results After a median 19-month follow-up (range, 12–36 months), the technique efficacy rate, nodule disappearance, and regrowth rate were 93.2% (119/129), 6.8% (10/129), and 0.8% (1/129), respectively. Operation time, hospitalization time, and medical costs were less for patients in the TA group than for patients in the ConT and ET groups (all p 0.05). Post-operative hypothyroidism was less frequent in the TA group than in the ConT and ET groups (all p

Total endoscopic thyroidectomy (TET) using low CO2 insufflation provides cosmetic advantage, excellent working space and visibility. On the contrary, suctioning blood or mist/smoke produced by energy device application causes narrowing of working space especially in neck surgery. In this regard, AirSeal intelligent flow system would be particularly suitable in TET. However, the benefit of AirSeal is unknown in TET unlike abdominal surgery. Therefore, the impact of AirSeal was evaluated in TET in this study. Twenty patients who underwent total endoscopic hemithyroidectomy were retrospectively analyzed. Insufflation was conducted by either conventional or AirSeal system according to the surgeon's preference. Short-term surgical outcomes including operation time, bleeding, frequency of scope cleaning, and disappearance of subcutaneous emphysema were compared as well as actual visibility. AirSeal application dramatically reduced obstacle smoke/mist and prevented narrowing working space by suctioning. Frequency of scope cleaning was significantly less in AirSeal group than that in conventional group (p = 0.016). In patients with nodule < 5 cm, intraoperative hemorrhage was less in AirSeal group than that in the counterpart (p = 0.077) regardless of larger nodule size in AirSeal group (p = 0.058). Notably, subcutaneous emphysema around surgical cavity disappeared significantly earlier in AirSeal group than in the counter parts (p = 0.019). On the contrary, AirSeal application did not shorten operation time in the current study. AirSeal provided excellent visibility and seamless operation. AirSeal has great potential to decrease not only surgeon's stress but surgical invasion on patients. The results in this study give rational to AirSeal application to TET. [ABSTRACT FROM AUTHOR]

Background: The transoral endoscopic thyroidectomy vestibular approach (TOETVA) is receiving increased attention, frequently due to growing requirements for cosmetic incisions. Here, we report our initial experience and discuss the safety and efficacy of the innovative surgical working space suspension system for gasless TOETVA. Methods: We retrospectively analyzed 75 consecutive patients for whom gasless TOETVA with our novel working space suspension system was used. This suspension system included self-developed retractors, a sterile bandage, and an anesthesia stand. We also improved some main surgical instruments in gasless TOETVA. Results: The study included 75 patients who successfully underwent thyroidectomy and central neck dissection via gasless TOETVA. The mean operating time was 143.27 ± 34.60 min. The mean number of retrieved lymph nodes was 8.00 ± 5.39. Conversion to open surgery did not occur, nor did patients exhibit serious postoperative complications. Postoperative complications included 4 cases of transient recurrent laryngeal nerve (RLN) palsy, 9 of transient hypoparathyroidism, and 3 of transient mental nerve injury. One patient with subcutaneous fluid after surgery recovered after aspiration. Another patient with submental minor perforation recovered well after suturing. There was no evidence of specific complications related to self-designed retractors. Conclusion: The innovative working space suspension system for gasless TOETVA provided enough and stable working space and optimized the clarity of the surgical field without CO2-related complications. [ABSTRACT FROM AUTHOR]

Objective To analyze the advantages and disadvantages of endoscopic thyroidectomy through different approaches compared with conventional transcervical thyroidectomy. Methods Between January 2019 and January 2021, 100 patients underwent thyriodectomy through different approaches for thyroid cancer in our department. The medical records of these patients were reviewed retrospectively, and the surgical complications were assessed on the basis of clinical findings. Pain score and cosmetic satisfaction was evaluated in questionnaires at first day and 1month, 6 months after surgery respectively. Results Patients of endoscopic groups were younger than the traditional group, while the lymph node positive rate and metastasis ratio of the endoscopic groups were same with the traditional group. The operating time of the endoscopic groups was longer than that of the traditional group. The hospitalization time and drainage placement time was longer in endoscopic groups compared with the traditional group. Pain was most obvious at the first day in the transoral group, and relieved significantly one month postoperatively. Cosmetic satisfaction was the highest in the transoral group, followed by the transaxillary group. Conclusions Endoscopic thyroidectomy had good surgical effect compared with conventional transcervical thyroidectomy. Although endoscopic surgery extends hospitalization time and increases hospitalization costs, cosmetic satisfaction after surgery was high, which could further improve the patients' quality of life. [ABSTRACT FROM AUTHOR]

Although squamous metaplasia is a well-known occurrence in papillary thyroid carcinoma (PTC), it is extremely uncommon to diagnose a PTC with squamous differentiation (PTC-SD), especially in a non-elderly patient, thus raising a diagnostic challenge when considering its broad histopathological differential diagnosis. Endoscopic thyroidectomy via axillo-bilateral breast approach (ABBA) has been recently validated as an appropriate surgical alternative to conventional thyroidectomy for treating PTC in the selected patients. Hereby, we report a rare case of PTC-SD diagnosed in a solitary thyroid nodule (STN) in a 30-year-old man with a family history of thyroid cancer who was operated using the endoscopic ABBA. In fact, detection of the squamous cell carcinoma component may not be feasible through fine needle aspiration cytology or frozen section examinations, while permanent paraffin sections and immunohistochemistry (if required) usually allows for its identification. Due to their diverse clinical and biological behaviors, it is important to differentiate PTC-SD from other conditions in which a thyroid specimen contains a squamous epithelium. PTC-SD patients with favorable clinicopathological criteria as young age and localized disease can be fortunate candidates for the minimally invasive thyroidectomy approaches as endoscopic ABBA. [ABSTRACT FROM AUTHOR]

Background: Transoral thyroidectomy has superior cosmesis and better postoperative voice outcomes than conventional thyroidectomy. However, it usually requires a steep learning curve and longer operative time. The transoral robotic thyroidectomy (TORT) learning curve has not been well investigated. This study aimed to evaluate the TORT learning curve and factors affecting operative time. Methods: We retrospectively studied 173 consecutive patients who underwent TORT with or without central neck dissection from July 2017 to August 2021. We assessed the TORT learning curve using operative time, complication rate, and surgical success (procedure conversion) rate. The operative time and surgical success rate learning curves were calculated using the cumulative summation (CUSUM) method. Additionally, we analyzed factors affecting operative time in TORT. Results: Total thyroidectomy operative time was significantly longer than those of lobectomy and isthmusectomy (p < 0.001). In correlation analysis, a significantly positive correlation was observed between body mass index (BMI) and operative time (R2 = 0.04, p = 0.025). The TORT learning curve was 52 cases in the CUSUM operative time analysis. In the CUSUM surgical success rate chart, the turning point was the 55th case. Complication and procedure conversion rates were significantly decreased after the learning curve. Conclusions: The CUSUM learning curve of TORT was about 52–55 cases, and the operative time, total complication rate, and procedure conversion decreased significantly after the learning curve. The operative time was associated with the extent of thyroidectomy and BMI. [ABSTRACT FROM AUTHOR]

Background: Scarless endoscopic thyroidectomy (ET) is increasingly accepted by the growing amount of surgeons. The target of this study is to assess the efficacy and summarise the experiences of total areola approach for ET (TAAET). Subjects and Methods: TAAET was performed on 529 patients between January 2016 and October 2021. All operated patients were divided into two groups according to the chronological order. Demographic data, perioperative data and post-operative complications were collected to assess the effectiveness of TAAET. Results: Five hundred and twenty-eight patients were successfully treated with TAAET, while 1 case was converted to open surgery due to bleeding. The surgical approach consists of lobectomy or total thyroidectomy with or without central lymph node dissection. The post-operative pathology of 433 (81.9%) patients was diagnosed with T1 ~2N0M0. The average number of unilateral lymph node dissection was 7.72 ± 2.44 while the bilateral lymph node was 10.70 ± 3.72. In terms of complications, 38 cases had transient hoarseness, 28 cases had tetany and numbness, 3 cases had post-operative bleeding, 1 case had infection and 33 cases had subcutaneous fluid. There were statistically significant differences between the two groups with respect to transient hoarseness (P < 0.001), tetany and numbness (P = 0.005), intraoperative blood loss (P = 0.003) and operation time for malignant tumour (P < 0.001) because of the accumulation of surgical experience and the maturation of technology. Conclusions: TAAET which conforms to the anatomical pathway of open thyroidectomy is a safe, effective and feasible technique and is highly suitable for novices. [ABSTRACT FROM AUTHOR]

Objective: Studies have shown that carbon dioxide (CO2) insufflation during endoscopic thyroidectomy is associated with many risks. Recently, we have designed a simple lifting tool using Kirschner wire. We aimed to use this tool for flap-lifting in modified areola approach endoscopic thyroidectomy and compare it with conventional CO2 insufflation. Methods: In a prospective study, patients who underwent endoscopic thyroidectomy via modified areola approach were randomly assigned into gasless (n = 20) or CO2 groups (n = 22). Pre-operative variables included age, gender, tumor diameter, and clinical diagnosis. Intra-operative hemodynamic monitoring included mean arterial pressure, heart rate, pulse oximetry, end-tidal carbon dioxide (ET-CO2) and arterial pH. Other intraoperative details included total operative time, operative blood loss, conversion from endoscopic surgery to open surgery, intra-operative events, and endoscope video score. Postoperatively, the hospital stay, drainage volume, and complications were recoded. Results: Patient characteristics were not different between the two groups. During the operation, ET-CO2 levels were significantly higher in the CO2 group (P < 0.05), whereas arterial pH levels were significantly lower (P < 0.05). The CO2 group had longer operation time and higher endoscope clarity VAS score than gasless group. Hospital stay, drainage volume, and postoperative complications did not differ significantly between the two groups (P > 0.05). Conclusions: The gasless endoscopic thyroidectomy we performed via our Kirschner wire hook was safe, feasible, and yielded good results. [ABSTRACT FROM AUTHOR]