ObjectiveTo compare the efficacy of transoral vestibular endoscopic thyroidectomy (TOET) and transaxillary endoscopic thyroidectomy (TAET). MethodsRelevant literature comparing the two surgical approaches was retrieved via computer from both domestic and international databases from inception to April 2025. The included studies were analyzed using RevMan 5.4 software, with observation indicators including operative time, intraoperative blood loss, number of central lymph nodes dissected, postoperative drainage volume, postoperative pain score, postoperative parathyroid hormone level, postoperative complications rate, total hospital stay, and incision satisfaction. ResultsA total of 13 studies involving 1 619 patients (784 in the TOET group and 835 in the TAET group) were included. Compared with the TAET group, the TOET group had longer operative time [MD (95%CI)=17.04 (3.40, 30.69), P=0.01], more number of central lymph nodes dissected [MD (95%CI)=1.89 (0.68, 3.10), P=0.002], higher postoperative complications rate [OR (95%CI)=1.46 (1.03, 2.05), P=0.02], shorter total hospital stay [MD (95%CI)=–0.14 (–0.23, –0.04), P=0.005], and better incision satisfaction [OR (95%CI)=4.30 (1.53, 12.05), P=0.006]. There were no statistically significant differences between the two groups in intraoperative blood loss [MD (95%CI)=–0.29 (–1.25, 0.68), P=0.56], postoperative drainage volume [MD (95%CI)=–9.63 (–35.38, 16.11), P=0.46], postoperative pain score [MD (95%CI)=0.05 (–0.77, 0.86), P=0.91], or postoperative parathyroid hormone level [MD (95%CI)=–2.71 (–5.60, 0.18), P=0.07]. ConclusionsTOET demonstrates advantages in the number of lymph nodes dissected, incision satisfaction, and total hospital stay. However, it is associated with a longer operative time and a higher complications rate. The choice of surgical approach should be based on a comprehensive consideration of the patients’ cosmetic needs, tumor characteristics, and the surgeon’s experience.
ObjectiveTo evaluate the safety and efficacy of gasless endoscopic thyroidectomy via transaxillary approach in treating papillary thyroid cancer (PTC). MethodsThe patients who underwent gasless endoscopic thyroidectomy (Abbreviated as the “endoscopic group”) and neck open surgery (Abbreviated as the “open group”), in the Zhejiang Provincial People’s Hospital from January 2018 to June 2023, were collected. The intraoperative and postoperative outcomes of the patients in the two groups were compared after propensity score matching (PSM). Statistical analysis was conducted using SPSS 26.0 software, with a test level of α=0.05. ResultsAfter PSM, there were 409 patients in the endoscopic group and 421 patients in the open group. There were no statistically significant differences in the baseline data between the two groups (P>0.05), except for tumor location, vascular invasion, intraglandular dissemination, and preoperative levels of total triiodothyronine and thyroid hormone (P<0.05). Compared with the open group, the patients in the endoscopic group had less intraoperative blood loss (P<0.05), higher points of incision satisfaction and cosmetic effect (P<0.05), but the number of lymph nodes dissected was less (P<0.05) and the operation time was longer (P<0.05) in the endoscopic group. The incidence of postoperative overall complications had no statistically significant difference between the endoscopic group and open group (3.6% versus 5.8%, P=0.127). There was no statistically significant difference in the recurrence rate between the endoscopic group and open group within one year of follow-up (0.2% versus 0.5%, P=0.099). ConclusionsFrom the results of this study, the gasless endoscopic thyroidectomy is safety and reliability in treatment of PTC. It can achieve the same effect as traditional open thyroidectomy. However, it can also be seen that young female patients are more willing to choose gasless endoscopic thyroidectomy as long as their condition permits (such as early tumor stage, low invasiveness).
