Division of Head and Neck Endocrine Surgery, Department of Otolaryngology - Head and Neck Surgery, The Johns Hopkins University School of Medicine, 601 N. Caroline Street, 6th Floor, Baltimore, MD, 21287, USA.
Department of Surgery, KUMC Thyroid Center, Korea University College of Medicine, Seoul, South Korea.
World J Surg. 2021 Mar;45(3):774-781. doi: 10.1007/s00268-020-05874-8. Epub 2020 Nov 17.
North American adoption of the transoral endoscopic thyroidectomy vestibular approach (TOETVA) has been limited due to concerns regarding the generalizability of published outcomes, as data are predominantly from Asian cohorts with a different body habitus. We describe our experience with TOETVA in a North American population in the context of the conventional transcervical approach thyroidectomy (TCA).
Cases of TOETVA and TCA were reviewed from August 2017 to March 2020 at a tertiary care center. Outcomes included operative time, major (permanent recurrent laryngeal nerve (RLN) injury, permanent hypoparathyroidism, hematoma, conversion to open surgery), and minor complications. The TOETVA cohort was stratified into body mass index (BMI) classes of underweight/normal < 25 kg/m, overweight 25-29.9 kg/m, and obese ≥ 30 kg/m for comparative analysis. Multivariable logistic regression analyses were performed for odds of cumulative complication.
Two hundred TOETVA and 333 TCA cases were included. There was no difference in incidence of major complications between the TOETVA and TCA cohorts (1.5% vs. 2.1%, p = 0.75). No difference was found in the rate of temporary RLN injury (4.5% vs. 2.1%, p = 0.124) or temporary hypoparathyroidism (18.2% vs. 12.5%, p = 0.163) for TOETVA and TCA, respectively. Surgical technique (TOETVA vs TCA) did not alter the odds of cumulative complication (OR 0.69 95% CI [0.26-1.85]) on logistic regression analysis. In the TOETVA cohort, higher BMI did not lead to a significantly greater odds of cumulative complication, 0.52 (95% CI [0.17-1.58]) and 1.69 (95% CI [0.74-3.88]) for the overweight and obese groups, respectively.
TOETVA can be performed in a North American patient population without a difference in odds of complication compared to TCA. Higher BMI is not associated with greater likelihood of complication with TOETVA.
由于担心发表的结果的普遍性，北美对经口内镜甲状腺切除术前庭入路（TOETVA）的采用受到限制，因为数据主要来自亚洲队列，体型不同。我们描述了在传统经颈入路甲状腺切除术（TCA）背景下，在北美人群中使用 TOETVA 的经验。
在一家三级护理中心，对 2017 年 8 月至 2020 年 3 月期间的 TOETVA 和 TCA 病例进行了回顾性分析。结果包括手术时间、主要（永久性喉返神经（RLN）损伤、永久性甲状旁腺功能减退、血肿、转为开放手术）和次要并发症。TOETVA 队列按体重指数（BMI）分类为体重不足/正常 < 25 kg/m、超重 25-29.9 kg/m 和肥胖 ≥ 30 kg/m 进行分层，以进行比较分析。使用多变量逻辑回归分析累积并发症的可能性。
共有 200 例 TOETVA 和 333 例 TCA 病例纳入研究。TOETVA 组和 TCA 组的主要并发症发生率无差异（1.5% vs. 2.1%，p=0.75）。TOETVA 和 TCA 组暂时性 RLN 损伤（4.5% vs. 2.1%，p=0.124）和暂时性甲状旁腺功能减退（18.2% vs. 12.5%，p=0.163）的发生率也无差异。手术技术（TOETVA 与 TCA）不会改变累积并发症的可能性（TOETVA 与 TCA 的比值比（OR）0.69，95%置信区间（CI）[0.26-1.85]）。在 TOETVA 队列中，较高的 BMI 并没有导致累积并发症的可能性显著增加，超重组为 0.52（95%CI [0.17-1.58]），肥胖组为 1.69（95%CI [0.74-3.88]）。
TOETVA 可在北美患者人群中安全施行，与 TCA 相比，并发症的可能性没有差异。较高的 BMI 与 TOETVA 并发症的可能性增加无关。
