Department of General, Visceral, and Transplant Surgery, Ludwig-Maximilians-University Munich, Marchioninistr. 15, 81377, Munich, Germany.
Department of General, Visceral, Vascular and Endocrine Surgery, Agatharied Hospital, Hausham, Germany.
Surg Endosc. 2022 Feb;36(2):968-979. doi: 10.1007/s00464-021-08361-w. Epub 2021 Mar 8.
Thyroid surgery is often performed, especially in young female patients. As patient satisfaction become more and more important, different extra-cervical "remote" approaches have evolved to avoid visible scars in the neck for better cosmetic outcome. The most common remote approaches are the transaxillary and retroauricular. Aim of this work is to compare Endoscopic Cephalic Access Thyroid Surgery (EndoCATS) and axillo-bilateral-breast approach (ABBA) to standard open procedures regarding perioperative outcome and in addition to control cohorts regarding quality of life (QoL) and patient satisfaction.
In a single center, 59 EndoCATS und 52 ABBA procedures were included out of a 2 years period and compared to 225 open procedures using propensity-score matching. For the endoscopic procedures, cosmetic outcome, patient satisfaction and QoL (SF-12 questionnaire) were examined in prospective follow-up. For QoL a German standard cohort and non-surgically patients with thyroid disease were used as controls.
The overall perioperative outcome was similar for all endoscopic compared to open thyroid surgeries. Surgical time was longer for endoscopic procedures. There were no cases of permanent hypoparathyroidism and no significant differences regarding temporary or permanent recurrent laryngeal nerve (RLN) palsies between open and ABBA or EndoCATS procedures (χ; p = 0.893 and 0.840). For ABBA and EndoCATS, 89.6% and 94.2% of patients were satisfied with the surgical procedure. Regarding QoL, there was an overall significant difference in distribution for physical, but not for mental health between groups (p < 0.001 and 0.658). Both endoscopic groups performed slightly worse regarding physical health, but without significant difference between the individual groups in post hoc multiple comparison.
Endoscopic thyroid surgery is safe with comparable perioperative outcome in experienced high-volume centers. Patient satisfaction and cosmetic results are excellent; QoL is impaired in surgical patients, as they perform slightly worse compared to German standard cohort and non-surgical patients.
甲状腺手术通常需要进行，尤其是在年轻女性患者中。随着患者满意度变得越来越重要，为了获得更好的美容效果，不同的颈部以外的“远程”入路已经发展起来以避免颈部可见的疤痕。最常见的远程入路是经腋窝和耳后。本研究的目的是比较内镜经头皮入路甲状腺手术（EndoCATS）和双侧乳晕入路（ABBA）与标准开放手术在围手术期结果方面的差异，并与德国标准队列和非手术甲状腺疾病患者进行对照，评估生活质量（QoL）和患者满意度。
在单中心，在 2 年期间纳入了 59 例 EndoCATS 和 52 例 ABBA 手术，并与 225 例采用倾向评分匹配的开放式手术进行比较。对于内镜手术，在前瞻性随访中检查美容效果、患者满意度和 QoL（SF-12 问卷）。对于 QoL，使用德国标准队列和非手术甲状腺疾病患者作为对照组。
所有内镜与开放甲状腺手术的总体围手术期结果相似。内镜手术的手术时间较长。无永久性甲状旁腺功能减退症病例，且在开放与 ABBA 或 EndoCATS 手术之间，暂时性或永久性喉返神经（RLN）麻痹的发生率无显著差异（χ; p=0.893 和 0.840）。ABBA 和 EndoCATS 组患者对手术的满意度分别为 89.6%和 94.2%。关于 QoL，在物理健康方面，各组之间的分布存在总体显著差异，但在精神健康方面无差异（p<0.001 和 0.658）。两组内镜组的物理健康状况均稍差，但在后验多重比较中，两组间无显著差异。
在经验丰富的高容量中心，内镜甲状腺手术是安全的，具有可比较的围手术期结果。患者满意度和美容效果极佳；与德国标准队列和非手术甲状腺疾病患者相比，手术患者的生活质量受损，因为他们的表现略差。
