Department of Surgery, NSCB Medical College, Jabalpur, Madhya Pradesh, India.
Breast Surgery, Wythenshawe Hospital, NHS, Manchester, UK.
World J Surg. 2024 Feb;48(2):379-385. doi: 10.1002/wjs.12012. Epub 2023 Dec 23.
It is important for the endoscopic thyroid surgeon to understand the pros and cons of trans-oral endoscopic thyroidectomy-vestibular approach (TOETVA) vis-à-vis, open conventional thyroidectomy (OTx) so he/she can help patients in making informed choices regarding the type of procedure to opt for. Swallowing related quality of life (SWAL-QoL) has not been compared between the two approaches. Using a rigorous qualitative methodology and validated reliable tool, this study set out to compare the swallowing related quality of life in patients undergoing TOETVA versus OTx.
Prospective study at 3 time points in patients planned for hemithyroidectomy (Preoperative, 1 week and 12 weeks). Data were collected on patients at a tertiary teaching institute in India. Participants ranged from age 18-60 years with a diagnosis of benign euthyroid nodule undergoing hemithyroidectomy. Exclusion criteria were-(1) pre-existing vocal cord abnormalities, (2) undergoing surgery for recurrent nodules, and (3) any neuro-muscular disease affecting swallowing ability. Main outcome measure was comparison of swallowing related quality of life domain scores between patients undergoing hemithyroidectomy via either endoscopic trans-oral or open approach.
Of the 82 included patients, 40 underwent TOETVA and 42 OTx. Both the groups were comparable in terms of demographic and clinicopathological profile. The mean preoperative SWAL-QOL scores were comparable in all domains. Mean SWAL-QoL scores for all domains on postoperative day 7 were significantly better in TOETVA group with domains burden, eating desire, mental health and communication having medium effect sizes. Physical symptom domain was better in the OTx group but had a small effect size. The difference in SWAL-QoL domains between the two groups persisted for 3 months also.
Swallowing related quality of life after trans-oral endoscopic thyroidectomy compared to conventional open surgery has not been reported in the literature. Our findings suggest that trans-oral endoscopic thyroidectomy results in significant superior swallowing related quality of life in the majority of domains.
对于内镜甲状腺外科医生来说，了解经口内镜甲状腺切除术-前庭入路（TOETVA）与开放式常规甲状腺切除术（OTx）的优缺点非常重要，这样他/她才能帮助患者在选择手术类型时做出明智的选择。目前尚未比较这两种方法的吞咽相关生活质量（SWAL-QoL）。本研究采用严格的定性方法和可靠的验证工具，旨在比较接受 TOETVA 与 OTx 的患者的吞咽相关生活质量。
这是一项在印度一家三级教学医院进行的前瞻性研究，在患者接受半甲状腺切除术的 3 个时间点（术前、术后 1 周和术后 12 周）收集数据。参与者年龄在 18-60 岁之间，诊断为良性甲状腺结节，接受半甲状腺切除术。排除标准为：（1）存在声带异常；（2）因复发性结节而接受手术；（3）任何影响吞咽能力的神经肌肉疾病。主要观察指标是比较接受经口内镜或开放式甲状腺切除术的患者的吞咽相关生活质量领域评分。
在纳入的 82 例患者中，40 例行 TOETVA，42 例行 OTx。两组在人口统计学和临床病理学特征方面具有可比性。所有领域的术前平均 SWAL-QOL 评分均相似。TOETVA 组术后第 7 天所有领域的平均 SWAL-QoL 评分均明显更好，负担、进食欲望、心理健康和沟通领域具有中等效应大小。OTx 组的躯体症状领域更好，但效应量较小。两组在 3 个月时 SWAL-QoL 评分的差异仍然存在。
经口内镜甲状腺切除术与常规开放式手术相比，其术后吞咽相关生活质量尚未见文献报道。我们的研究结果表明，经口内镜甲状腺切除术在大多数领域显著提高了吞咽相关生活质量。
