A comparison between transoral endoscopic thyroidectomy vestibular approach and transareolar thyroidectomy regarding postoperative pain and cosmetic outcomes: A systematic review and meta-analysis.

OBJECTIVES

Remote scarless surgeries have been developed for cosmetic reasons; literature showed that remote endoscopic surgeries were superior to conventional thyroidectomy. However, no researchers have compared the transoral thyroidectomy vestibular approach and transareolar approach regarding cosmetic outcomes and postoperative pain score. This meta-analysis assessed the same among patients with papillary microcarcinoma, thyroid disease, and small-size papillary carcinoma.

METHODS

We searched PubMed MEDLINE, Web of Science, SCOPUS, and Cochrane Library from the date of the first inception up to January 2024. The general keywords used are trans-areolar thyroidectomy, trans-oral thyroidectomy vestibular approach, scar-less thyroidectomy, remote thyroidectomy, pain score, and cosmetic effects. The MeSH terms "mouth", "areola", "nipples", "vestibular", "oral", "endoscopes", "endoscopic", and "thyroid" were used. Out of the 389 studies and 114 remained after the removal of duplication, from them, 22 full texts were screened, and only 10 studies were included in the final meta-analysis.

RESULTS

The tansoral thyroidectomy vestibular approach showed better cosmetic outcomes compared to the trans-areolar approach, odd ratio, 1.26, 95% CI, 0.53-1.99. However, no significant statistical difference was found regarding postoperative pain score, odd ratio, -0.11, 95% CI, -0.26-0.04, and central lymph node dissection, odd ration, 1.52, 95% CI, -0.14-3.17.

CONCLUSION

The transoral endoscopic thyroidectomy vestibular approach was better compared to the trans-areolar approach in terms of cosmetic outcomes, no differences were evident regarding pain score and central lymph node dissection. Further larger well-controlled studies assessing operative and postoperative outcomes are needed.