Comparative Study Of Endoscopic Thyroidectomy And Traditional Open Thyroidectomy Through Oral Vestibular Approach

Objective:We analyzed the indicators after lumpectomy with transoral vestibular approach and conventional open thyroidectomy,compared the advantages and disadvantages of each procedure,and evaluated the safety,feasibility and effectiveness of lumpectomy with transoral vestibular approach to thyroid surgery.Methods:Ninety-one patients with preoperatively confirmed or highly suspected papillary thyroid cancer who were admitted to the Department of Thyroid Surgery,First Hospital of Shanxi Medical University,Taiyuan,Shanxi Province,from June 2020 to December2021 were selected,among whom patients undergoing transoral vestibular lumpectomy were one group,referred to as the transoral group(patients had a request for no scarring of the neck and signed a consent form for transoral vestibular lumpectomy treatment),and patients undergoing traditional open surgery were One group,referred to as the traditional group(patients requested open surgery and signed the consent form for traditional surgery),was used as the control group.We collected and compiled basic personal information(age,BMI,occupation,marital status),collected clinical case data(thyroid volume,maximum tumor diameter),compared intraoperative data(whether the tumor invaded the peritoneum,number of lymph nodes dissected,length of surgery,intraoperative bleeding),postoperative data(drainage,days of drainage tube retention,days of hospitalization,complications,surgical fees and total hospitalization costs),postoperative pain scores(visual analog scale VAS)at 6h,24 h and 72 h,and follow-up QLQ-C33 scores were assessed and recorded at 1 and 3 months postoperatively.Statistical analysis was done with SAS 9.4 software,and logistic regression analysis was applied to explore the factors that may influence the choice of surgical modality.Results:The patients in the transoral group were younger,had lower BMI,and a higher proportion of unmarried patients.The differences in thyroid volume,maximum tumor diameter,invasion of the perineum,number of lymph nodes dissected,intraoperative bleeding,postoperative drainage,and pain scores at 6h,24 h,and 72 h postoperatively were not statistically significant(P>0.05);while the patients in the transoral group had higher numbers of days of drainage tube retention,operative time,hospital stay,and total cost of surgery and hospitalization than those in the traditional group.The differences were statistically significant(P < 0.05)in terms of the number of days of drainage tube retention,operation time,hospitalization time,operation cost and total hospitalization cost,which were higher in the transoral group than in the conventional group.The difference in QLQ-C33 scores between the two groups was statistically significant at 1and 3 months after surgery during the follow-up period,and the scores of patients in the transoral group were smaller than those in the conventional group,indicating higher overall satisfaction.No serious complications,local recurrence,or secondary surgery were observed during the follow-up period in either group.In terms of complications,there was one case of rash and pruritus,one case of temporary hypocalcemia,one case of fever,and two cases of lower lip numbness in the transoral group.In the conventional group,there was one case of temporary hypocalcemia,two cases of postoperative fever,one case of postoperative bleeding,two cases of nausea and vomiting,and one case of celiac leakage.No serious postoperative complications such as infection,fluid accumulation,tissue necrosis,tracheal and esophageal injury occurred in either group.Conclusion:Compared with traditional open surgery,it is safe,effective,and feasible to perform lumpectomy through the oral vestibular approach without any postoperative surface scarring,which significantly reduces patients’ psychological and physiological burden and improves their quality of life and overall satisfaction.With the improvement of operation technique and the improvement of lumpectomy equipment,it is believed that the operation time and cost will be gradually reduced,and the indications for the operation will be gradually expanded to become the main operation mode in the field of thyroid lumpectomy.