Clinical Outcomes Of Trans-Breast Approach Endoscopic Thyroidectomy

Objective: Through clinical prospective nonrandomized comparative study, to investigate the differences of invasiveness, post-operative pain, functional rehabilitation and cosmetic result between trans-breast approach endoscopic thyroidectomy and conventional open thyroidectomy, to address the minimal invasiveness of trans-breast approach endoscopic thyroidectomy , to initially analyze the relationship between the invasiveness and operation parameters of trans-breast approach endoscopic thyroidectomy, and further, to approach the way to minimize the invasiveness of trans-breast approach endoscopic thyroidectomy to patients.Methods: Twenty four patients underwent trans-breast approach endoscopic thyroidectomy and nineteen patients underwent conventional open thyroidectomy were collected in this study and was named endoscopic group and open group respectively. The length of incision, duration of operation, bleeding volume and weight of resected thyroid tissue were compared between two groups. The postoperative-to-preoperative variations of body temperature, WBC count, heterophil granulocyte number, serum concentration of IL-6, CRP and Cortisol were compared between two groups at the time points of 2hs, 12hs, 24hs and 48hs after surgery. The pain scale was compared between two groups at the time points of 2hs, 12hs, 24hs and 48hs after surgery. The cosmetic result was compared between two groups by NSS (Numeric Score System). By recording the first time patients getting out of bed, taking food and washing by themselves, the difference of functional rehabilitation between two groups was analyzed and compared. In endoscopic group, the relationship was analyzed between the patients' highest serum IL-6 concentration and operation parameters, including duration of operation, bleeding volume, weight of resected thyroid tissue and the area of separated skin flap on patients' anterior chest wall.Results: All of the procedures were completed successfully and no post-operative bleeding, recurrent laryngeal nerve injury, superior laryngeal nerve injury and parathyroid gland injury occurred. In endoscopic group, there was no convertion. No hypercapnia, subcutaneous emphysema and anterior chest wall effusion occurred. All patients discharged in good health.1. No difference was found in gender ratio, body weight and tumor volume between two groups (P > 0.05 ) . In edcoscopic group, the age of patients was smaller than that in open group (P >0.05) .2. No significant difference in duration of operation and weight of resected thyroid tissue was found between two groups (P > 0.05) . The bleeding volume and length of incision in endoscopic group was significantly less than that in open group (P<0.0001) .3. The body temperature at the time points of 2hs, 12hs, 24hs and 48hs after surgery in both groups was significantly higher than the pre-operative body temperature (P < 0.01). The postoperative-to-preoperative variation of body temperature in endoscopic group was significantly less than that in open group at the time point of 48hs after surgery(P < 0.05). The variations at other time points were of no difference between two groups(P > 0.05).4. In endoscopic group, at the time points of 12hs and 24hs after surgery, the WBC count in peripheral blood was much more than the pre-operative one(P<0.01). While at the time points of 2hs and 48hs after surgery, there was no difference(P > 0.05). In open group, at all the time points after surgery, he WBC count in peripheral blood was much more than the pre-operative one(P < 0.05), especially at the time points of 12hs and 24hs after surgery, the difference was significant(P<0.01). The postoperative-to-preoperative variation of WBC count in peripheral blood at all time points after surgery was of no difference between two groups(P > 0.05).5. In both groups, the heterophil granulocyte number at all time points after surgery was obviously more than the pre-operatife one(P < 0.01). The postoperative-to-preoperative variation of heterophil granulocyte number in peripheral blood at the time point of 24hs after surgery was significantly less in endoscopic group than in open group(P < 0.05). At other time points after surgery the variation was of no difference between two groups(P > 0.05).6. In both groups, the serum concentration of IL-6 at all time points after surgery was obviously higher than the pre-operative one(P < 0.01). No difference of postoperative-to-preoperative variation of IL-6 concentration was found at the time points of 2hs and 12hs after surgery between two groups. While at the time points of 24hs and 48hs after surgery, the postoperative-to-preoperative variation of IL-6 concentration was significant less in endoscopic group than in open group.7. In both groups, the serum concentration of CRP at the time points of 2hs and 12hs after surgery was of no difference with the pre-operative one(P > 0.05). While at the time points of 24hs and 48hs after surgery, the serum concentration of CRP was much higher than the pre-operative one in two groups(P < 0.01). No difference of postoperative-to-preoperative variation of CRP concentration was found at the time points of 2hs and 12hs after surgery between two groups. While at the time points of 24hs and 48hs after surgery, the postoperative-to-preoperative variation of CRP concentration was significantly less in endoscopic group than in open group.8. The postoperative-to-preoperative variation of Cortisol concentration was less in endoscopic group than in open group at the time point of 2hs after surgery(P < 0.05). At other time points, the postoperative-to-preoperative variation of Cortisol concentration was of no difference between two groups(P > 0.05).9. In endoscopic group and open group, the highest pain scale occurred at 12hs after surgery and the pain scale was 2.93±0.81 and 2.93±0.81 respectively. At the time points of 2hs, 12hs and 24hs after surgery, the pain scale in endoscopic group was significantly higher than that in open group(P < 0.01). Upon the time point of 48hs after surgery, there was no difference of pain scale between two groups(P > 0.05).10. In endoscopic group, the first time patients getting out of bed by themselves was 18.2±4.48hs after surgery, earlier than the patients in open group(23.2±3.86hs after surgery, P<0.05). In endoscopic group, the first time patients washing by themselves was 26.4±7.64hs after surgery, earlier than the patients in open group(37.1±6.85hs after surgery, P < 0.05). The time patients taking food by themselves was of no difference between endoscopic group(21.2±3.89hs after surgery) and open group(25.3±7.08hs after surgery, P > 0.05).11. Patients underwent trans-breast approach endoscopic thyroidectomy were more satisfied with the cosmetic result than patients underwent conventional open thyroidectomy one month and three months after surgery.12. In endoscopic group, the highest serum IL-6 concentration of patient was in tight connection with duration of operation, weight of resected thyroid tissue and the area of separated skin flap on anterior chest wall (P value is 0.0703, 0.0539 and 0.0209 respectively), among which the area of separated skin flap on anterior chest wall influenced the highest IL-6 concentration most (standardized regression coefficient is 0.40219). Bleeding volume was excluded from the influence factors of patients' highest IL-6 concentration.Conclusion:1. Trans-breast approach thyroidectomy provides significant benefit in terms of cosmetic result.2. The pain produced by trans-breast approach endoscopic thyroidectomy is less than that produced by conventional open thyroidectomy. The functional rehabilitation of patient underwent trans-breast approach endoscopic thyroidectomy is faster than that of patient underwent conventional open thyroidectomy.3. Duration of operation, weight of resected thyroid tissue and the area of separated skin flap on anterior chest wall are of significant contribution to the invasiveness produced by trans-breast approach endoscopic thyroidectomy, among which the area of separated skin flap on anterior chest wall influence the most. In the operation course of trans-breast approach endoscopic thyroidectomy, the invasiveness will be reduced further by reducing the unnecessary separation of skin flap to the limit, improving the skill of operator, enhancing the cooperation between operator and assistants and shortening the duration of operation.4. The invasiveness of trans-breast approach endoscopic thyroidectomy is less than conventional open thyroidectomy.