Endoscopic thyroidectomy: Which one is the better technique for the beginners?

Area of Science:

• Minimally Invasive Surgery
• Endocrine Surgery
• Surgical Education

Background:

• Endoscopic thyroidectomy presents a significant learning curve for surgeons.
• The combined axillary-breast approach (ABA) is a common method, while transoral endoscopic thyroidectomy vestibular approach (TOETVA) is emerging as a scarless option.
• The optimal initial approach for learning endoscopic thyroidectomy remains unclear.

Purpose of the Study:

• To compare the initial surgical experience between TOETVA and ABA.
• To evaluate the difficulties and outcomes associated with the early learning phase of each technique.

Main Methods:

• A prospective, non-randomized interventional study included the first ten patients for each approach (TOETVA and ABA).
• Patients underwent hemithyroidectomy for benign solitary thyroid nodules.
• Statistical analysis was performed using Sigma plot version 12.3.

Main Results:

• Operative time and blood loss were similar between TOETVA and ABA groups.
• While flap elevation was faster in TOETVA, it presented greater difficulty in accessing thyroid poles, leading to more intraoperative events and conversions to open surgery.
• Postoperative pain scores were higher in the TOETVA group, though hospital stay was comparable.

Conclusions:

• The combined axillary-breast approach (ABA) is recommended as the preferred initial method for learning endoscopic thyroidectomy.
• ABA is considered easier and safer for novice surgeons compared to the transoral endoscopic vestibular approach (TOETVA).