Axillo-breast versus bilateral axillo-breast endoscopic thyroidectomy: a randomized quality-of-life study

Area of Science:

• Endocrinology
• Surgical Oncology
• Minimally Invasive Surgery

Background:

• Thyroid lesions are prevalent globally, with conventional thyroidectomy leaving visible scars.
• Endoscopic techniques like Axillo-Breast Approach (ABA) and Bilateral Axillo-Breast Approach (BABA) aim to improve cosmetic outcomes.
• This study compares ABA and BABA for postoperative health-related quality of life (QOL).

Purpose of the Study:

• To compare the postoperative health-related quality of life (QOL) between Axillo-Breast Approach (ABA) and Bilateral Axillo-Breast Approach (BABA) endoscopic hemithyroidectomy.
• To evaluate secondary outcomes including complications, hospital stay, pain, and procedural difficulty.

Main Methods:

• A randomized controlled trial involving 64 adult patients with Bethesda category III or lower cytology and small thyroid glands.
• Patients were randomized to undergo endoscopic hemithyroidectomy via either ABA or BABA.
• Postoperative QOL was assessed using SF-36 and thyroid-specific questionnaires at 2, 6, and 12 weeks.

Main Results:

• No significant differences in most SF-36 QOL domains between ABA and BABA at 6 weeks.
• ABA showed a trend toward higher general health and vitality scores at 2 weeks.
• ABA demonstrated significantly less early postoperative neck/chest numbness and better neck mobility compared to BABA, with differences resolving by 6-12 weeks.

Conclusions:

• Both ABA and BABA endoscopic hemithyroidectomy are safe and effective procedures.
• Most long-term quality-of-life outcomes were comparable between the two endoscopic approaches.
• ABA offers a transient advantage in mitigating early postoperative discomfort and mobility limitations.