Hybrid Transoral Endoscopic Thyroidectomy Submental Access (H-TOETSA) Versus Conventional and Bilateral-Axillo Breast Approach (BABA) Thyroidectomy: A Comparative Study of Feasibility and Safety
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Purpose: This study evaluated the feasibility and safety of hybrid transoral endoscopic thyroidectomy submental access (H-TOETSA) by comparing it with conventional open thyroidectomy (COT) and the bilateral axillo-breast approach (BABA). Methods: We retrospectively analyzed 568 thyroidectomy cases performed between January 2015 and July 2021 at Dankook University Hospital. Patients who underwent total thyroidectomy were excluded because the number of H-TOETSA cases was too small for meaningful statistical comparison. A total of 388 lobectomy patients were included (319 COT, 31 BABA, and 38 H-TOETSA). Clinical and perioperative outcomes were compared using t test or χ2 test, and propensity score matching (1:1) was performed between the COT and H-TOETSA groups. Results: No significant differences were observed in estimated blood loss, hospital stay, or overall complication rates between COT and H-TOETSA. Operative time was significantly longer in H-TOETSA (114.8±29.2 minuntes vs. 81.8±37.4 minutes, P<0.001). The number of harvested central lymph nodes was similar between the two groups but higher in H-TOETSA than BABA (P=0.010). No permanent recurrent laryngeal nerve injury occurred. Conclusion: H-TOETSA demonstrated comparable safety and oncologic adequacy to conventional open surgery while providing excellent cosmetic outcomes through a small submental incision. It may serve as a feasible and safe alternative for patients with low-risk thyroid cancer.
Abstract
Purpose: This study evaluated the feasibility and safety of hybrid transoral endoscopic thyroidectomy submental access (H-TOETSA) by comparing it with conventional open thyroidectomy (COT) and the bilateral axillo-breast approach (BABA). Methods: We retrospectively analyzed 568 thyroidectomy cases performed between January 2015 and July 2021 at Dankook University Hospital. Patients who underwent total thyroidectomy were excluded because the number of H-TOETSA cases was too small for meaningful statistical comparison. A total of 388 lobectomy patients were included (319 COT, 31 BABA, and 38 H-TOETSA). Clinical and perioperative outcomes were compared using t test or χ2 test, and propensity score matching (1:1) was performed between the COT and H-TOETSA groups. Results: No significant differences were observed in estimated blood loss, hospital stay, or overall complication rates between COT and H-TOETSA. Operative time was significantly longer in H-TOETSA (114.8±29.2 minuntes vs. 81.8±37.4 minutes, P<0.001). The number of harvested central lymph nodes was similar between the two groups but higher in H-TOETSA than BABA (P=0.010). No permanent recurrent laryngeal nerve injury occurred. Conclusion: H-TOETSA demonstrated comparable safety and oncologic adequacy to conventional open surgery while providing excellent cosmetic outcomes through a small submental incision. It may serve as a feasible and safe alternative for patients with low-risk thyroid cancer.