Modern minimally invasive surgery is advancing fast and even replacing traditional open methods in several surgical specialties. With the development of several endoscopic thyroidectomy procedures, thyroidectomy was no exception. The innovative procedure known as trans-oral endoscopic trans-vestibular thyroidectomy (TOT) had promising results. For a study, researchers sought to evaluate the surgical results and learning curves for TOT and other endoscopic thyroidectomy procedures.

Papers comparing TOT versus trans-axillary thyroidectomy were found in the databases PubMed, MEDLINE, and EMBASE (TAT). The main endpoint was operative (OR) time. Secondary goals were the number of harvested lymph nodes (LNs), estimated blood loss (EBL), recurrent laryngeal nerve injury (RLN), hoarseness, seroma, infection, chyle leak, hypocalcemia, hospital length of stay (LOS), and cost. They also looked at the learning curve for each approach. Meta-regression, leave-out-out analysis, and subgroup analysis were used. The random effect inverse variance technique was utilized.

15 studies—10 unpaired and 5 matched—with a total of 2,173 individuals (TOT: 1,024 (47.12%) and TAT: 1,149 (52.87%)—met the criteria for inclusion out of the 3,820 retrieved studies. While there was less EBL in TOT compared to TAT (standard mean difference (SMD)=-0.26 [-0.43; -0.09], P=0.0018), the operational duration and harvested L. Ns number were greater in TOT compared to TAT (SMD=0.72 [95% CI 0.07; 1.37], P=0.029 and SMD=0.32 [95% CI 0.02; 0.62], P=0.036, respectively). No additional results revealed a noteworthy difference between the two groups. In terms of OR time, weighted mean values for TOT and TAT were 158.03 vs. 144.97 min, harvested LNs, 6.33 vs. 5.16, and cost, $5,919.05 vs. $6,253.79, respectively. Between 6 and 15 yearly instances, statistical significance in the development of the learning curve was seen.

Trans-oral thyroidectomy was a safe and dependable procedure with results similar to other endoscopic methods. It allowed for easier access to the core compartment through a more practicable LN dissection. Surgical results were projected to improve with increasing learning curve and technique expertise.

Reference: sciencedirect.com/science/article/abs/pii/S1743919122005167