Systematic comparison of cervical and extra-cervical surgical approaches for endoscopic thyroidectomy.

Objective: To evaluate the clinical application of different surgical approaches for endoscopic thyroidectomy and provide more rational treatment criteria.

Methods: Collect all randomized controlled trials, multi-center studies, clinical controlled trials, clinical trials and other comparative studies of endoscopic thyroidectomy with a large sample size in different databases through an established search strategy, make a systematic analysis of all the included literature.

Results: This study selected 12 publications for analysis from more than 800 articles: these included six publications describing cervical thyroidectomy (A) and six publications describing extra-cervical thyroidectomy (B). Conversion to open surgery occurred in 29 patients in group A and only 4 in group B (p < 0.001). The patients in group A experienced shorter hospital stays than patients in group B (1.90 ± 0.80 vs. 4.03 ± 0.99 days, p < 0.001), and there was shorter operating time in group A (p < 0.001). Hemorrhage occurred in 3 cases in group A and 8 cases in group B (p = 0.04), Seroma occurred in 25 cases in group B but in no cases in group A (p < 0.001). Postoperative cosmetic results evaluated by verbal response scales (VRS) registered showed: group A (3.35 ± 0.60) and group B (3.74 ± 0.50; p < 0.001). Other complications such as recurrent laryngeal nerve injury and hypocalcemia showed no significant differences.

Conclusions: Evaluation of the different surgical approaches for endoscopic thyroidectomy shows that the incidence of hemorrhage and seroma are higher in the extra-cervical group, but the rate of conversion to conventional open surgery is significantly higher in the cervical group. Furthermore, patients who undergo extra-cervical endoscopic thyroidectomy are associated with longer operating time and hospital stays; however, these studies suggest that the extra-cervical surgical approach for endoscopic thyroidectomy is preferable for dealing with more kinds of thyroid tumor and leaving no scars on neck.