[Clinical application of modified endoscopic thyroidectomy].

Objective: To compare clinical outcomes of endoscopic thyroidectomy via mammary areola approach and conventional via chest wall and breasts approach.

Methods: A total of 480 cases undergoing endoscopic thyroidectomy for thyroid nodules between September 2002 and September 2012 were reviewed, including 280 cases via the chest wall and breasts approach between September 2002 and August 2009 and 190 cases via mammary areola approach between September 2002 and September 2012. The mean operation time, the location and diameter of the puncture pore, intraoperative bleeding volume, the mean hospital stay after surgery, postoperative pain score scaled by visual analog scores (VAS) were compared between groups. After 3-month follow-up, long term post-surgical complications, the recurrence rates of nodules and scar cosmetic satisfaction evaluation were also compared. Statistical methods including χ(2) test, Students' test and ANOVA analysis were applied.

Results: Two groups were followed for 12 months. The differences between groups were statistically obvious in variables of diameters of the puncture pore (15.5 mm ± 4.9 mm vs. 20.6 mm ± 7.6 mm, t = 2.42, P = 0.046) , intraoperative bleeding volume (16.2 ml ± 4.5 ml vs. 30.5 ml ± 11.4 ml, t = 2.53, P = 0.032) , pain score on the first day after operation (1.5 ± 0.4) and (1.0 ± 0.2), (t = 4.68, P = 0.020) , scar cosmetic satisfaction evaluation 3 months after operation (χ(2) = 6.20, P < 0.05) , chest wall numbness (0 vs. 72.4%,χ(2) = 380, P = 0.000) . But there were no significant differences in the mean operation time, the mean hospital stay after surgery, and the recurrence rates of nodules between two groups.

Conclusion: Minimally invasive endoscopic thyroidectomy via mammary areola approach is a safe and effective method for the surgery of thyroid nodules with good aesthetic outcome.