A Comparative Analysis on the Clinical Outcome of Patients who underwent Endoscopic Thyroidectomy And Conventional Thyroidectomy at St. Luke’s Medical Center, Quezon City

Background: Conventional thyroidectomy (CT) has been the gold standard for the removal of both benign and malignant thyroid nodules, however this procedure often leaves undesirable scars in the anterior neck. With the era of minimally invasive technology, new techniques can be applied even in the field of endocrine surgery.  Endoscopic thyroidectomy (ET) is currently being explored as an alternative to conventional thyroidectomy. Locally, only a few surgeons utilize this procedure. To address the issues above, a detailed study focusing on several outcome measures of both ET and CT must be conducted.

Objective: The study aims to determine and compare the clinical outcome of patients who underwent endoscopic thyroidectomy to those underwent conventional thyroidectomy based on operative time, blood loss, length of hospital stay, complications, cosmetic outcome and post-operative pain. 

Methods: Between Jan 2006 to March 2015, 54 euthyroid patients with a <6cm solitary benign thyroid nodule on FNAB or with benign multiple nodules on one lobe and another normal lobe were randomly divided into two groups. 27 patients underwent conventional hemi-thyroidectomy (CT group) while 27 patients endoscopic hemi-thyroidectomy (ET group). 1 patient from the ET group was dropped due to a final histopathology of papillary thyroid carcinoma.  Mean operative time, blood loss, length of hospital stay and complications were determined and were compared for both groups.  Pain score using the visual analogue scale (VAS) on the 1^st hour, 24^th hour and 48^th hour after surgery was measured.  Three third party assessors assessed cosmetic results using a 10-point scale by reviewing photographs of the patients at 24 hours, 1 week and 1 month after surgery. 

Results: All 26 patients from the ET group were successfully completed with a mean operating time of 172.88 ± 38.30 mins.  This was statistically significant from patients under the CT group, who completed surgery with a mean operative time of 145.00 ± 37.31 mins (p < 0.05).  Blood loss was also not significant between the ET group and CT group, with a mean blood loss of 34.63 ± 12.86 ml and 25.00 ± 16.73 ml respectively (p > 0.05).  Hospital stay was significantly lower for the ET group with a mean hospital stay of 3.15 ± 0.37 days, in contrast to the CT group with a mean hospital stay of 3.48 ± 0.51 (p < 0.05).  There was also no significant difference in number of complications between ET and CT (p value > 0.05), with encountered complications being hematoma and ecchymosis only in both groups.  Pain score was significantly lower for patients who underwent endoscopic thyroidectomy compared to those that underwent conventional thyroidectomy in the 1^st hour, 24^th hour, and 48^th hour post operation.  Cosmetic score was also significantly higher for the ET group than the CT group 24 hours, 1 week, and 1 month post operation.

Conclusion: Endoscopic thyroidectomy provides better cosmetic results and lesser post-operative pain compared to conventional thyroidectomy. This procedure has comparable results with conventional thyroidectomy in terms of blood loss, length of hospital stay and complications.