PURPOSE OF THE STUDY
Comparative analysis of the results of hemithyroidectomy using two types of accesses — endoscopic «gasless» axillary and minimally invasive video-assisted cervical.
MATERIAL AND METHODS
The results of 71 hemithyroidectomy in patients with thyroid nodules were studied. Group 1 included 33 patients in whom surgery was performed through endoscopic «gasless» axillary access; The second group consisted of 38 patients in whom the operation was performed using a minimally invasive video-assisted cervical approach. Mean nodule size (4.4±1.3 vs. 2.8±0.8 cm; p<0.05) and thyroid gland volume (56.1±10.4 vs. 29.2±7.6 ml; p<0.05) were higher in the 1st group of patients, which is explained by the technical limitations of video-assisted cervical access. For all other preoperative parameters, the groups were comparable.
RESULTS
The average duration of the operation (159.5±62.1 min. vs. 56.5±14.4 min.; p<0.01), the duration of the need for parenteral anesthesia (2.3±0.5 days vs. 1.5±0.5 days; p<0.05), the length of stay of patients in the hospital (6.4±1.3 days versus 3.0±1.2 days; p<0.05) was longer after intervention through endoscopic axillary access. The overall complication rate was also higher with the axillary approach (27.3% vs. 5.2%; p<0.05), but the difference was associated with the incidence of brachial plexitis (7 cases; 21.2%) due to access and duration of intervention. From the point of view of complications specific to thyroid surgery, no statistically significant differences were found in the compared groups. In total, the study recorded 2 cases of access conversion that occurred during operations using video-assisted cervical access. On a 5-point scale, the average assessment of patients’ overall satisfaction with treatment after surgery using axillary and cervical access was 4.61±1.45 and 4.47±1.67 points (p>0.05), and the evaluation of the cosmetic result was 4, 79±0.94 and 4.34±1.76 points (p<0.05), respectively.
CONCLUSION
Endoscopic «gasless» axillary access is advisable to use for large thyroid nodules and its volume, as well as for patients seeking the maximum cosmetic result and the absence of a scar on the neck. Minimally invasive video-assisted cervical access is applicable for small nodules and thyroid volumes and is appropriate for patients who prefer a more comfortable early postoperative period and earlier recovery after surgery.
