| Objective In this study, we aim to describe the new method of supraclavicular lateral collar incision for thyroidectomy and to do a series of comparative studies with conventional thyroidectomy and totally endoscopic thyroidectomy, thus to discuss the safety and efficacy of the new approach for thyroidectomy, and further to indetify the cosmetic effects of different approaches and their use and position in thyroidetomies.Methods From November 2005 to April 2008, 220 thyroidectomies were performed at our department. Among whom three groups were divided, that was conventional approach, lateral approach and endoscopic approach group. There were 102 thyroidectomies with the conventional approach, with an average age of 46.0±12.7(range 19 to 78) yr, male 21 cases and female 81 cases; 70 thyroidectomies with the lateral collar incision approach, with an average age of 45.6±12.2(range 9 to 73) yr, male 12 cases and female 58 cases; 48 thyroidectomies with totally endoscopic approach, with an average age of 37.4±7.34 (range 18 to 52) yr. All the data of the three groups were retrospectively studied and analyzed in terms of anesthesia, type of procedures, length of incision, blood loss, operative time, final pathologic findings, postoperative complications, length of hospitalization and cosmetic effect as well as the demographic characteristics of the patients.Results1. The supraclavicular lateral collar incision approach and conventional approach: There were no statistical significances between the two groups in terms of general characteristics, anesthesia, estimated blood loss, operative time, nodule size, postoperative hospitalization and perioperative complications, while the statistical difference was significant in terms of incision length (6.54±1.28cm vs. 5.39±1.08cm, P<0.001). The patients were more satisfied and compatible with the cosmetic appearance of lateral collar incision than conventional approach, of which the numerical score was 8.70±0.70 and 7.17±1.08(P<0.001), respectively.2. Supraclavicular lateral collar incision approach and totally endoscopic approach: There were no statistical significance between the two groups in the aspects of gender, estimated blood losss and perioperative complications, while there were significant statistical differences in terms of age, incision length, operative time, nodule size, postoperative hospitalization and cosmetic effect. There were no incisional scar left on the neck area with totally endoscopic approach; The operative time was 96.6±29.1min vs. 120.8±24.7min (P<0.001) for the lateral collar approach and endoscopic appraoch, respectively. While the nodule size were 3.68±1.92cm vs. 2.6±1.1cm (P =0.005)and the cosmetic numerical score was 8.70±0.70 vs. 9.96±0.17(P<0.001).Conclusions1. The supraclavicular lateral collar incision is a feasible and safe approach for thyroidectomy. It holds the advantages of extensive indications, similar complication rate and operative expenditure compared with conventional approach but achieving a better cosmetic result.2. On the basis of skilled laparoscopic manipulation and profound familiarization with the endoscopic thyroid anatomy, the technique of totally endoscopic thyroidectomy is also safe and feasible. Compared with other groups of thyroidectomies, it holds the advantages of excellent cosmetic appearance and quick recovery, but at the same time, its technical indications is only confined to small nodules or thyroid volume, which constrained its application.3. In clinical practice, we should take into consideration the distinct treatment strategy between different diseases and cosmetic requirements of specific patients, within adquate surgery indications of different approach, thus we can make the best choice with flexibility. |
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