Comparison Between Two Approaches For Endoscopic Thyroidectomy And Open Thyroidectomy

Objective:Through the comparison and analysis of the clinical efficacy and smoke produced by the two approaches of endoscopic thyroidectomy and traditional open thyroidectomy,the safety of different thyroidectomy methods and their influence on the operating room environment were discussed.Methods:This study included 48 patients with thyroid cancer treated in our hospital by different surgical methods from June 2020.to December 2021.12.The surgical scope was unilateral glandular lobotomy plus isthmus plus ipsilateral central lymph node dissection.They were divided into three groups according to different surgical approaches: open thyroidectomy(n= 15),breast approach endoscopic thyroidectomy(n= 15)and gasless transaxillary endoscopic thyroidectomy(n=18).Clinical data of all patients were analyzed,including general information,tumor size,operation time,number of lymph nodes dissected,first-day drainage volume,days of drainage tube placement and days of hospitalization after surgery.The Patient and Observer Scar Assessment Scale,(POSAS)assesses and compares incision aesthetics at 3 and 6months after surgery and monitors the particulate matter(PM)aggregate,peak,and dynamic changes associated with the use of the energy device particulate matter(PM)in the vicinity of the patient at the time of surgery.Particles include particle size≤2.5μm PM(PM2.5)and particle size ≤10μm PM(PM10).Results:The operative time of the transaxillary approach group and the transareolar approach group was longer than that of the traditional open thyroidectomy group[(154.83±22.3)minutes vs.(160.47±17.55)minutes vs.(99.87±14.89)minutes,P <0.05].The first-day drainage volume in both the transaxillary approach group and the transareolar approach group was higher than that in the open thyroidectomy group[(37.00±5.24)ml vs.(42.73±9.33)ml vs.(27.60±7.57)ml,P < 0.05].There was no significant difference in the safety and surgical complications of the three methods of thyroidectomy(P > 0.05).In postoperative follow-up,the transaxillary approach group had the best incision aesthetics,followed by the transareolar approach group,and the open group had the worst incision aesthetics,with statistical significance(P <0.01).During a single incision,the peaks of PM2.5 and PM10 and the total count of surgical smoke in the transaxillary approach and transareolar approach groups were significantly lower than those in the open thyroidectomy group(P < 0.01).There was no significant difference in the peak value and total count of PM2.5 and PM10 of surgical smoke between two approaches for endoscopic thyroidectomy(P > 0.05).During the whole operation,the amount of PM2.5 and PM10 of surgical smoke produced per minute in the open thyroidectomy was higher than that in the two endoscopic thyroidectomy groups(P < 0.01),but the total amount of PM2.5 and PM10 of surgical smoke produced in the open thyroidectomy group was lower than that in the two endoscopic thyroidectomy groups(P < 0.01).Conclusion:There was no significant difference in the efficacy and complications of the three kinds of thyroidectomy,and the aesthetic effect of the two kinds of endoscopic thyroidectomy was better than that of open thyroidectomy.Open thyroidectomy produced more surgical smoke during a single incision than endoscopic thyroidectomy,but there was no significant difference between endoscopic thyroidectomy.From the perspective of environmental smoke pollution in the operating room,endoscopic thyroidectomy is superior to open thyroidectomy..