Transaxillary endoscopic thyroid lobectomy: gas insufflation versus gasless technique

The objective of this study is to compare the clinical outcomes between gas insufflation and gasless techniques used in transaxillary endoscopic thyroid lobectomy.

Data of patients who underwent transaxillary endoscopic thyroid lobectomy from June 2011 to August 2019 were reviewed. All surgeries were performed by one experienced surgeon. The patients were divided into two groups according to surgical technique as gas insufflation or gasless technique. The clinical outcomes such as complications, postoperative pain score assessed using VAS, length of hospital stay, and presence of iatrogenic ectopic thyroid tissue were compared between the two groups.

During the study period, a total of 60 patients underwent transaxillary endoscopic thyroid lobectomy: 38 patients via gas insufflation and 22 using the gasless technique. The basic characteristic features of the patients and their diseases were not significantly different between the two groups. Gas insufflation yielded significantly better surgical outcomes than the gasless technique: shorter operative time (209.3 ± 63.1 min. vs. 267.6 ± 66.0 min.; P = 0.001), less estimated blood loss [10.0 (5.0, 20.0) mL vs. 30.0 (16.2, 50.0) mL; P < 0.001], less drainage content [10.0 (0.0, 70.0) mL vs. 81.5 (74.2, 104.5) mL; P < 0.001], and shorter hospital stay [1.5 (1.1, 2.0) days vs. 1.8 (1.5, 2.5) days; P = 0.032]. Regarding postoperative pain, there was no statistically significant difference in visual analog scales (VAS) at 24 and 48 h. Finally, no evidence of iatrogenic ectopic thyroid tissue was found in both groups.

Compared to the gasless technique, the gas insufflation technique provided shorter operative time, less estimated blood loss, less drainage content, and shorter hospital stay. Moreover, there were comparable outcomes regarding postoperative pain, complications and iatrogenic ectopic thyroid tissue.