Increased acute-phase reaction after the transoral endoscopic thyroidectomy vestibular approach (TOEVA) compared with minimally invasive video-assisted thyroidectomy (MIVAT) for unilateral thyroidectomy

We analyzed the acute-phase response in unilateral thyroidectomy by comparing the transoral endoscopic thyroidectomy vestibular approach (TOEVA) with the minimally invasive video-assisted thyroidectomy (MIVAT).

Patients were randomly assigned to undergo either TOEVA or MIVAT, after we obtained their written informed consent to participate in this study. Blood count, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), interleukin-1β (IL-1β), IL-6 and tumor necrosis factor (TNF-) were measured before surgery and then 4, 24, and 48 h after surgery. The VAS pain score, analgesic utilization, and time to resume normal activities were recorded.

There were 29 patients who underwent TOETVA and 30 who underwent MIVAT. The groups were well balanced in terms of age, gender, American Society of Anesthesiologists (ASA) score, and preoperative values. There were no postoperative complications in this series. The operation time was longer in the TOETVA group (p < 0.001). Patients recommenced routine activities earlier after MIVAT (p < 0.05). The TOETVA group showed a greater drop in lymphocyte count 4 h (p < 0.01) and 24 h (p = 0.04) postoperatively, a higher ESR value 48 h postoperatively (p = 0.02), a longer increase in IL-6 (p = 0.05), 24 (p = 0.003) and 48 h postoperatively (p < 0.001), and a higher CRP 24 (p = 0.05) and 48 h postoperatively (p = 0.01) than the MIVAT group. There was no difference in postoperative IL-1β, TNF, total white blood cell count, polymorphonuclear cell count, and VAS or analgesic requirement between the groups, except on the day of surgery.

An increased inflammatory response in the acute phase was observed after TOETVA compared with MIVAT, suggesting that TOETVA is associated with increased tissue trauma. This may account for the earlier recovery after the MIVAT procedure.