EP150 – Effects of surgical trauma of transoral endoscopic thyroidectomy vestibular approach (TOETVA) vs. traditional open thyroidectomy


    Dionigi, Gianlorenzo1; Lavazza, Matteo1; Pappalardo, Vincenzo1; Inversini, Davide1; Che-Wei Wu2; Xiaoli, Liu3; Hui, Sun3; Chai, Young Jun4; Tufano, Ralph P.5; Kim, Hoon Yub6; Anuwong, Angkoon7


    1 1st Division of General Surgery, Research Center for Endocrine Surgery, Department of Surgical Sciences and Human Morphology, University of Insubria (Varese-Como), Varese, Italy
    2 Department of Otolaryngology – Head and Neck Surgery, Kaohsiung Medical University Hospital; Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung City, Taiwan.
    3 Jilin Provincial Key Laboratory of Surgical Translational Medicine, China-Japan Union Hospital of Jilin University, Division of Thyroid Surgery, Changchun city, Jilin Province, China
    4 Department of Surgery, Seoul National University Seoul Metropolitan Government Boramae Medical Center, Dongjak-gu, Seoul, South Korea
    5 Division of Head and Neck Endocrine Surgery, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
    6 Department of Surgery, Division of Breast and Endocrine Surgery, Minimally Invasive Surgery and Robotic Surgery Center, KUMC Thyroid Center Korea University, Anam Hospital Seoul-Korea
    7 Minimally Invasive and Endocrine Surgery Division, Department of Surgery, Police General Hospital, Bangkok, Thailand


    Backgroud: Surgical trauma stimulates a response and its intensity is proportional to the trauma. Although endoscopy provides distinct clinical advantages as cosmesis, it is not yet clear that it lessens the stress response of elective surgical procedures, and the morbidity of surgery. The aim of this study was to compare intensity of acute-phase reaction and metabolic changes in patients undergoing TOETVA vs.traditional open thyroidectomy for different thyroid disease.

    Method: Surgical trauma resulting from TOETVA and open thyroidectomy were compared by assessing the postoperative acute phase alterations of selected plasma proteins, hormones and lymphocyte subpopulations in fifty-seven patients. Patients were prospectively randomized to undergo either TOETVA (n=23) or traditional open thyroidecromy (n=27). We collected 15ml of venous blood on the day before surgery and on postoperative days. A control group comprised 30healthy volunteers; the control group was used only to ensure that baseline values were totally comparable with a normal population.

    Results: Duration of operation and general anesthesia was longer in the patients group 1. Patients in the two groups had not statistically different postoperative acute phase increase in plasma C-reactive protein, cortisol, and prolactin blood level was recorded (p>0.05). The postoperative acute phase decrease in the blood total-T-lymphocyte count (CD3 cells) and in the activated-lymphocyte count (OKDR cells) in both groups.

    Conclusions: Up to now it has been unclear whether TOETVA has fewer immunosuppressive effects than open procedure. These results, showing that acute phase responses are similarly marked after TOETVA and after open thyroidectomy, support the concept that the TOETVA procedure is a minimally invasive procedure.


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