OP35 -Transoral endoscopic thyroidectomy vestibular approach (TOETVA) or open thyroidectomy: a prospective randomised trial to compare length of stay and postoperative pain

      Dionigi, Gianlorenzo1; Lavazza, Matteo1; Pappalardo, Vincenzo1; Inversini, Davide1; Wu,  Che-Wei2;Liu, Xiaoli3; 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), via Guicciardini 9, 21100 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   Background: Post operative pain after thyroid surgery might be important especially in the early postoperative hours. Different endoscopic techniques have been assessed. In this study we compared postoperative pain management in two techniques for thyroid surgery, that is TOETVA vs. traditional open thyroidectomy. Methods: his is a prospective randomised open study. The study enrolled 49 patients who required thyroidectomy for different thyroid diseases confirmed by ultrasound and endocrinological workup. 47patients were randomly allocated to TOETVA (n = 21) or open thyroidectomy (n = 26). TOETVA was done using a 3-trocar technique, and group 2 through a transverse cervical incision as short as possible. Outcome measures were length of hospital stay and postoperative pain evaluated by visual analogue scale (VAS) and the need for medications. Before the end of surgery, paracetamol 1gr and nefopam 20mg was administered in all patients. Results: The two group patients had a similar postoperative stay in hospital 2.1 (1.5) days vs. 2.1 (1.6) days; p>0.05. Pain scores in mental and vestibular area were higher in group 1 patients (p<0.05). Pain scores in neck area were higher in group 2 patients (p<0.008). Pain scores in back cervical region were higher in group 2 patients (p< 0.05). Pain scores during first deglutition/lunch were higher in group 2 patients (p< 0.03). Patients had similar postoperative pain after TOETVA and group 2 on the 5th and 7th day as reflected by VAS scale and the need for medications according to the different locations (p>0.05). Conclusion: Different profile pain scores and management have been detected for TOETVA and open thyroidectomy.


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