Comparison of transaxillary endoscopic and open approaches in thyroid surgery (systematical review and meta-analysis)

Introduction. The cosmetic effect of endoscopic thyroidectomy is indisputable. However, there are questions about the appropriateness of such an operation. A meta-analysis was performed to summarize data on the advantages of endoscopic over open access in thyroid surgery. Aim of the study. To conduct a meta-analysis of the results of operations on the thyroid gland with transaxillary endoscopic (TATE) and open access (OTE). Materials and methods. 8 retrospective, 4 prospective and 1 randomized comparative study were analyzed, including the results of treatment of 6484 patients. Statistical processing was performed in the Review Manager 5.4 program. The sum of the dichotomous data was reported with a 95 % confidence interval as an odds ratio. Statistical heterogeneity among the studies included in the meta-analysis was assessed using the χ2 test. At p50 % heterogeneity was considered statistically significant. Results. The conducted meta-analysis confirmed the advantage of TATE over OTE in terms of cosmetic results of treatment. With regard to the volume of intraoperative blood loss, the frequency and structure of postoperative complications, TATE was comparable to OTE. There was no statistically significant difference between TATE and OTE in the severity of pain syndrome and the length of stay of patients in the hospital. Conclusion. TATE for benign and malignant neoplasms of the thyroid gland is a safe alternative to open surgery. TATE is most effective and safe when performed by an experienced surgeon who has gone through a learning curve.