Efficacy Comparison of Submental Tri-Hole Versus Transoral Endoscopic Thyroidectomy
Overview
This study compares totally endoscopic thyroidectomy via the submental tri-hole approach with transoral endoscopic thyroidectomy without insufflation in 60 patients. Both techniques demonstrated safety and effectiveness, with differences in surgical approach, tumor size eligibility, and cosmetic outcomes.
Background
Thyroid cancer incidence has increased, driving interest in minimally invasive surgical options that optimize both oncologic outcomes and patient satisfaction. Endoscopic thyroidectomy techniques have evolved since the 1990s, with various approaches developed to improve access and reduce surgical difficulty. The submental tri-hole approach involves three small incisions under the chin, while the transoral approach accesses the thyroid through the mouth without insufflation. This study aims to provide comparative data on these two methods to guide surgical decision-making.
Data Highlights
Sixty patients with thyroid tumors were randomized into two groups: 40 underwent the submental tri-hole approach and 20 underwent the transoral approach. Groups were comparable in age, gender, tumor size, histopathology, and surgical site (P > 0.05). Inclusion and exclusion criteria varied slightly, with the submental group allowing larger tumors and more complex locations. All surgeries were performed by the same surgeon, ensuring consistency in technique.
Key Findings
The submental tri-hole approach allowed treatment of slightly larger tumors and those near critical structures, compared to the transoral approach.
Both techniques provided effective thyroidectomy with lymph node dissection when indicated, maintaining oncologic safety.
The transoral approach was preferred for patients with strong cosmetic demands and smaller tumors due to its scarless nature.
Both methods required careful dissection to preserve the recurrent laryngeal nerve and parathyroid glands, with autologous transplantation performed if necessary.
The submental approach involved three small incisions under the chin, while the transoral approach used incisions inside the mouth without insufflation, impacting postoperative recovery and aesthetics.
Clinical Implications
Surgeons can select the submental tri-hole approach for patients with larger or more complex thyroid tumors requiring safe access near critical structures. The transoral approach is suitable for patients prioritizing cosmetic outcomes with smaller tumors. Both techniques demand meticulous surgical skill to preserve nerve and parathyroid function, ensuring patient safety and satisfaction.
Conclusion
Totally endoscopic thyroidectomy via the submental tri-hole and transoral approaches are both safe and effective. Choice of technique should be individualized based on tumor characteristics and patient cosmetic preferences to optimize outcomes.
References
Affiliated Hospital of Panzhihua College 2023 -- Comparative Study of Endoscopic Thyroidectomy Techniques
