Abstract:

Objective To explore the impact of total endoscopic thyroid surgery via air⁃free transaxillary approach on function of recurrent laryngeal nerve（RLN）. Methods A total of 300 patients met the criteria for inclusion and exclusion were divided into endoscopy group（n = 150）and open group（n = 150）. The patients in the endoscopy group were treated with total endoscopic thyroidectomy via air⁃free transaxillary approach，while those in the open group received open surgery through anterior cervical incision. The surgical situation and postoperative recovery in the two groups were compared. Cox proportional hazard regression model was used to analyze the influ⁃ encing factors of occurring intraoperative RLN injury. Results As compared with the open group，the endoscopy group had longer surgical duration，less intraoperative blood loss，more postoperative drainage and shorter postop⁃ erative hospital stay，and it had lower VAS score and higher satisfaction score on the cosmetic incision 24 and 48 hours after operation. One week after operation，the incidences of vocal cord lesions（χ2 = 15.153，P < 0.001）， dysphonia and dysphagia（χ2 = 12.837，P < 0.001）in the endoscope group were significantly lower than those in the control group（P < 0.05）. Total endoscopic thyroid surgery via air⁃free transaxillary approach and malignant tumors were the key risk factors for intraoperative RLN injury. Conclusions Total endoscopic thyroid surgery via air⁃free transaxillary approach can effectively improve the postoperative quality of life in patients and is worthy of clinical application.

Key words:

air ?free transaxillary approach, total endoscopy, thyroid surgery, recurrent laryngeal nerve, voice and swallowing function