Comparative Study of Gasless Transaxillary, Bilateral Axillo-Breast, Unilateral Axillo-Breast With Carbon Dioxide Insufflation, Retroauricular, and Transoral Vestibular Endoscopic Thyroidectomy Approaches at a Single Institution: A Retrospective Analysis and Lessons Learned

Objectives. This study aimed to present our experiences with various approaches for endoscopic thyroidectomy (ET) and to offer lessons for choosing an approach. Methods. The medical records of 701 patients who underwent ET via the transaxillary (TA), bilateral axillo-breast (BABA), unilateral axillo-breast with carbon dioxide insufflation (UABA), retroauricular (RA), or transoral vestibular (TO) ap-proach between May 2008 and March 2020 were retrospectively reviewed. Postoperative pain and cosmetic out-comes were evaluated using visual analog scales. Results. The mean operative time of UABA was the shortest among the five approaches (TA, 194.65 +/- 51.13 minutes; BABA, 189.11 +/- 61.53 minutes; UABA, 118.62 +/- 30.23 minutes; RA, 168.22 +/- 45.63 minutes; TO, 196.10 +/- 40.19 minutes; P= 0.02). BABA was the most painful approach, while TO was the least painful on postoperative day 1 (TA, 3.09 +/- 0.96; BABA, 3.59 +/- 0.92; UABA, 2.39 +/- 0.54; RA, 3.49 +/- 0.93; TO, 2.01 +/- 0.37; P= 0.04) and day 3 (TA, 2.10 +/- 0.77; BABA, 2.59 +/- 0.88; UABA, 1.84 +/- 0.37; RA, 3.01 +/- 0.67; TO, 1.49 +/- 0.45; P= 0.04). The TO group had the best cosmet-ic outcomes at 3 months (TA, 3.91 +/- 1.21; BABA, 4.52 +/- 1.13; UABA, 4.49 +/- 0.74; RA, 4.28 +/- 0.74; TO, 4.81 +/- 0.48; P= 0.04). Conclusion. We present a single-surgeon experience of five distinctive ET approaches and the lessons from each approach, together with a literature review. This data may aid endoscopic thyroid surgeons in choosing from various ET ap-proaches.