The Advantages of Applying a 5-mm Endoscope in the Transoral Endoscopic Thyroidectomy Vestibular Approach

Objective: We sought to compare the effect of applying a 5-mm endoscope and a 10-mm endoscope in the transoral endoscopic thyroidectomy vestibular approach (TOETVA) and to clarify the advantages of using a 5-mm endoscope. Materials and Methods: A retrospective analysis of the clinical data of 135 patients who were diagnosed with papillary thyroid carcinoma and who had undergone TOETVA in the thyroid disease center of The First Affiliated Hospital of Nanchang University between January 2019 and May 2020 was performed. Among the included patients, a 10-mm endoscope was used in 50 cases (the 10-mm endoscope group) and a 5-mm endoscope was used in 85 cases (the 5-mm endoscope group), respectively. Operative trauma, operative parameters, postoperative complications, and postoperative mandibular sensation score were compared and analyzed. Results: Compared with the 10-mm endoscope group, the 5-mm endoscope group had less surgical trauma, less injury to the mandibular muscles (orbicularis oris, depressor labii inferioris, and mentalis muscle), shorter operative times (107.7 +/- 8.1 vs. 121.3 +/- 11.6 min, P<0.01), less intraoperative bleeding (14.3 +/- 4.8 vs. 17.9 +/- 5.3 mL, P<0.01), no obvious postoperative complications, lower mandibular sensation score values (5.7 +/- 0.6 vs. 6.0 +/- 0.4 points, P<0.01), and shorter mandibular recovery times (9.4 +/- 2.5 vs. 12.3 +/- 3.6 d, P<0.01). Conclusion: The application of a 5-mm endoscope not only improves the cosmetic effect of TOETVA but also reduces the degree of surgical trauma, saves the surgical space, improves the surgical efficiency, and reduces postoperative discomfort, with a promising application prospect.