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Effect of Endoscopic Thyroidectomy via Anterior Chest Wall Approach on Treatment of Benign Thyroid Tumors

TABLE 5: TNF (ug/dl) postoperative hospital stay between patients received
endoscopic thyroidectomy and conventional thyroidectomy.
Postoperative Postoperative
Preoperative No postoperative complication was observed in this study. All
day 1 [1] day 3 [1]
these clinical data can prove that this kind of operation has
EG (Mean ± SD) 9.9 ± 1.49 11.31 ± 1.90* 10.48 ± 1.18 inclined towards maturity. Reviewing the history of all 174
CG (Mean ± SD) 9.97 ± 2.04 11.71 ± 1.62* 10.44 ± 1.36 patients treated with endoscopic thyroid surgery in our center,
p-value [2] 0.110 0.320 0.580
6 patients presented with hoarseness after surgery, 5 were
[1] Values from postoperative day 1 and day 3 were compared with transient, only one permanent recurrent laryngeal nerve damage
that from preoperative measurement. *p-value < 0.05. who was then recovered by taking neurosuture, 4 of these 6
[2] p-values are from comparisons between CG and EG at each
measurement point. patients were confirmed by pathological examination as thyroid
carcinoma, including the permanent damage one, the other 2
were nodular goiters.
TABLE 6: CRP (ug/dl) The insufflation pressure of sustaining the operative space
Postoperative Postoperative had already been verified through many laboratory and clinical
Preoperative 1,2 1,3
day 1 [1] day 3 [1] researches. Bellantone and Rubinos, animal experiment
proved that low pressure (<10 mmHg) of CO insufflation in the
EG (Mean ± SD) 0.36 ± 0.03 1.11 ± 0.14* 0.48 ± 0.05* 2
anterior neck region had no obvious negative effect on
CG (Mean ± SD) 0.45 ± 0.03 1.03 ± 0.11* 0.72 ± 0.8* circulation and blood-flow dynamics. Recently, the generally
recommended insufflation pressure is 4-6 mmHg, it can
p-value [2] 0.950 0.420 0.054
absolutely provide an ideal operative space for the surgeons.
[1] Values from postoperative day 1 and day 3 were compared with Our research showed only TCO and PCO increased statistically
2
2
that from preoperative measurement. *p-value < 0.05. during insufflation, but came back to baseline value right after
[2] p-values are from comparisons between CG and EG at each –
measurement point. desufflation. TCO consists of two parts, one is HCO ,
2
3
(occupies 95% of the consistence of TCO ) and the other is
2
–
soluble CO . The unchanged THCO explains the increase of
2
3
soluble CO . And soluble CO can sufficiently be compensatory
Table 2.7: Cortisol (ug/dl) 2 2
by mechanical ventilation. The stable acid-base index, the rapid
Postoperative Postoperative recovery of TCO and PCO and the absence of insufflation
Preoperative 2 2
day 1 [1] day 3 [1] complication can best prove that 4-6 mmHg of insufflation will
EG (Mean ± SD) 7.36 ± 1.26 8.2 ± 0.86* 9.07 ± 0.85* not cause any irreversible damage to human body.
Studies comparing endoscopic surgery and related con-
CG (Mean ± SD) 7.79 ± 0.91 10.6 ± 1.2* 10.14 ± 0.78*
ventional surgery have been carried out universally with con-
p-value [2] 0.43 0.03 0.56 sistent conclusions. Researches focused on inflammatory
responses after laparoscopic surgery involve not only general
[1] Values from postoperative day 1 and day 3 were compared with
that from preoperative measurement. *p-value < 0.05. but also focal responses. Due to the insufflation of CO , the pH
2
4-6
[2] p-values are from comparisons between CG and EG at each value is suppressed focally in the operative field, but not in
measurement point. general system. The acid circumstances can than lead to focal
immune suppression and reduce inflammatory response. IL-6,
TNF and CRP, the general measurement for acute inflammatory
DISCUSSION
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response, indicate the degree of surgical damage. Blood
Since the establishment of our minimally invasive surgery centre cortisol is widely accepted as the suppressor of inflammatory
in 2003, we’ve successfully carried out more than 170 endoscopic response, which can decrease IL-6, TNF and CRP generations.
thyroid operations via the anterior chest wall approach. After Our study found that TNF and IL-6 increased significantly
the originating period, the physician learning curve gradually on postoperative day 1 and recovered to preoperative level on
drives to stability. According to the analysis of about 100 postoperative day 3 in both groups. There was no difference of
patients who received endoscopic thyroidectomy during 2004 IL-6 or TNF between the two groups at any measurement point.
and 2006, the mean operative duration was 93.5 min. In our CRP is an acute-phase protein, which increased significantly
study, we reported similar endoscopic thyroidectomy operative after surgery. But there was no difference between two groups
duration (98.5 min), which was 13 minutes shorter than the mean either. It was reported that the increasing concentration of CO 2
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operative time in the conventional thyroidectomy. The small in the blood can inhibit the releasing of blood cortisol. In our
size of this study limited the statistical power to show the study, blood CO transiently increased during endoscopic
2
significance of the difference. There was no difference of surgery, and meanwhile the blood cortisol in the endoscopic
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