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Meta-Analysis
. 2024 Jul 4;409(1):204.
doi: 10.1007/s00423-024-03377-x.

Transoral endoscopic thyroidectomy submental vestibular approach for early-stage papillary thyroid carcinoma: a systematic review and meta-analysis

Mahmoud Diaa Hindawi  1 , Ahmed Hamdy G Ali  2 , Ruaa Mustafa Qafesha  3 , Wesam Soliman  4 , Haitham Salem  5 , Eslam Bali  1 , Amr Elrosasy  6
Affiliations
Meta-Analysis

Transoral endoscopic thyroidectomy submental vestibular approach for early-stage papillary thyroid carcinoma: a systematic review and meta-analysis

Mahmoud Diaa Hindawi et al. Langenbecks Arch Surg. .

Abstract

Purpose: Our study aimed to compare the effectiveness and complications of the transoral endoscopic thyroidectomy submental vestibular approach (TOETSMVA) versus the transoral endoscopic thyroidectomy vestibular approach (TOETVA) or conventional open thyroidectomy (COT) in patients with early-stage papillary thyroid carcinoma (PTC).

Methods: We searched online databases up to January 2024. The outcomes were analyzed using RevMan 5.4 and inverse variance.

Results: Seven studies (two RCTs and five retrospective cohort studies) were included. We established higher significance differences for TOETSMVA in comparison with TOETVA in terms of all primary outcomes; operation time, hospital stay, number of resected lymph nodes [MD -21.05, 95% CI= -30.98, -11.12; p < 0.0001], [MD -1.76, 95% CI= -2.21, -1.32, p < 0.00001], [MD -2.99, 95% CI= -19.75, 13.76, p < 0.73], [MD -0.83, 95% CI = -1.19 to -0.47; p < 0.00001], respectively, except the drainage volume, it showed no difference [MD -2.99, 95% CI= -19.75, 13.76, p < 0.73]. In secondary outcomes, it was favored only in mandibular numbness and return to normal diet outcomes. Additionally, TOETSMVA compared with COT showed a significant difference in drainage volume, pain, cosmetic effect, and satisfaction score.

Conclusions: TOETSMVA showed a significant improvement compared to the TOETVA in operation time, hospital stay, number of resected lymph nodes, mandibular numbness, and return to normal diet but did not show a difference in drainage volume. However, TOETSMVA was better in cosmetic effect, drainage volume, satisfaction, and pain scores compared with COT. Further RCTs with larger sample size, multicentral, and longer follow-up are necessary to evaluate the limitations.

Keywords: Conventional open thyroidectomy; Endoscopic thyroidectomy; Papillary thyroid carcinoma; Transoral endoscopic thyroidectomy submental vestibular approach; Transoral endoscopic thyroidectomy vestibular approach.

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Conflict of interest statement

Mahmoud Diaa Hindawi, Ahmed Hamdy G. Ali, Ruaa Mustafa Qafesha, Wesam Soliman, Haitham Salem, Eslam Bali, and Amr Elrosasy have no conflicts of interest or financial ties to disclose.

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
PRISMA flow diagram of the study selection process
Fig. 2
Fig. 2
(a) Risk of bias summary for randomized controlled trials using ROB2. (b) summary of Newcastle-Ottawa Scale (NOS) quality assessments
Fig. 3
Fig. 3
Meta-analysis forest plot containing the primary outcomes (a) operation time, (b) length of hospital stay, (c) drainage volume, and (d) number of lymph nodes resected
Fig. 4
Fig. 4
Meta-analysis forest plots containing (a) pain (VAS score), (b) cosmetic effect
Fig. 5
Fig. 5
Meta-analysis forest plots containing (a) temporary hoarseness, and (b) recurrent laryngeal nerve injury
See this image and copyright information in PMC

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