Increased acute-phase reaction after the transoral endoscopic thyroidectomy vestibular approach (TOEVA) compared with minimally invasive video-assisted thyroidectomy (MIVAT) for unilateral thyroidectomy.

IF 1.7 4区医学 Q2 SURGERY

Surgery Today Pub Date : 2025-01-04 DOI:10.1007/s00595-024-02982-z

Daqi Zhang, Lanlan Wan, Francesco Frattini, Gianlorenzo Dionigi

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引用次数: 0

Abstract

Purposes: We analyzed the acute-phase response in unilateral thyroidectomy by comparing the transoral endoscopic thyroidectomy vestibular approach (TOEVA) with the minimally invasive video-assisted thyroidectomy (MIVAT).

Methods: Patients were randomly assigned to undergo either TOEVA or MIVAT, after we obtained their written informed consent to participate in this study. Blood count, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), interleukin-1β (IL-1β), IL-6 and tumor necrosis factor (TNF-) were measured before surgery and then 4, 24, and 48 h after surgery. The VAS pain score, analgesic utilization, and time to resume normal activities were recorded.

Results: There were 29 patients who underwent TOETVA and 30 who underwent MIVAT. The groups were well balanced in terms of age, gender, American Society of Anesthesiologists (ASA) score, and preoperative values. There were no postoperative complications in this series. The operation time was longer in the TOETVA group (p < 0.001). Patients recommenced routine activities earlier after MIVAT (p < 0.05). The TOETVA group showed a greater drop in lymphocyte count 4 h (p < 0.01) and 24 h (p = 0.04) postoperatively, a higher ESR value 48 h postoperatively (p = 0.02), a longer increase in IL-6 (p = 0.05), 24 (p = 0.003) and 48 h postoperatively (p < 0.001), and a higher CRP 24 (p = 0.05) and 48 h postoperatively (p = 0.01) than the MIVAT group. There was no difference in postoperative IL-1β, TNF, total white blood cell count, polymorphonuclear cell count, and VAS or analgesic requirement between the groups, except on the day of surgery.

Conclusions: An increased inflammatory response in the acute phase was observed after TOETVA compared with MIVAT, suggesting that TOETVA is associated with increased tissue trauma. This may account for the earlier recovery after the MIVAT procedure.

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经口内窥镜甲状腺切除术前庭入路（TOEVA）与微创视频辅助甲状腺切除术（MIVAT）单侧甲状腺切除术后急性期反应增加。

目的：我们通过比较经口内窥镜甲状腺切除术前庭入路（TOEVA）和微创视频辅助甲状腺切除术（MIVAT）来分析单侧甲状腺切除术的急性期反应。方法：在获得患者的书面知情同意后，随机分配患者接受TOEVA或MIVAT。术前及术后4、24、48 h分别测定血细胞计数、c反应蛋白（CRP）、红细胞沉降率（ESR）、白细胞介素-1β (IL-1β)、IL-6、肿瘤坏死因子（TNF-）。记录VAS疼痛评分、镇痛药使用情况及恢复正常活动时间。结果：29例患者行TOETVA， 30例患者行MIVAT。各组在年龄、性别、美国麻醉医师协会（ASA）评分和术前值方面均达到良好平衡。本组病例均无术后并发症。结论：与MIVAT相比，TOETVA术后急性期炎症反应增加，提示TOETVA与组织损伤增加有关。这可能是在MIVAT程序之后较早恢复的原因。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Surgery Today 医学-外科

CiteScore

4.90

自引率

4.00%

发文量

208

审稿时长

1 months

期刊介绍： Surgery Today is the official journal of the Japan Surgical Society. The main purpose of the journal is to provide a place for the publication of high-quality papers documenting recent advances and new developments in all fields of surgery, both clinical and experimental. The journal welcomes original papers, review articles, and short communications, as well as short technical reports("How to do it"). The "How to do it" section will includes short articles on methods or techniques recommended for practical surgery. Papers submitted to the journal are reviewed by an international editorial board. Field of interest: All fields of surgery.