title: Video-assisted thyroidectomy significantly reduces the risk of early postthyroidectomy voice and swallowing symptoms.
abstract: BACKGROUND
  Voice and swallowing symptoms are frequently reported after thyroidectomy even in absence of objective voice alterations. We evaluated the influence of the video-assisted approach on voice and swallowing outcome of thyroidectomy.
  
  
  METHODS
  Sixty-five patients undergoing total thyroidectomy (TT) were recruited. Eligibility criteria were: nodule size<or=30 mm, thyroid volume<or=30 ml, no previous neck surgery. Exclusion criteria were: younger than aged 18 years and older than aged 75 years, vocal fold paralysis, history of voice, laryngeal or pulmonary diseases, malignancy other than papillary thyroid carcinoma. Patients were randomized for video-assisted (VAT) or conventional (CT) thyroidectomy. Videostrobolaryngoscopy (VSL), acoustic voice analysis (AVA), and maximum phonation time (MPT) evaluation were performed preoperatively and 3 months after TT. Subjective evaluation of voice (voice impairment score=VIS) and swallowing (swallowing impairment score=SIS) were obtained preoperatively, 1 week, 1 month, and 3 months after TT.
  
  
  RESULTS
  Fifty-three patients completed the postoperative evaluation: 29 in the VAT group, and 24 in the CT group. No laryngeal nerves injury was shown at postoperative VSL. Mean postoperative MPT, F0, Flow, Fhigh, and the number of semitones were significantly reduced in the CT group but not in the VAT group. Mean VIS 3 months after surgery was significantly higher than preoperatively in CT group but not in the VAT group. Mean SIS was significantly decreased 1 and 3 months after VAT but not after CT.
  
  
  CONCLUSIONS
  The incidence and the severity of early voice and swallowing postthyroidectomy symptoms are significantly reduced in patients who undergo VAT compared with conventional surgery.
authors.affiliation: Division of Endocrine Surgery, Department of Surgery, Università Cattolica del Sacro Cuore, Policlinico A. Gemelli, L.go A. Gemelli 8, 00168 Rome, Italy.
authors.forename: Celestino P
authors.initials: CP
authors.lastname: Lombardi
authors.forename: Marco
authors.initials: M
authors.lastname: Raffaelli
authors.forename: Lucia
authors.initials: L
authors.lastname: D'alatri
authors.forename: Carmela
authors.initials: C
authors.lastname: De Crea
authors.forename: Maria Raffaella
authors.initials: MR
authors.lastname: Marchese
authors.forename: Daria
authors.initials: D
authors.lastname: Maccora
authors.forename: Gaetano
authors.initials: G
authors.lastname: Paludetti
authors.forename: Rocco
authors.initials: R
authors.lastname: Bellantone
mesh_terms: D000328:Adult; D000368:Aged; D003680:Deglutition Disorders / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007828:Laryngoscopy; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D049489:Stroboscopy; D013959:Thyroid Diseases / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D013965:Thyroidectomy / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome; D020535:Video-Assisted Surgery; D014832:Voice Disorders / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*