title: Systematic comparison of cervical and extra-cervical surgical approaches for endoscopic thyroidectomy.
abstract: OBJECTIVE
  To evaluate the clinical application of different surgical approaches for endoscopic thyroidectomy and provide more rational treatment criteria.
  
  
  METHODS
  Collect all randomized controlled trials, multi-center studies, clinical controlled trials, clinical trials and other comparative studies of endoscopic thyroidectomy with a large sample size in different databases through an established search strategy, make a systematic analysis of all the included literature.
  
  
  RESULTS
  This study selected 12 publications for analysis from more than 800 articles: these included six publications describing cervical thyroidectomy (A) and six publications describing extra-cervical thyroidectomy (B). Conversion to open surgery occurred in 29 patients in group A and only 4 in group B (p < 0.001). The patients in group A experienced shorter hospital stays than patients in group B (1.90 ± 0.80 vs. 4.03 ± 0.99 days, p < 0.001), and there was shorter operating time in group A (p < 0.001). Hemorrhage occurred in 3 cases in group A and 8 cases in group B (p = 0.04), Seroma occurred in 25 cases in group B but in no cases in group A (p < 0.001). Postoperative cosmetic results evaluated by verbal response scales (VRS) registered showed: group A (3.35 ± 0.60) and group B (3.74 ± 0.50; p < 0.001). Other complications such as recurrent laryngeal nerve injury and hypocalcemia showed no significant differences.
  
  
  CONCLUSIONS
  Evaluation of the different surgical approaches for endoscopic thyroidectomy shows that the incidence of hemorrhage and seroma are higher in the extra-cervical group, but the rate of conversion to conventional open surgery is significantly higher in the cervical group. Furthermore, patients who undergo extra-cervical endoscopic thyroidectomy are associated with longer operating time and hospital stays; however, these studies suggest that the extra-cervical surgical approach for endoscopic thyroidectomy is preferable for dealing with more kinds of thyroid tumor and leaving no scars on neck.
authors.affiliation: Department of General Surgery, The Second Affiliated Hospital of Shantou Medical College, Shantou, People's Republic of China.
authors.forename: Geng-Zhen
authors.initials: GZ
authors.lastname: Chen
authors.forename: Xuan
authors.initials: X
authors.lastname: Zhang
authors.forename: Wei-Lin
authors.initials: WL
authors.lastname: Shi
authors.forename: Ze-Rui
authors.initials: ZR
authors.lastname: Zhuang
authors.forename: Xi
authors.initials: X
authors.lastname: Chen
authors.forename: Hui
authors.initials: H
authors.lastname: Han
mesh_terms: D000328:Adult; D004724:Endoscopy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009333:Neck / Q000601:surgery; D013959:Thyroid Diseases / Q000601:surgery*; D013965:Thyroidectomy / Q000009:adverse effects / Q000379:methods*