title: Thyroidectomy: a novel endoscopic oral vestibular approach.
abstract: BACKGROUND
  To date, no report has discussed endoscopic thyroidectomy using the oral vestibular approach (ETOVA). The objective of this study was to evaluate the feasibility, safety, efficacy, and cosmetic results of endoscopic thyroidectomy involving this surgical approach.
  
  
  METHODS
  Twenty-four patients with benign thyroid nodules were randomized into the ETOVA (n = 12) and the endoscopic thyroidectomy by areola approach (ETAA) groups (n = 12). Therapeutic effects were assessed at follow-up by physical examination. All patients were followed to evaluate thyroid function and scar formation from endoscopic treatment.
  
  
  RESULTS
  Complete resection of all the lesions was performed endoscopically, and no conversion to open surgery was needed. There was no difference between the 2 groups with respect to surgical time (60.4 vs 59.6 min), blood loss (10.8 vs 13.8 mL), postoperative hospital stay (4.9 vs 4.6 d), or cost of surgery (17.6 vs 17.4 thousand yuan). Patients who underwent the areola approach had 3 scars, 10 × 2 mm, 5 × 1 mm, and 5 × 1 mm in size, all of which were visible at the 6-month follow-up. Patients in the ETOVA group did not have any scars. Follow-up showed a significant difference (P = .019) in the satisfaction score between the ETOVA (2.33 ± 0.65) and the ETAA group (1.58 ± 0.79). Imaging showed that all patients had complete resection and no residual disease. Severe complications such as subcutaneous accumulation of blood and fluid, superior or recurrent laryngeal nerve injury, and parathyroid dysfunction were not observed.
  
  
  CONCLUSIONS
  ETOVA was found to be safe and feasible and did not leave any scars; however, large-scale, randomized clinical trials are necessary for confirmation.
authors.affiliation: Department of General Surgery, the First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, P.R. China. Electronic address: twcc@jnu.edu.cn.
authors.forename: Cunchuan
authors.initials: C
authors.lastname: Wang
authors.affiliation: Department of General Surgery, the First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, P.R. China.
authors.forename: Hening
authors.initials: H
authors.lastname: Zhai
authors.affiliation: Department of Stomatology, the First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, P.R. China.
authors.forename: Weijun
authors.initials: W
authors.lastname: Liu
authors.affiliation: Department of General Surgery, the First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, P.R. China.
authors.forename: Jinyi
authors.initials: J
authors.lastname: Li
authors.affiliation: Department of General Surgery, the First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, P.R. China.
authors.forename: Jingge
authors.initials: J
authors.lastname: Yang
authors.affiliation: Department of General Surgery, the First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, P.R. China.
authors.forename: Youzhu
authors.initials: Y
authors.lastname: Hu
authors.affiliation: Department of General Surgery, the First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, P.R. China.
authors.forename: Jing
authors.initials: J
authors.lastname: Huang
authors.affiliation: Department of General Surgery, the First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, P.R. China.
authors.forename: Wah
authors.initials: W
authors.lastname: Yang
authors.affiliation: Department of General Surgery, the First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, P.R. China.
authors.forename: Yunlong
authors.initials: Y
authors.lastname: Pan
authors.affiliation: Department of General Surgery, the First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, P.R. China.
authors.forename: Hui
authors.initials: H
authors.lastname: Ding
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006042:Goiter / Q000601:surgery*; D006801:Humans; D008297:Male; D057605:Natural Orifice Endoscopic Surgery / Q000379:methods* / Q000706:statistics & numerical data; D017060:Patient Satisfaction; D011446:Prospective Studies; D013965:Thyroidectomy / Q000379:methods* / Q000706:statistics & numerical data; D016896:Treatment Outcome; D055815:Young Adult