title: A prospective 1-year comparative study of transaxillary total thyroidectomy regarding functional outcomes: Is it really promising?
abstract: BACKGROUND
  The purpose of this study was to evaluate postoperative voice outcomes and functional parameters in total thyroidectomy via a transaxillary (TA) approach.
  
  
  METHODS
  Seventy-six patients who underwent total thyroidectomy via a TA approach (TA group) were included. A total of 204 patients who underwent conventional open total thyroidectomy (conventional group) in the same time period were analyzed as a control group. All patients underwent prospective functional evaluations before surgery and at 1 week and 1, 3, 6, and 12 months postoperatively using a comprehensive battery of functional assessments.
  
  
  RESULTS
  There was no conversion to conventional open thyroidectomy in the TA group. Operation time and the amount of drainage were significantly higher in the TA group than in the conventional group (p < 0.001 and p = 0.033, respectively), while vocal cord paralysis, hypoparathyroidism, and hematoma were not different among two groups (p = 0.215, 0.290, and 0.385, respectively). Regarding GRBAS, the TA group showed a more aggravated tendency postoperatively, although statistical significance was attained only at postoperative 6 months (p = 0.043). The voice handicap index abruptly increased postoperatively in the TA group, showing significant differences with the conventional group at postoperative 1 week and 1 month (p < 0.001 and p = 0.001, respectively). Fundamental frequency and maximal vocal pitch did not significantly change postoperatively in either group. The conventional group showed a more rapid decline in pain than the TA group, and paresthesias on the neck and chest were more aggravated in the TA group during the early postoperative period. The dysphagia handicap index was higher in the TA group, while cosmesis was better in the TA group at all postoperative periods.
  
  
  CONCLUSIONS
  Although cosmetic outcome was better with the TA approach, the longer operation time, aggravated subjective voice outcomes, paresthesia, and swallowing function need to be considered in selecting the operative approach.
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, Korea University College of Medicine, 126-1 An Am-Dong 5Ka, Sungbuk-Ku, Seoul, 136-705, South Korea.
authors.forename: Doh Young
authors.initials: DY
authors.lastname: Lee
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, Korea University College of Medicine, 126-1 An Am-Dong 5Ka, Sungbuk-Ku, Seoul, 136-705, South Korea.
authors.forename: Saehee
authors.initials: S
authors.lastname: Lim
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, Korea University College of Medicine, 126-1 An Am-Dong 5Ka, Sungbuk-Ku, Seoul, 136-705, South Korea.
authors.forename: Sung Hoon
authors.initials: SH
authors.lastname: Kang
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, Korea University College of Medicine, 126-1 An Am-Dong 5Ka, Sungbuk-Ku, Seoul, 136-705, South Korea.
authors.forename: Kyoung Ho
authors.initials: KH
authors.lastname: Oh
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, Korea University College of Medicine, 126-1 An Am-Dong 5Ka, Sungbuk-Ku, Seoul, 136-705, South Korea.
authors.forename: Jae-Gu
authors.initials: JG
authors.lastname: Cho
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, Korea University College of Medicine, 126-1 An Am-Dong 5Ka, Sungbuk-Ku, Seoul, 136-705, South Korea.
authors.forename: Seung-Kuk
authors.initials: SK
authors.lastname: Baek
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, Korea University College of Medicine, 126-1 An Am-Dong 5Ka, Sungbuk-Ku, Seoul, 136-705, South Korea.
authors.forename: Jeong-Soo
authors.initials: JS
authors.lastname: Woo
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, Korea University College of Medicine, 126-1 An Am-Dong 5Ka, Sungbuk-Ku, Seoul, 136-705, South Korea.
authors.forename: Soon-Young
authors.initials: SY
authors.lastname: Kwon
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, Korea University College of Medicine, 126-1 An Am-Dong 5Ka, Sungbuk-Ku, Seoul, 136-705, South Korea. kyjungmd@gmail.com.
authors.forename: Kwang-Yoon
authors.initials: KY
authors.lastname: Jung
mesh_terms: D000328:Adult; D001365:Axilla; D016022:Case-Control Studies; D004954:Esthetics; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D010292:Paresthesia / Q000209:etiology; D011446:Prospective Studies; D013964:Thyroid Neoplasms / Q000601:surgery; D013965:Thyroidectomy / Q000379:methods*; D014833:Voice Quality
keywords: Conventional thyroidectomy; Swallowing; Total thyroidectomy; Transaxillary approach; Voice