title: Comparison of transaxillary approach, retroauricular approach, and conventional open hemithyroidectomy: A prospective study at single institution.
abstract: BACKGROUND
  The aims of this study were to evaluate and compare the operative outcomes and postoperative subjective functional parameters of transaxillary (TA) and retroauricular (RA) approach thyroidectomy, with those of conventional hemithyroidectomy.
  
  
  METHODS
  From May 2011 through December 2013, 153 patients who underwent hemithyroidectomy were categorized prospectively into 3 groups according to the surgical approach used (TA, RA, and conventional hemithyroidectomy groups). All patients underwent prospective acoustic and functional evaluation, using a comprehensive battery of functional assessments, preoperatively and postoperatively at 1 week, 1 month, 3 months, 6 months, and 12 months.
  
  
  RESULTS
  Age at diagnosis was significantly lower in the TA (n = 50) and RA groups (n = 42) than in the conventional group (n = 61; P < .001). The frequency of occurrence of vocal cord paralysis, inadvertently excised parathyroid, and hematoma did not differ among the groups (P = .447, .519, and .069, respectively). Three months postoperatively, maximal vocal pitch was significantly higher in the RA group than in the conventional and TA groups (P = .021). Although the overall pain score was not different, the Dysphagia Handicap Index of the RA group at 1 month postoperatively was significantly higher (P < .001) than in the other groups. Chest paresthesia was significantly more severe in the TA group, especially at 3 months postoperative (P = .035). The cosmetic satisfaction score was significantly higher in the RA and TA groups than in the conventional group (P = .001 and 0.035, respectively) at 3 and 6 months postoperatively.
  
  
  CONCLUSIONS
  Both TA and RA hemithyroidectomy were followed by excellent surgical outcomes, especially with regard to cosmesis. However, delayed recovery of swallowing in RA and chest paresthesia in TA may be mitigating factors.
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, Korea University, College of Medicine, Seoul, 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, Seoul, Korea.
authors.forename: Ki Jeong
authors.initials: KJ
authors.lastname: Lee
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, Korea University, College of Medicine, Seoul, Korea.
authors.forename: Won Gue
authors.initials: WG
authors.lastname: Han
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, Korea University, College of Medicine, Seoul, 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, Seoul, 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, Seoul, 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, Seoul, 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, Seoul, 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, Seoul, Korea. Electronic address: kyjungmd@gmail.com.
authors.forename: Kwang-Yoon
authors.initials: KY
authors.lastname: Jung
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002277:Carcinoma / Q000601:surgery*; D002291:Carcinoma, Papillary; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011183:Postoperative Complications; D011446:Prospective Studies; D011788:Quality of Life; D016037:Single-Blind Method; D000077273:Thyroid Cancer, Papillary; D013964:Thyroid Neoplasms / Q000601:surgery*; D013965:Thyroidectomy / Q000379:methods*; D016896:Treatment Outcome