title: Reoperative thyroid surgery: can endoscopic areola approach be used?
abstract: Reoperative thyroid surgery is associated with a higher morbidity and has traditionally been done in conventional open approach. This study aimed to evaluate the safety and effectiveness of endoscopic areola approach for reoperative thyroid surgery.
  
  
  
  A retrospective study was conducted in 46 patients undergoing reoperative thyroid surgery with endoscopic areola approach (endoscopic group) and 70 patients with conventional open approach (open group). Perioperative and follow-up outcomes were compared between the two groups.
  
  
  
  Baseline characteristics were comparable between the two groups. Except for two cases of the endoscopic group intraoperatively converted to open surgery, all the other surgery was successfully completed. No significant difference was found between two groups concerning operation time, drainage volume, drainage time and postoperative hospital stay (all P > 0.05). Estimated blood loss was more in the open group than the endoscopic group (P = 0.000). Although not statistically significant, the overall complication rate was less in the endoscopic group than in the open group (21.7 vs. 37.1 %, P = 0.079). Of these complications, transient hypocalcemia was the most common (endoscopic group, 17.4 %; open group, 21.4 %; P = 0.594). One patient of the endoscopic group and 7 patients of the open group suffered from transient recurrent laryngeal nerve (RLN) paralysis (P = 0.210). Moreover, 2 patients of open group experienced permanent RLN paralysis. During the follow-up period (range 1-6 years), no recurrent case was encountered, but the endoscopic group had a higher cosmetic score (9.0 ± 0.9 vs. 5.9 ± 0.9, P = 0.000).
  
  
  
  In high-volume centers, with strict operation indication, sufficient preoperative evaluation and careful surgical maneuvers, endoscopic areola approach is a safe and effective method for reoperative thyroid surgery, allowing to provide a better cosmetic result and reduce intraoperative blood loss compared with open approach.
authors.affiliation: Department of General Surgery, First Affiliated Hospital of Jinan University, Guangzhou, 510630, China.
authors.forename: Bingsheng
authors.initials: B
authors.lastname: Guan
authors.affiliation: Department of General Surgery, First Affiliated Hospital of Jinan University, Guangzhou, 510630, China.
authors.forename: Jinyi
authors.initials: J
authors.lastname: Li
authors.affiliation: Department of General Surgery, First Affiliated Hospital of Jinan University, Guangzhou, 510630, China.
authors.forename: Wah
authors.initials: W
authors.lastname: Yang
authors.affiliation: Department of General Surgery, First Affiliated Hospital of Jinan University, Guangzhou, 510630, China.
authors.forename: Jingge
authors.initials: J
authors.lastname: Yang
authors.affiliation: Department of General Surgery, First Affiliated Hospital of Jinan University, Guangzhou, 510630, China.
authors.forename: Guo
authors.initials: G
authors.lastname: Cao
authors.affiliation: Department of General Surgery, First Affiliated Hospital of Jinan University, Guangzhou, 510630, China.
authors.forename: Peng
authors.initials: P
authors.lastname: Sun
authors.affiliation: Department of General Surgery, First Affiliated Hospital of Jinan University, Guangzhou, 510630, China. wangcunchuan@tom.com.
authors.forename: Cunchuan
authors.initials: C
authors.lastname: Wang
mesh_terms: D000328:Adult; D016063:Blood Loss, Surgical; D004724:Endoscopy / Q000379:methods*; D004954:Esthetics; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009558:Nipples; D011183:Postoperative Complications; D012086:Reoperation / Q000379:methods*; D012189:Retrospective Studies; D013965:Thyroidectomy / Q000379:methods*; D014826:Vocal Cord Paralysis / Q000209:etiology
keywords: Areola approach; Conventional open approach; Endoscopic thyroidectomy; Reoperative thyroid surgery