title: Comparison of endoscopic and conventional open thyroidectomy for Graves' disease: A meta-analysis.
abstract: BACKGROUND
  Despite experience with the use of endoscopic surgical technology, there is controversy over the role of endoscopic thyroidectomy (ET) for Graves' disease (GD). This study aimed to conduct a meta-analysis to evaluate the cosmetic and safety outcomes of ET versus conventional open thyroidectomy (OT) for GD with respect to short-term consequences.
  
  
  METHODS
  We searched the following English language databases (Ovid MEDLINE, ISI Web of Science, and the Cochrane Library), and Chinese language databases (CNKI, CBMdisc, and SinoMed) between January 1996 and November 2015. The quality of the included studies was determined by the Newcastle-Ottawa Scale. A meta-analysis was conducted using RevMan 5.3 software. Pooled mean differences (MD) or odds ratios(OR) with I2were calculated using either fixed or random-effect models.
  
  
  RESULTS
  Six trials including 846 total cases were ultimately selected for meta-analysis. ET was associated with reduced blood loss (MD = -32.02; 95%CI: -36.92 to -27.12; P < 0.00001) and better cosmetic satisfaction (OR = 38.92; 95%CI: 17.40-87.06; P < 0.00001) than OT. However, OT was associated with reduced operation time (MD = 19.70; 95%CI: 2.04-37.35; P = 0.03) and lower hospital costs (MD = 303.21; 95%CI: 123.07, 483.36; P = 0.0010). Furthermore, ET and OT were not significantly different in terms of drainage volume, and they had an equivalent complication rate, including for transient recurrent laryngeal nerve palsy, transient hypocalcemia, postoperative hypothyroidism, and recurrent-hyperthyroidism.
  
  
  CONCLUSIONS
  ET appeared to provide better cosmetic satisfaction and a reduction in blood loss, whereas OT had a shorter operation time and lower hospital costs. Randomized clinical trials with large samples that include long-term follow-up data are necessary to confirm our findings.
authors.affiliation: Department of Surgery, Jinan University Institute for Minimally Invasive Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, China. Electronic address: jnu_zyc1989@163.com.
authors.forename: Yichao
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: Department of Surgery, Jinan University Institute for Minimally Invasive Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, China. Electronic address: zhiyongdong1986@163.com.
authors.forename: Zhiyong
authors.initials: Z
authors.lastname: Dong
authors.affiliation: Department of Surgery, Jinan University Institute for Minimally Invasive Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, China. Electronic address: lijinyi2016@126.com.
authors.forename: Jinyi
authors.initials: J
authors.lastname: Li
authors.affiliation: Department of Surgery, Jinan University Institute for Minimally Invasive Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, China. Electronic address: yangjg@yeah.net.
authors.forename: Jingge
authors.initials: J
authors.lastname: Yang
authors.affiliation: Department of Surgery, Jinan University Institute for Minimally Invasive Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, China. Electronic address: yangwahh@163.com.
authors.forename: Wah
authors.initials: W
authors.lastname: Yang
authors.affiliation: Department of Surgery, Jinan University Institute for Minimally Invasive Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, China. Electronic address: twcc@jnu.edu.cn.
authors.forename: Cunchuan
authors.initials: C
authors.lastname: Wang
mesh_terms: D000328:Adult; D004724:Endoscopy / Q000379:methods*; D005260:Female; D006111:Graves Disease / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011183:Postoperative Complications / Q000209:etiology*; D013961:Thyroid Gland / Q000601:surgery; D013965:Thyroidectomy / Q000379:methods*; D016896:Treatment Outcome
keywords: Comparative study; Conventional open; Endoscopy; Graves' disease; Meta-analysis; Thyroidectomy