Open vs. Total Endoscopic Approach to the Thyroid

Abstract

Objective

1) Learn the TATE approach to the thyroid. 2) Compare open vs. TATE approach.

Methods

From June 2005 to February 2008, 10 patients underwent TATE procedures for hemi-thyroidectomy with isthmusectomy. We used a control group of 10 consecutive open approaches. Hospital records were reviewed. Postoperatively, patients were asked to rate aspects of their surgery on a scale of 1–5.

Results

Thyroid pathology consisted of benign nodules as well as foci of papillary carcinoma in both groups. No patients in the TATE group required conversion to an open approach. The TATE approach to the thyroid gland added 37 minutes on average to the operative time (142 vs 105). The average of the last 5 TATE approaches decreased (114) compared to the first 5 TATE approaches (170). Blood loss was less in the TATE group (10 to 43). Patients expressed a greater satisfaction with the TATE approach for the surgery (1.375 to 1.5) and the incision (1.375 to 1.4). Patients did express greater pain 24 hrs after surgery in the TATE group (2.625 to 1.7), but this became equivalent 1 week after surgery (1.5 to 1.4). Patients returned to normal activites sooner in the TATE group than the control (2.125 / 2.4). No patients in either group experienced hoarseness 3 months after surgery.

Conclusions

The TATE approach to the thyroid gland is safe. Advantages include the absence of any surgical incisions in the neck and greater patient satisfaction. Operative time is longer in the TATE approach but this differential decreases with operative experience.