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Voice Handicap Index (VHI-10) questionnaire is regarded as the subjective assessment for dysphonia. It contains 10 questions in total, each scaled from 0 (no impairment) to 4 (maximum impairment).  

Voice Handicap Index (VHI-10) questionnaire is regarded as the subjective assessment for dysphonia. It contains 10 questions in total, each scaled from 0 (no impairment) to 4 (maximum impairment).  

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Objectives: The purpose of this study was to compare the quality of life (QoL) between conventional open and robotic total thyroidectomy in papillary thyroid carcinoma. Materials and methods: From January 2011 to July 2013, 229 patients (112 robot and 117 open) were randomly selected. QoL, including overall satisfaction, cosmetic results, voice/...

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... into five phases from extremely satisfied (4), satisfied (3), acceptable (2), dissatisfied (1) to extremely dissatisfied (0). The voice func- tion was assessed using the Voice Handicap Index (VHI-10), a subjective assessment measure comprising 10 questions in total, and its total score ranged from 0 (no impairment) to 40 (maximum impairment) (Fig. ...

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... Some authors present open thyroidectomy as the one with a better outcome than the endoscopic method [40,41], while others report worse prevalence of dysphagia in open surgeries [36] or even some others place open surgeries somewhere between endoscopic and endoscopic-assisted thyroidectomies [42]. Focusing on the robotic surgery, in a couple of studies it is maintained that this technique provides more beneficial scores based on Swallowing Impairment Score (SIS) at the first, third and sixth post-thyroidectomy months [43,44], while at the same time this is contradicted by other studies [45,46]. The differences mentioned above are hard to explain, since many factors were investigated but there are insufficient data to draw a conclusion about the superiority of one technique over the others. ...
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Purpose Swallowing disorders following thyroidectomy are common, even after surgery without confirmed complications. The purpose of the current systematic review is to investigate the prevalence of dysphagia at various time points after thyroidectomy, at the whole spectrum of it (total/partial, open/endoscopic, for benign/malignant disease). Methods The literature available at PubMed, SciELO and Cochrane Library databases was reviewed, according to PRISMA guidelines, using the terms “dysphagia”, “swallowing disorder”, “deglutition disorder”, “thyroidectomy” and “thyroid surgery” in the appropriate combinations. A quantitative synthesis of the results followed. Results The systematic review of the literature resulted in 35 articles, which met the inclusion criteria and were analyzed regarding their type, sample, follow-up and results regarding post-thyroidectomy dysphagia in multiple follow-up times. A significant increase of swallowing impairment compared to baseline was recorded shortly after surgery. Dysphagia reverted to pre-operative levels 2–3 months later. Dysphagia continued to be reported in a significantly lower proportion of patients, even 1 year after surgery. No significant difference was noticed between open and endoscopic thyroid surgery at 2–3 months post-surgery. Conclusions The swallowing disorders reported after thyroidectomy should be expected, but are not always detectable through objective methods. This should not lead to underestimation of symptoms, since the patients’ quality of life is negatively affected by the symptomatology.
... Порушення ковтання та відчуття стиснення горла також трапляються, але відсоток таких ускладнень низький [9,39]. ...
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З розвитком мініінвазійної хурургії прагнення покращити косметичний ефект після резекції щитоподібної залози привело до розробки трансоральної ендоскопічної тиреоїдектомії вестибулярного варіанта (ТОЕТВВ). Дана методика передбачає встановлення портів через переддвер’я ротової порожнини в субплатизматичний простір. Ендоскопічна тиреоїдектомія може виконуватися за допомогою робота. На відміну від відкритої резекції щитоподібної залози ТОЕТВВ не виконується при великих розмірах залози, суб- та декомпенсованому дифузному токсичному зобі, високому підборідді, загруднинному зобі, попередніх операціях на шиї і/або радіотерапії, існують також обмеження щодо розмірів вузла залежно від гістологічного типу. Частота післяопераційних ускладнень не відрізняється від відкритої методики. ТОЕТВВ притаманне специфічне ускладнення — ушкодження підборідного нерва. Трансоральна резекція щитоподібної залози є доцільною і безпечною операцією з відмінним косметичнимта клінічним результатами для ретельно відібраних пацієнтів. Необхідні подальші дослідження методики.
... 12,27 However, as pointed out in previous studies, the average operative time and length of postoperative hospital stay were significantly longer in the transaxillary group due to the complexity of cavity building and the use of an endoscopic approach. 8,28 In addition, more patients in the open group experienced throat discomfort at 1 month postoperatively, which was gradually relieved and was considered to be related to the injury of the anterior cervical muscle during open surgery. Overall, we believe that endoscopic thyroid surgery via the transaxillary approach is a safe and minimally invasive technique for PTMC. ...
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Background: Transaxillary endoscopic thyroidectomy has been introduced to achieve better cosmetic outcomes. However, the benefits of this technology on the patients' health-related quality of life (HRQoL) remain unclear. We aimed to investigate whether transaxillary endoscopic lobectomy is comparable to conventional open lobectomy in terms of QOL and cosmetic results in order to provide more evidence for establishing appropriate clinical decisions. Methods: Between August 2019 and May 2020, transaxillary endoscopic lobectomy and conventional open lobectomy were performed in 73 and 99 patients with papillary thyroid microcarcinoma, respectively. HRQoL was assessed at 1, 3, 6, and 12 months after surgery using the Thyroid Cancer-Specific Quality of Life Questionnaire. The cosmetic outcomes were assessed 12 months after surgery using the Patient and Observer Scar Assessment Scale (POSAS). Results: No significant difference was observed in the surgical results between the two groups. However, the data showed that the average operative time and postoperative hospital stay of the transaxillary group were longer than those of the open group (p < 0.001). Both groups showed similar changes in the QOL scores over time. However, the transaxillary group had fewer complaints of the throat or oral problems at 1 month postoperatively than the open group (p < 0.001). During the follow-up, the cosmetic results of scars in the transaxillary group were significantly better than those in the open group (p < 0.05). Patients who underwent transaxillary endoscopic lobectomy had higher overall satisfaction with their scar appearance, determined using POSAS, at 12 months postoperatively. Conclusions: The current findings suggest that transaxillary endoscopic lobectomy may offer better cosmetic and HRQoL outcomes.
... Una cicatriz visible en el cuello es un estigma difícil de ocultar de un antecedente médico potencialmente relevante. Pero también se ha trabajado en otros temas, como la disminución del dolor postoperatorio [39,40] o los resultados vocales, ambos potenciales beneficiarios de la minimización del daño quirúrgico. En el caso de la voz existen dos posibles beneficios. ...
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Introducción y objetivo: El desarrollo de las técnicas de acceso remoto para cirugía de tiroides y paratiroides en los últimos años ha llevado a la consolidación de las cuatro configuraciones que actualmente se utilizan de manera estándar. El objetivo de esta revisión es describir la experiencia acumulada en tiroidectomía y paratiroidectomía por abordaje axilar, axilo-pectoral bilateral, retroauricular y transoral, así como exponer los resultados publicados por los diferentes grupos. Síntesis: El abordaje transaxilar fue el primero que se describió y tiene las series más antiguas y algunas de las más numerosas, cuyos resultados reproducen los estándares de la cirugía abierta para las mismas indicaciones. Sin embargo en los últimos años se ha ido abandonando a favor de abordajes alternativos. El abordaje retroauricular se describió inicialmente para la cirugía de tiroides, pero sus indicaciones han migrado hacia otra patología cervical. El abordaje axilopectoral bilateral ha sido extensamente utilizado en cirugía de tiroides y reproduce no solo los exigentes estándares respecto a las lesiones recurrenciales y el hipopartiroidismo postoperatorio, sino también los estándares oncológicos en el manejo quirúrgico del carcinoma diferenciado de tiroides. El abordaje transoral / transvestibular, el último en llegar, se encuentra en franca expansión y es potencialmente aplicable a la mayoría de los casos quirúrgicos de tiroides y paratiroides. Conclusiones: Las técnicas de acceso remoto han demostrado ser seguras y eficaces. El volumen de actividad publicado y los resultados las convertirían ya en procedimientos estándar, aunque sigue siendo necesario comprobar en series multicéntricas prospectivas la reproductibilidad de los resultados.
... As these symptoms are subjective, they are often dismissed by clinicians. In thyroid surgery, postoperative adhesion during the healing process is associated with swallowing impairment [39]. In this study, thyroiditis and tumor size were associated with postoperative swallowing impairment, which we consider to be the result of more traction or excessive handling in cases with large tumor size or thyroiditis. ...
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The transoral endoscopic thyroidectomy vestibular approach (TOETVA) has excellent cosmetic effects and its popularity is increasing worldwide. We present our experience with TOETVA and its short-term outcomes. This study included 110 consecutive patients who underwent TOETVA at a single institution between July 2016 and June 2020. We analyzed clinicopathologic data, short-term postoperative outcomes, and learning curve using cumulative summation (CUSUM) analysis. Of the 110 patients who underwent TOETVA, 101 had malignant disease and 100 (90.9%) underwent lobectomy. The mean age was 39.7 ± 9.7 years, and the mean tumor size was 1.0 ± 0.7 cm (range, 0.3–3.6 cm). Operation time was 168.0 ± 63.4 min for total thyroidectomy, 111.0 ± 27.7 min for lobectomy, and 73.7 ± 18.1 min for isthmusectomy. Five patients (4.5%) experienced transient vocal cord palsy (VCP) and one (0.9%) had permanent VCP. The swallowing impairment index-6 score was 2.18 ± 3.21 at postoperative three months, and 0.97 ± 1.72 at postoperative six months. The learning curve for lobectomy was 58 cases in CUSUM analysis. TOETVA is a safe and feasible approach with an acceptable operation time and a low complication rate. This approach is a surgical option for patients who desire excellent cosmesis.
... The surgical techniques may also influence swallowing. Authors who have compared conventional open thyroidectomy to robotic techniques, minimally inva- sive thyroid surgery, and subfascial approach to the thyroid reported a statistically significant increase of swallowing impairments in the conventional group 10,11,16,33,37,38,52,53 . Additionally, laryngopharyngeal reflux (lPR) could influence postsurgical swallowing complaints 6,13,25,54,55 . ...
... The Swallowing impairment index (SiS-6) was the most-used questionnaire among the reviewed studies (14 studies) 5,6,8,11,[16][17][18]25,33,38,40,53,56 . it is a specifically designed questionnaire self-evaluation that, with simple statements, addresses the spectrum of symptoms typically reported by patients. ...
... The nine items in geTS can be further divided into three subgroups to represent different symptoms: dysphagia, globus sensation, pain and swelling in the throat. The total geTS score (0-70) is classified into four degrees which are: asymptomatic (0-2), mildly symptomatic (3-8), symptomatic (9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20), and strongly symptomatic (>20). only 4 studies investigated the influence of swallowing difficulties related to thyroidectomy on Qol. ...
Article
This study aims to provide insight into the etiology and frequency of swallowing complications that arise after thyroidectomy and to outline the available diagnostic procedures by revising the existing literature on this topic. We conducted a bibliographic search using the electronic database MEDLINE/PubMed to identify all relevant articles and 44 studies were included in the review out of a total of 218 published articles. Dysphagia after thyroid surgery is a common postoperative complication which, in the short- or long-term, significantly affects patient life quality. There is no standard diagnostic protocol for thyroidectomy-related swallowing impairment. Among the reviewed studies, 8 questionnaires and 12 instrumental diagnostic tools were used to identify swallowing difficulties related to thyroid surgery. The Swallowing Impairment Index (SIS-6) was the most-used questionnaire. Fiberoptic endoscopy is a standard diagnostic tool performed prior and after thyroid surgery, primarily to identify changes in vocal fold mobility. Although instrumental findings usually reveal non-specific alterations of swallowing; swallowing videofluoroscopy and esophageal manometry can be the most helpful tools in further management of thyroidectomy dysphagia. In patients with thyroidectomy-related swallowing difficulties and suspected laryngopharyngeal reflux, 24-hour MII-pH metry should be performed.
... Regarding volume of blood loss, it was similar between the groups. However, the endoscopic procedure took significantly longer, as noted in previous studies [4,18]. The longer operative time may increase the risk of complications and morbidity due to longer exposure time to general anesthesia. ...
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Background: Trans-oral endoscopic thyroidectomy allows obviating scar of the neck that expects to gain quality of life (QOL). However, the benefit of the QOL from this technique has not been adequately investigated, therefore, this study compared the QOL outcomes, including cosmetic outcomes, between thyroidectomy by trans-oral endoscopy and conventional open surgery. Methods: A study was conducted from January 30, 2017 to November 10, 2018. Thirty-two and 38 patients underwent trans-oral endoscopic thyroid surgery and conventional open surgery, respectively. Their quality of life was evaluated at 2, 6, and 12 weeks postoperatively using a thyroid surgery-specific questionnaire and a 36-item short-form questionnaire. Results: Trans-oral endoscopic group, patients were younger and presented with smaller thyroid nodules (p < 0.05). Regarding surgical outcomes, there were no statistically significant differences between the two groups. Mean operative time was significantly longer in the trans-oral endoscopic group (p < 0.05). The quality of life parameters in the trans-oral endoscopic group was significantly better than in the conventional surgery group (p < 0.05). These parameters included reduction of physical activity, psychosocial impairment, the role of physic, and emotion at 2 weeks after surgery; swallowing impairment, psychosocial impairment, the role of physic, social function and mental health 6 weeks after surgery; tingling and feeling of vitality at 12 weeks after surgery. Cosmetic outcomes and overall satisfaction were significantly better in the trans-oral endoscopic group than in the conventional surgery group at all of our follow up times (p < 0.05). Conclusions: The trans-oral endoscopic approach allows real scarless on the skin with better cosmetic and QOL outcomes. Trial registration: This trial was retrospectively registered at the ClinicalTrial.gov (NCT03048539), registered on 4 March 2017.
... However, in our interpretation, not having a visible scar should result in an esthetic benefit and greater patient satisfaction. This is corroborated when we make a parallel with studies where non-cervical remote accesses were used to perform thyroidectomies and neck dissections: it was evidenced that these remote accesses, especially the retroauricular access, have important advantages in terms of increased cosmetic satisfaction [23][24][25][26][27]. Unfortunately, this data has not been evaluated in the literature for submandibular gland surgery. ...
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Background Surgical scars are a significant cosmetic problem, especially when in exposed areas such as the anterior neck. To avoid or reduce visible scarring, diverse innovative surgical approaches to the neck have been introduced. The purpose of this study was to evaluate the feasibility and safety of the endoscopic resection using the retroauricular approach for submandibular gland excision. Methods The present study enrolled 48 patients who underwent conventional transcervical submandibular gland excision and 23 patients who underwent endoscope-assisted retroauricular approach submandibular gland excision, from February 2014 through February 2018 at the Department of Head and Neck Surgery and Otorhinolaryngology of the AC Camargo Cancer Center, in Sao Paulo, Brazil. The surgical outcomes were retrospectively reviewed. Results In the conventional group, 26 (54%) patients were male. The mean age was 49.3 years (range 22–81). Twenty-two patients (46%) had sialoadenitis; twenty-one (44%) had benign and five (10%) had malignant tumors. The mean total surgical time was 86.4 min (range 40–180), and the mean total length of hospital stay was 1.3 days. Twenty-seven (56%) patients suffered from local postoperative complications in the neck. In the retroauricular group, 14 (61%) patients were male. The mean age was 44.1 years (range 24–71 years). Seven patients (31%) had sialoadenitis, twelve (53%) had benign tumors and four (16%) had malignant tumors. The mean total surgical time was 86.4 min (range 75–300 min), and the mean total length of hospital stay was 1.2 days. Twelve (53%) patients suffered from local postoperative complications in the neck. No surgical site infections or systemic complications were described. Conclusions The retroauricular endoscopic-assisted submandibular gland resection is feasible, with excellent cosmetic results and no significant complication rate increase, and can be a safe potential surgical alternative for patients who are motivated to avoid a visible neck scar.
... Despite these results, few studies to date have evaluated physiological change in this population. Furthermore, existing data have been generated via subjective appraisal of swallowing function using interviews or questionnaires [7][8][9]. A prospective approach with direct measurement of functional and physiologic swallowing change post-thyroidectomy is likely to provide additional, detailed information that may help guide clinical management of these patients. ...
... However, at 3 months, deteriorated hyoid and laryngeal excursion in the present thyroidectomy patients still remain similar to at 1 week after surgery. Given that physiological change and surgical procedure are dependent on tumor location [8,18,19], minor discrepancies between previous reports and the present study are understandable. Under normal circumstances, the usual trajectory of the hyoid and laryngeal excursion in swallowing involves stylohyoidal and stylopharyngeal muscle contraction. ...
Article
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The aim of this study was to assess pharyngeal swallowing impairments in thyroidectomy patients and to delineate the contributory kinematic components. Forty consecutive patients (mean age = 47.33 years) and fourteen age- and sex-matched heathy adult volunteers (mean age = 42.64 years) participated in this study. A videofluoroscopic swallowing study (VFSS) was performed 1 day prior to surgery, and at 1 week and 3 months post-surgery. VFSS images were evaluated using the Modified Barium Swallowing Impairment Profile (MBSImp). Kinematic and temporal aspects of swallowing were characterized by measurement of maximum hyoid and laryngeal excursion, pharyngeal transit duration, laryngeal response duration (LRD), and laryngeal closure duration at each three time-points. At 1 week post-surgery, only pharyngeal impairment was significantly deteriorated than pre-surgery (p = 0.001). However, at 3 months, a significant improvement was observed to pre-surgery level (p = 0.01). Post-surgery, maximum hyoid excursion was significantly reduced in patients compared controls (p = 0.001). Although the maximal distance of the hyoid and the laryngeal excursion was shorter than before surgery, laryngeal excursion at all three time-points was similar to that of controls. At all three time-points, LRD was significantly longer in patients than in controls (p = 0.01). Following thyroidectomy, pharyngeal aspects of swallowing as measured by the MBSImp and kinematic aspects of swallowing were reduced with incomplete recovery at 3 months. These exploratory data may guide decision regarding management of pharyngeal swallowing impairment with patients undergoing total thyroidectomy.
... Moreover, robotic thyroidectomy confers superior cosmesis over the open approach. The evidence for this is level 1b as in addition to the several case control and cohort studies evaluating patient-reported outcome measures [1,[28][29][30], there is also a randomised controlled trial to support this though the latter failed to demonstrate cosmetic superiority of the transaxillary robotic approach over minimally invasive video-assisted thyroidectomy [17]. ...
Article
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Robotic transaxillary thyroidectomy, pioneered in South Korea, is firmly established throughout the Far East but remains controversial in Western practice. This relates to important population differences (anthropometry and culture) compounded by the smaller mean size of thyroid nodules operated on in South Korea due to a national thyroid cancer screening programme. There is now level 2 evidence (including from Western World centres) to support the safety, feasibility, and equivalence of the robotic approach to its open counterpart in terms of recurrent laryngeal nerve injury, hypoparathyroidism, haemorrhage, and oncological outcomes for differentiated thyroid cancer. Moreover, robotic thyroidectomy has been shown to be superior to open surgery for certain patient-reported outcome measures, namely scar cosmesis and pain. Downsides include its high cost, longer operative time, and risk of complications not encountered in open thyroidectomy (brachial plexus neurapraxia). Careful patient selection is paramount as this procedure is not for every patient, surgeon, or hospital. It should only be undertaken by high-volume surgeons operating as part of a multidisciplinary robotic team in specialised centres. Novel robotic approaches utilising the retroauricular and transoral routes for thyroidectomy have recently been described but further studies are required to establish their respective role in modern thyroid surgery.