Endoscopic Thyroidectomy by a Gasless Unilateral Axillo-breast or Axillary Approach

Background: Although the excellent short-term cosmesis after robotic/endoscopic thyroidectomy has been reported, the long-term cosmetic outcome is not yet known. The aim of this study was to evaluate the long-term cosmetic outcome of robotic/endoscopic thyroidectomy. Patients and Methods: We compared 147 patients who underwent robotic or endoscopic thyroidectomy using a gasless unilateral axillo-breast (GUAB) approach or a gasless unilateral axillary (GUA) approach with 161 conventional open thyroidectomy patients. Subjective cosmetic outcomes were evaluated using a series of scar-specific questions as well as the Vancouver scar scale at 12-18 months after surgery. The cosmetic satisfaction score was defined as the sum of the two cosmetic satisfaction questions with a rating scale of 1-5. The scar consciousness score was defined as the sum of the four scar consciousness questions with a rating scale of 0-3. Results: The cosmetic satisfaction and scar consciousness scores were significantly better in the robotic/endoscopic group than in the open group (P<.001 in both). The cosmetic satisfaction and scar consciousness scores were the same in the robotic and endoscopic groups and were also the same in the GUA and GUAB approach groups. Patients treated by the GUA approach were more satisfied with their scarless breasts than patients treated by the GUAB approach having breast scars. Conclusions: Long-term postoperative cosmesis after robotic/endoscopic thyroidectomy using GUAB/GUA approaches is significantly better than conventional open thyroidectomy. In the robotic/endoscopic group, the scarless breasts resulting from the GUA approach lead to greater satisfaction than those after the GUAB approach