Comparison of transoral vestibular <i>versus</i> transaxillary endoscopic thyroidectomy: a meta-analysis_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

YANG Liu ¹ ,  REN ZHongfeng ²

1. Department of Special Examination, Linyi Cancer Hospital, Linyi, Shandong 276000, P. R. China;
2. Ward 1, Department of Head and Neck Surgery, Linyi Cancer Hospital, Linyi, Shandong 276000, P. R. China;

Corresponding?author：

REN ZHongfeng, Email: 516155214@qq.com

Keywords：

thyroid cancer; endoscopic thyroidectomy; transoral vestibular approach; transaxillary approach; meta-analysis

DOI：

10.7507/1007-9424.202508004

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To compare the efficacy of transoral vestibular endoscopic thyroidectomy (TOET) and transaxillary endoscopic thyroidectomy (TAET) by means of a meta-analysis. Methods Relevant literature comparing the two surgical approaches was retrieved via computer from both domestic and international databases from inception to April 2025. The included studies were analyzed using RevMan 5.4 software, with observation indicators including operative time, intraoperative blood loss, number of central lymph nodes dissected, postoperative drainage volume, postoperative pain score, postoperative parathyroid hormone level, postoperative complication rate, length of hospital stay, and cosmetic outcome of the incision. Results A total of 13 studies involving 1 619 patients (784 in the TOET group and 835 in the TAET group) were included. Compared with the TAET group, the TOET group had a longer operative time [MD=17.04, 95%CI (3.40, 30.69), P=0.01], a greater number of central lymph nodes dissected [MD=0.92, 95%CI (0.77, 1.06), P<0.000 01], a higher overall postoperative complication rate [OR=1.52, 95%CI (1.06, 2.17), P=0.02], a shorter hospital stay [MD=–0.14, 95%CI (–0.23, –0.04), P=0.005], and a better cosmetic outcome of the incision [MD=–0.64, 95%CI (–0.77, –0.50), P<0.000 01]. There were no statistically significant differences between the two groups in intraoperative blood loss [MD=–0.29, 95%CI (–1.25, 0.68), P=0.56], postoperative drainage volume [MD=–9.63, 95%CI (–35.38, 16.11), P=0.46], postoperative pain score [MD=0.05, 95%CI (–0.77, 0.86), P=0.91], or postoperative parathyroid hormone level [MD=–2.71, 95%CI (–5.60, 0.18), P=0.07]. Conclusions TOET demonstrates advantages in the number of lymph nodes dissected, cosmetic outcome, and length of hospital stay. However, it is associated with a longer operative time and a higher complication rate. The choice of surgical approach should be based on a comprehensive consideration of the patient’s cosmetic needs, tumor characteristics, and the surgeon’s experience.

1.	Seib CD, Sosa JA. Evolving understanding of the epidemiology of thyroid cancer. Endocrinol Metab Clin North Am, 2019, 48(1): 23-35.
2.	杜宏超, 尹明龍, 徐龍. 無充氣腋窩入路腔鏡下甲狀腺癌根治術在單側甲狀腺乳頭狀癌中的療效. 中國現代普通外科進展, 2024, 27(7): 558-560.
3.	佘鍵濤, 高恒元, 王存川, 等. 中國腔鏡甲狀腺外科的發展歷程與現狀. 中國醫刊, 2024, 59(10): 1050-1054.
4.	Miccoli P, Berti P, Conte M, et al. Minimally invasive surgery for thyroid small nodules: preliminary report. J Endocrinol Invest, 1999, 22(11): 849-851.
5.	Hüscher CS, Chiodini S, Napolitano C, et al. Endoscopic right thyroid lobectomy. Surg Endosc, 1997, 11(8): 877. doi: 10.1007/s004649900476.
6.	石臣磊, 侯超越, 石鐵鋒, 等. 經腋窩無充氣腔鏡甲狀腺癌根治術效果及相關因素分析. 中國實用外科雜志, 2022, 42(8): 925-931.
7.	陳露陽, 彭書旺, 彭坷平, 等. 經腋窩入路與乳暈入路腔鏡甲狀腺癌根治術的療效及美學效果觀察. 中國現代手術學雜志, 2022, 26(5): 341-346.
8.	劉三保, 王亞兵, 任俊玲. 3種不同入路腔鏡手術治療甲狀腺微小癌的療效及并發癥對比研究. 重慶醫科大學學報, 2024, 49(1): 65-69.
9.	閔逸洋, 趙寧, 王沛豪. cT1N0期甲狀腺癌三種腔鏡術式和開放術式的對比研究. 中華普外科手術學雜志(電子版), 2022, 16(4): 443-446.
10.	章書銘, 吳冬冬, 張華, 等. 不同入路行單側甲狀腺葉切除術治療甲狀腺微小乳頭狀癌的療效分析. 中華內分泌外科雜志, 2023, 17(4): 440-444.
11.	李紅強, 樊玉霞, 陳亞麗, 等. 單側甲狀腺微小乳頭狀癌腔鏡手術中3種入路的臨床評價. 鄭州大學學報(醫學版), 2021, 56(2): 160-163.
12.	宋艾紅, 陳智杰, 陳成, 等. 經口腔前庭入路腔鏡甲狀腺腺葉切除聯合中央區淋巴結清掃術的臨床應用. 局解手術學雜志, 2021, 30(9): 808-812.
13.	凌堯, 蘭雪君, 歐敏. 經口腔前庭入路與經腋窩入路腔鏡手術治療甲狀腺癌的效果對比. 中國美容醫學, 2024, 33(5): 13-17.
14.	馬銀玲. 經腋窩入路與口腔前庭入路免充氣腔鏡甲狀腺手術臨床應用研究. 寧夏醫科大學, 2023.
15.	崔儀, 賈曉斌, 向輝, 等. 經口腔前庭入路與無充氣腋窩入路腔鏡甲狀腺手術治療甲狀腺乳頭狀癌的臨床效果觀察. 中國現代普通外科進展, 2025, 28(3): 221-224.
16.	孫思雨, 張松, 錢立宇, 等. 經口腔前庭入路與經腋窩入路腔鏡單側甲狀腺癌根治術的療效對比. 腹腔鏡外科雜志, 2024, 29(9): 647-651.
17.	高愿, 王圣應, 方靜, 等. 不同免充氣腔鏡術式治療甲狀腺癌的效果比較. 中國臨床保健雜志, 2024, 27(3): 391-393.
18.	Zhang WD, Dai L, Le Q, et al. Transoral endoscopic thyroidectomy vestibular approach versus gasless transaxillary endoscopic thyroidectomy for patients with unilateral papillary thyroid carcinoma: a retrospective study. Surg Laparosc Endosc Percutan Tech, 2023, 33(4): 347-350.
19.	Zheng G, Xu J, Wu G, et al. Transoral versus gasless transaxillary endoscopic thyroidectomy: a comparative study. Updates Surg, 2022, 74(1): 295-302.
20.	Lee MC, Ahn J, Choi IJ, et al. Comparative study of gasless transaxillary, bilateral axillo-breast, unilateral axillo-breast with carbon dioxide insufflation, retroauricular, and transoral vestibular endoscopic thyroidectomy approaches at a single institution: a retrospective analysis and lessons learned. Clin Exp Otorhinolaryngol, 2022, 15(3): 283-291.
21.	蔣瑞科, 周璐, 陳陽, 等. 腔鏡與開放甲狀腺癌頸側區淋巴結清掃術臨床療效的Meta分析. 腹腔鏡外科雜志, 2024, 29(08): 561-568.
22.	朱卿, 張彪, 劉佳寧. 經腋窩腔鏡下與傳統甲狀腺切除術治療乳頭狀癌的療效比較. 腹腔鏡外科雜志, 2024, 29(03): 174-178.
23.	章德廣, 高力, 謝磊, 等. 改良Miccoli手術頸側區淋巴結清掃術治療甲狀腺乳頭狀癌130例臨床分析. 中華外科雜志, 2016, 54(11): 864-869.
24.	吳國洋, 林福生. 經口入路腔鏡技術在甲狀腺癌治療中的應用及操作技巧. 國際外科學雜志, 2018, 45(12): 793-796.
25.	石臣磊, 侯超越, 石鐵鋒, 等. 經腋窩無充氣腔鏡甲狀腺癌根治術效果及相關因素分析. 中國實用外科雜志, 2022, 42(8): 925-931.
26.	王登歡, 任艷鑫, 馮恩梓, 等. 經口腔入路甲狀腺腔鏡手術在治療甲狀腺微小癌的應用價值及美容性效果. 昆明醫科大學學報, 2020, 41(10): 119-123.
27.	喬雷, 賈文磊, 董朝, 等. 經口腔前庭入路甲狀腺癌根治術與開放手術比較. 中華保健醫學雜志, 2021, 23(5): 516-517.
28.	潘先均, 胡代星, 蘇新良. 頸部中央區淋巴結清掃及術中冰凍病理檢查在甲狀腺微小乳頭狀癌治療中的臨床價值. 上海交通大學學報(醫學版), 2018, 38(2): 180-183.
29.	許志亮, 史曼曼, 廖仕翀, 等. 兩種常用腔鏡技術在甲狀腺微小乳頭狀癌中央組淋巴結清掃中的運用. 武漢大學學報(醫學版), 2019, 40(4): 613-616.
30.	王登歡, 張冉, 馮恩梓, 等. 經口腔前庭入路腔鏡手術在甲狀腺癌中央區淋巴結清掃中的有效性研究. 臨床耳鼻咽喉頭頸外科雜志, 2022, 36(7): 540-544+558.
31.	彭歡. 經腋窩入路充氣式腔鏡下甲狀腺癌根治術治療單側分化型甲狀腺癌的療效及安全性分析. 貴州醫藥, 2024, 48(9): 1402-1404.
32.	傅錦波, 羅曄哲, 洪曉泉, 等. 經腋窩入路與經胸乳入路腔鏡甲狀腺切除術的對比研究. 中國微創外科雜志, 2017, 17(8): 688-690.
33.	曾沁欣, 王浩斌, 邵帥, 等. 經口腔前庭入路腔鏡甲狀腺手術空間的建立與維持. 腹腔鏡外科雜志, 2024, 29(12): 936-940.
34.	Tae K, Lee DW, Bang HS, et al. Sensory change in the chin and neck after transoral thyroidectomy: Prospective study of mental nerve injury. Head Neck, 2020, 42(11): 3111-3117.
35.	Wilhelm T, Metzig A. Endoscopic minimally invasive thyroidectomy (eMIT): a prospective proof-of-concept study in humans. World J Surg, 2011, 35(3): 543-551.
36.	王存川, 翟賀寧, 劉衛軍, 等. 經口腔前庭腔鏡甲狀腺切除術6例經驗. 中國內鏡雜志, 2013, 19(04): 363-366.
37.	徐嘉, 史維臣, 何奕卉, 等. 無充氣腋窩入路與鎖骨下入路腔鏡對單側甲狀腺癌的療效比較. 中國現代普通外科進展, 2024, 27(07): 561-563.
38.	梁歡. 經腋窩入路與經胸乳入路腔鏡下甲狀腺切除術臨床治療比較研究. 吉林大學, 2023.

1. Seib CD, Sosa JA. Evolving understanding of the epidemiology of thyroid cancer. Endocrinol Metab Clin North Am, 2019, 48(1): 23-35.
2. 杜宏超, 尹明龍, 徐龍. 無充氣腋窩入路腔鏡下甲狀腺癌根治術在單側甲狀腺乳頭狀癌中的療效. 中國現代普通外科進展, 2024, 27(7): 558-560.
3. 佘鍵濤, 高恒元, 王存川, 等. 中國腔鏡甲狀腺外科的發展歷程與現狀. 中國醫刊, 2024, 59(10): 1050-1054.
4. Miccoli P, Berti P, Conte M, et al. Minimally invasive surgery for thyroid small nodules: preliminary report. J Endocrinol Invest, 1999, 22(11): 849-851.
5. Hüscher CS, Chiodini S, Napolitano C, et al. Endoscopic right thyroid lobectomy. Surg Endosc, 1997, 11(8): 877. doi: 10.1007/s004649900476.
6. 石臣磊, 侯超越, 石鐵鋒, 等. 經腋窩無充氣腔鏡甲狀腺癌根治術效果及相關因素分析. 中國實用外科雜志, 2022, 42(8): 925-931.
7. 陳露陽, 彭書旺, 彭坷平, 等. 經腋窩入路與乳暈入路腔鏡甲狀腺癌根治術的療效及美學效果觀察. 中國現代手術學雜志, 2022, 26(5): 341-346.
8. 劉三保, 王亞兵, 任俊玲. 3種不同入路腔鏡手術治療甲狀腺微小癌的療效及并發癥對比研究. 重慶醫科大學學報, 2024, 49(1): 65-69.
9. 閔逸洋, 趙寧, 王沛豪. cT1N0期甲狀腺癌三種腔鏡術式和開放術式的對比研究. 中華普外科手術學雜志(電子版), 2022, 16(4): 443-446.
10. 章書銘, 吳冬冬, 張華, 等. 不同入路行單側甲狀腺葉切除術治療甲狀腺微小乳頭狀癌的療效分析. 中華內分泌外科雜志, 2023, 17(4): 440-444.
11. 李紅強, 樊玉霞, 陳亞麗, 等. 單側甲狀腺微小乳頭狀癌腔鏡手術中3種入路的臨床評價. 鄭州大學學報(醫學版), 2021, 56(2): 160-163.
12. 宋艾紅, 陳智杰, 陳成, 等. 經口腔前庭入路腔鏡甲狀腺腺葉切除聯合中央區淋巴結清掃術的臨床應用. 局解手術學雜志, 2021, 30(9): 808-812.
13. 凌堯, 蘭雪君, 歐敏. 經口腔前庭入路與經腋窩入路腔鏡手術治療甲狀腺癌的效果對比. 中國美容醫學, 2024, 33(5): 13-17.
14. 馬銀玲. 經腋窩入路與口腔前庭入路免充氣腔鏡甲狀腺手術臨床應用研究. 寧夏醫科大學, 2023.
15. 崔儀, 賈曉斌, 向輝, 等. 經口腔前庭入路與無充氣腋窩入路腔鏡甲狀腺手術治療甲狀腺乳頭狀癌的臨床效果觀察. 中國現代普通外科進展, 2025, 28(3): 221-224.
16. 孫思雨, 張松, 錢立宇, 等. 經口腔前庭入路與經腋窩入路腔鏡單側甲狀腺癌根治術的療效對比. 腹腔鏡外科雜志, 2024, 29(9): 647-651.
17. 高愿, 王圣應, 方靜, 等. 不同免充氣腔鏡術式治療甲狀腺癌的效果比較. 中國臨床保健雜志, 2024, 27(3): 391-393.
18. Zhang WD, Dai L, Le Q, et al. Transoral endoscopic thyroidectomy vestibular approach versus gasless transaxillary endoscopic thyroidectomy for patients with unilateral papillary thyroid carcinoma: a retrospective study. Surg Laparosc Endosc Percutan Tech, 2023, 33(4): 347-350.
19. Zheng G, Xu J, Wu G, et al. Transoral versus gasless transaxillary endoscopic thyroidectomy: a comparative study. Updates Surg, 2022, 74(1): 295-302.
20. Lee MC, Ahn J, Choi IJ, et al. Comparative study of gasless transaxillary, bilateral axillo-breast, unilateral axillo-breast with carbon dioxide insufflation, retroauricular, and transoral vestibular endoscopic thyroidectomy approaches at a single institution: a retrospective analysis and lessons learned. Clin Exp Otorhinolaryngol, 2022, 15(3): 283-291.
21. 蔣瑞科, 周璐, 陳陽, 等. 腔鏡與開放甲狀腺癌頸側區淋巴結清掃術臨床療效的Meta分析. 腹腔鏡外科雜志, 2024, 29(08): 561-568.
22. 朱卿, 張彪, 劉佳寧. 經腋窩腔鏡下與傳統甲狀腺切除術治療乳頭狀癌的療效比較. 腹腔鏡外科雜志, 2024, 29(03): 174-178.
23. 章德廣, 高力, 謝磊, 等. 改良Miccoli手術頸側區淋巴結清掃術治療甲狀腺乳頭狀癌130例臨床分析. 中華外科雜志, 2016, 54(11): 864-869.
24. 吳國洋, 林福生. 經口入路腔鏡技術在甲狀腺癌治療中的應用及操作技巧. 國際外科學雜志, 2018, 45(12): 793-796.
25. 石臣磊, 侯超越, 石鐵鋒, 等. 經腋窩無充氣腔鏡甲狀腺癌根治術效果及相關因素分析. 中國實用外科雜志, 2022, 42(8): 925-931.
26. 王登歡, 任艷鑫, 馮恩梓, 等. 經口腔入路甲狀腺腔鏡手術在治療甲狀腺微小癌的應用價值及美容性效果. 昆明醫科大學學報, 2020, 41(10): 119-123.
27. 喬雷, 賈文磊, 董朝, 等. 經口腔前庭入路甲狀腺癌根治術與開放手術比較. 中華保健醫學雜志, 2021, 23(5): 516-517.
28. 潘先均, 胡代星, 蘇新良. 頸部中央區淋巴結清掃及術中冰凍病理檢查在甲狀腺微小乳頭狀癌治療中的臨床價值. 上海交通大學學報(醫學版), 2018, 38(2): 180-183.
29. 許志亮, 史曼曼, 廖仕翀, 等. 兩種常用腔鏡技術在甲狀腺微小乳頭狀癌中央組淋巴結清掃中的運用. 武漢大學學報(醫學版), 2019, 40(4): 613-616.
30. 王登歡, 張冉, 馮恩梓, 等. 經口腔前庭入路腔鏡手術在甲狀腺癌中央區淋巴結清掃中的有效性研究. 臨床耳鼻咽喉頭頸外科雜志, 2022, 36(7): 540-544+558.
31. 彭歡. 經腋窩入路充氣式腔鏡下甲狀腺癌根治術治療單側分化型甲狀腺癌的療效及安全性分析. 貴州醫藥, 2024, 48(9): 1402-1404.
32. 傅錦波, 羅曄哲, 洪曉泉, 等. 經腋窩入路與經胸乳入路腔鏡甲狀腺切除術的對比研究. 中國微創外科雜志, 2017, 17(8): 688-690.
33. 曾沁欣, 王浩斌, 邵帥, 等. 經口腔前庭入路腔鏡甲狀腺手術空間的建立與維持. 腹腔鏡外科雜志, 2024, 29(12): 936-940.
34. Tae K, Lee DW, Bang HS, et al. Sensory change in the chin and neck after transoral thyroidectomy: Prospective study of mental nerve injury. Head Neck, 2020, 42(11): 3111-3117.
35. Wilhelm T, Metzig A. Endoscopic minimally invasive thyroidectomy (eMIT): a prospective proof-of-concept study in humans. World J Surg, 2011, 35(3): 543-551.
36. 王存川, 翟賀寧, 劉衛軍, 等. 經口腔前庭腔鏡甲狀腺切除術6例經驗. 中國內鏡雜志, 2013, 19(04): 363-366.
37. 徐嘉, 史維臣, 何奕卉, 等. 無充氣腋窩入路與鎖骨下入路腔鏡對單側甲狀腺癌的療效比較. 中國現代普通外科進展, 2024, 27(07): 561-563.
38. 梁歡. 經腋窩入路與經胸乳入路腔鏡下甲狀腺切除術臨床治療比較研究. 吉林大學, 2023.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Latest ArticlesComparison of transoral vestibular versus transaxillary endoscopic thyroidectomy: a meta-analysis

Abstract Full text Figures/Tables Video References Cited by

Format

Content