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Classifying pain in transoral endoscopic thyroidectomy

  • D. Zhang
  • E. CarusoEmail author
  • H. Sun
  • A. Anuwong
  • R. Tufano
  • G. Materazzi
  • G. Dionigi
  • H. Y. Kim
Original Article

Abstract

Purposes

Knowledge of visual analog scale (VAS) pain assessment for transoral endoscopic thyroidectomy vestibular approach (TOETVA) is limited. The purpose of this analysis was to classify the postoperative discomfort scores in patients undergoing TOETVA compared to open thyroidectomy.

Methods

Observational clinical study of patients who underwent thyroidectomy by VAS pain assessment from September 2016 to March 2017. Patients were stratified into two groups: patients eligible for TOETVA (Group TOETVA) and non-candidates for endoscopic intervention (open thyroidectomy approach—OTA). VAS was recorded in the recovery room, at 24 h, + 2, + 5, + 15, + 30, + 90 days, and 6 months after surgery. Pain assessment was stratified in VAS-lower lip, VAS-chin, VAS-jaw, VAS-anterior neck, VAS-cervical/back, VAS-swallowing, VAS-brushing, VAS-speaking, and VAS-shaving. Secondary outcome assessed were analgesic rescue dose, morbidity, operative notes, hospital stay, and histopathology.

Results

41 TOETVA and 45 OTA constituted the analysis. There were differences between the TOETVA and OTA for age, gland volume, mean nodule diameter, coexistence thyroiditis, bilateral procedures, and use of drain. Operative time was longer in TOETVA. Results indicated that TOETVA was associated with reduced neck, cervical back, and swallowing VAS scores in the 24 h after surgery. Conversely, jaw and brushing teeth resulted in higher VAS score in TOETVA group. OTA patients never experienced lower lip or chin pain. The use of rescue analgesics did not differ between the two groups.

Conclusions

VAS was used to measure treatment outcome in TOETVA. VAS scores achieved overall a minimal clinical importance difference from the two procedures. There appears to be both a short- and long-term different range of interpretations of pain between TOETVA and OTA.

Keywords

Thyroid surgery TOETVA Postoperative pain management VAS Analgesia 

Notes

Author contributions

Conception and design: all authors. Administrative support: all authors. Collection and assembly of data: all authors. Data analysis and interpretation: all authors. Manuscript writing: all authors. Final approval of manuscript: all authors.

Funding

None.

Compliance with ethical standards

Conflict of interest

No authors of this study have financial relationships with the surgical industry or other personal, professional, or financial conflicts of interest in the publication of this study.

Ethical approval

This study was approved by the Ethics Committee of the Institutional Review Board (Protocol n. 17-oyi211).

Informed consent

Informed consent was obtained from all participants in the study.

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Copyright information

© Italian Society of Endocrinology (SIE) 2019

Authors and Affiliations

  • D. Zhang
    • 1
  • E. Caruso
    • 2
    Email author
  • H. Sun
    • 1
  • A. Anuwong
    • 3
  • R. Tufano
    • 4
  • G. Materazzi
    • 5
  • G. Dionigi
    • 2
  • H. Y. Kim
    • 6
  1. 1.Division of thyroid Surgery, China-Japan Union Hospital Of Jilin University, Jilin Provincial Key Laboratory Of Surgical Translational MedicineJilin Provincial Precision Medicine Laboratory of Molecular Biology and Translational Medicine on Differentiated Thyroid CarcinomaChangchunP.R. China
  2. 2.Division for Endocrine Surgery, Department of Human Pathology in Adulthood and Childhood ‘‘G. Barresi’’, University Hospital G. MartinoUniversity of MessinaMessinaItaly
  3. 3.Minimally Invasive and Endocrine Surgery Division, Department of SurgeryPolice General HospitalBangkokThailand
  4. 4.Department of Otolaryngology-Head and Neck SurgeryThe Johns Hopkins University School of MedicineBaltimoreUSA
  5. 5.Department of Surgical, Medical, Molecular Pathology and Critical AreaUniversity of PisaPisaItaly
  6. 6.Department of Surgery, KUMC Thyroid Center, Korea University HospitalKorea University College of MedicineSeoulSouth Korea

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