Comparison of postoperative cosmesis in transaxillary, postauricular facelift, and conventional transcervical thyroidectomy

Abstract

Background

The most important advantage of remote-access robotic and endoscopic thyroidectomies is believed to be the excellent postoperative cosmesis. The purpose of this study was to compare directly the postoperative cosmetic outcomes of robotic/endoscopic thyroidectomy via gasless transaxillary and postauricular facelift approaches with those of conventional thyroidectomy.

Methods

We prospectively studied 100 patients who underwent robotic/endoscopic thyroidectomy using a gasless unilateral axillary (GUA) approach (50 patients) or a postauricular facelift approach (50 patients), and 50 who underwent conventional transcervical thyroidectomy. Postoperative cosmetic satisfaction scores and scar consciousness scores were evaluated at 3 months and 1 year after surgery using questionnaires developed by us. Vancouver scar scales were evaluated at the same time. The cosmetic satisfaction score was defined as the sum of the two cosmetic satisfaction questions with a rating scale of 1–5 each. The scar consciousness score was defined as the sum of the four scar consciousness questions with a rating scale of 0–3 each.

Results

The cosmetic satisfaction and scar consciousness scores were significantly lower (corresponding to greater satisfaction) in the transaxillary and postauricular facelift groups than the conventional group at 3 months and 1 year postoperatively. They did not differ between the transaxillary and postauricular facelift groups. However, the Vancouver scar scale score of the conventional group was significantly lower than those of the transaxillary and postauricular facelift groups (P < 0.001 in both).

Conclusion

Robotic/endoscopic thyroidectomy via transaxillary or postauricular facelift approaches results in better cosmesis than the conventional approach. However, scar healing itself is worse in the transaxillary and facelift approaches than the conventional approach.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3

References

  1. 1.

    Schlumberger MJ (1998) Papillary and follicular thyroid carcinoma. N Engl J Med 338:297–306

    CAS  Article  Google Scholar 

  2. 2.

    Song CM, Tae K (2016) Robotic thyroidectomy: evolution and outcomes. Hanyang Med Rev 36:205–210

    Article  Google Scholar 

  3. 3.

    Tae K, Ji YB, Song CM, Ryu J (2019) Robotic and endoscopic thyroid surgery: evolution and advances. Clin Exp Otorhinolaryngol 12(1):1–11

    Article  Google Scholar 

  4. 4.

    Kang SW, Lee SC, Lee SH, Lee KY, Jeong JJ, Lee YS, Nam KH, Chang HS, Chung WY, Park CS (2009) Robotic thyroid surgery using a gasless, transaxillary approach and the da Vinci S system: the operative outcomes of 338 consecutive patients. Surgery 146:1048–1055

    Article  Google Scholar 

  5. 5.

    Terris DJ, Singer MC, Seybt MW (2011) Robotic facelift thyroidectomy: II. Clinical feasibility and safety. Laryngoscope 121:1636–1641

    Article  Google Scholar 

  6. 6.

    Anuwong A (2016) Transoral endoscopic thyroidectomy vestibular approach: a series of the first 60 human cases. World J Surg 40(3):491–497

    Article  Google Scholar 

  7. 7.

    Tae K, Ji YB, Cho SH, Kim KR, Kim DW, Kim DS (2011) Initial experience with a gasless unilateral axillo-breast or axillary approach endoscopic thyroidectomy for papillary thyroid microcarcinoma: comparison with conventional open thyroidectomy. Surg Laparosc Endosc Percutaneous Tech 21:162–169

    Article  Google Scholar 

  8. 8.

    Tae K, Ji YB, Jeong JH, Lee SH, Jeong MA, Park CW (2011) Robotic thyroidectomy by a gasless unilateral axillo-breast or axillary approach: our early experiences. Surg Endosc 25:221–228

    Article  Google Scholar 

  9. 9.

    Tae K, Ji YB, Cho SH, Lee SH, Kim DS, Kim TW (2012) Early surgical outcomes of robotic thyroidectomy by a gasless unilateral axillo-breast or axillary approach for papillary thyroid carcinoma: 2 years’ experience. Head Neck 34:617–625

    Article  Google Scholar 

  10. 10.

    Sung ES, Ji YB, Song CM, Yun BR, Chung WS, Tae K (2016) Robotic thyroidectomy: comparison of a postauricular facelift approach with a gasless unilateral axillary approach. Otolaryngol Head Neck Surg 154:997–1004

    Article  Google Scholar 

  11. 11.

    Tae K, Song CM, Ji YB, Sung ES, Jeong JH, Kim DS (2016) Oncologic outcomes of robotic thyroidectomy: 5-year experience with propensity score matching. Surg Endosc 30:4785–4792

    Article  Google Scholar 

  12. 12.

    Tae K, Song CM, Ji YB, Kim KR, Kim JY, Choi YY (2014) Comparison of surgical completeness between robotic total thyroidectomy versus open thyroidectomy. Laryngoscope 124:1042–1047

    Article  Google Scholar 

  13. 13.

    Song CM, Ji YB, Bang HS, Park CW, Kim H, Tae K (2014) Long-term sensory disturbance and discomfort after robotic thyroidectomy. World J Surg 38:1743–1748

    Article  Google Scholar 

  14. 14.

    Song CM, Ji YB, Bang HS, Park CW, Kim DS, Tae K (2014) Quality of life after robotic thyroidectomy by a gasless unilateral axillary approach. Ann Surg Oncol 21:4188–4194

    Article  Google Scholar 

  15. 15.

    Ji YB, Song CM, Bang HS, Lee SH, Park YS, Tae K (2014) Long-term cosmetic outcomes after robotic/endoscopic thyroidectomy by a gasless unilateral axillo-breast or axillary approach. J Laparoendosc Adv Surg Tech A 24:248–253

    Article  Google Scholar 

  16. 16.

    Sullivan T, Smith J, Kermode J, McIver E, Courtemanche DJ (1990) Rating the burn scar. J Burn Care Rehabil 11:256–260

    CAS  Article  Google Scholar 

  17. 17.

    Draaijers LJ, Tempelman FR, Botman YA, Tuinebreijer WE, Middelkoop E, Kreis RW, van Zuijlen PP (2004) The patient and observer scar assessment scale: a reliable and feasible tool for scar evaluation. Plast Reconstr Surg 113:1960–1965

    Article  Google Scholar 

  18. 18.

    Lee J, Nah KY, Kim RM, Ahn YH, Soh EY, Chung WY (2010) Differences in postoperative outcomes, function, and cosmesis: open versus robotic thyroidectomy. Surg Endosc 24:3186–3194

    Article  Google Scholar 

  19. 19.

    Kandil EH, Noureldine SI, Yao L, Slakey DP (2012) Robotic transaxillary thyroidectomy: an examination of the first one hundred cases. J Am Coll Surg 214:558–564

    Article  Google Scholar 

  20. 20.

    Ikeda Y, Takami H, Sasaki Y, Takayama J, Niimi M, Kan S (2003) Clinical benefits in endoscopic thyroidectomy by the axillary approach. J Am Coll Surg 196:189–195

    Article  Google Scholar 

  21. 21.

    Lee DY, Lee KJ, Han WG, Oh KH, Cho JG, Baek SK, Kwon SY, Woo JS, Jung KY (2016) Comparison of transaxillary approach, retroauricular approach, and conventional open hemithyroidectomy: a prospective study at single institution. Surgery 159:524–531

    Article  Google Scholar 

  22. 22.

    Arora A, Garas G, Sharma S, Muthuswamy K, Budge J, Palazzo F, Darzi A, Tolley N (2016) Comparing transaxillary robotic thyroidectomy with conventional surgery in a UK population: a case control study. Int J Surg 27:110–117

    Article  Google Scholar 

  23. 23.

    Sasaki A, Nakajima J, Ikeda K, Otsuka K, Koeda K, Wakabayashi G (2008) Endoscopic thyroidectomy by the breast approach: a single institution’s 9-year experience. World J Surg 32:381–385

    Article  Google Scholar 

  24. 24.

    Toll EC, Loizou P, Davis CR, Porter GC, Pothier DD (2012) Scars and satisfaction: do smaller scars improve patient-reported outcome? Eur Arch Otorhinolaryngol 269:309–313

    CAS  Article  Google Scholar 

  25. 25.

    Son D, Harijan A (2014) Overview of surgical scar prevention and management. J Korean Med Sci 29:751–757

    Article  Google Scholar 

  26. 26.

    Materazzi G, Fregoli L, Manzini G, Baggiani A, Miccoli M, Miccoli P (2014) Cosmetic result and overall satisfaction after minimally invasive video-assisted thyroidectomy (MIVAT) versus robot-assisted transaxillary thyroidectomy (RATT): a prospective randomized study. World J Surg 38:1282–1288

    Article  Google Scholar 

  27. 27.

    Li J, Chen J, Kirsner R (2007) Pathophysiology of acute wound healing. Clin Dermatol 25:9–18

    CAS  Article  Google Scholar 

  28. 28.

    Janis JE, Harrison B (2016) Wound healing: part I. Basic science. Plast Reconstr Surg 138:9S–17S

    CAS  Article  Google Scholar 

  29. 29.

    Baum CL, Arpey CJ (2005) Normal cutaneous wound healing: clinical correlation with cellular and molecular events. Dermatol Surg 31:674–686

    CAS  Article  Google Scholar 

  30. 30.

    James AG, Pople JE, Parish WE, Moore AE, Dunbar N (2006) Histological evaluation of hyperpigmentation on female Filipino axillary skin. Int J Cosmet Sci 28:247–253

    CAS  Article  Google Scholar 

  31. 31.

    Kim SM, Chun KW, Chang HJ, Kim BW, Lee YS, Chang HS, Park CS (2015) Reducing neck incision length during thyroid surgery does not improve satisfaction in patients. Eur Arch Otorhinolaryngol 272:2433–2438

    Article  Google Scholar 

  32. 32.

    Linos D, Economopoulos KP, Kiriakopoulos A, Linos E, Petralias A (2013) Scar perceptions after thyroid and parathyroid surgery: comparison of minimal and conventional approaches. Surgery 153:400–407

    Article  Google Scholar 

  33. 33.

    Arora A, Swords C, Garas G, Chaidas K, Prichard A, Budge J, Davies DC, Tolley N (2016) The perception of scar cosmesis following thyroid and parathyroid surgery: a prospective cohort study. Int J Surg 25:38–43

    Article  Google Scholar 

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to Kyung Tae.

Ethics declarations

Disclosures

Dong Won Lee, Seok Hwa Ko, Chang Myeon Song, Yong Bae Ji, Jeong Kyu Kim, and Kyung Tae have no conflicts of interest or financial ties to disclose.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Lee, D.W., Ko, S.H., Song, C.M. et al. Comparison of postoperative cosmesis in transaxillary, postauricular facelift, and conventional transcervical thyroidectomy. Surg Endosc 34, 3388–3397 (2020). https://doi.org/10.1007/s00464-019-07113-1

Download citation

Keywords

  • Cosmesis
  • Transaxillary approach
  • Postauricular facelift approach
  • Robotic thyroidectomy
  • Endoscopic thyroidectomy
  • Remote-access thyroidectomy