Outpatient thyroidectomy: A feasibility study

Thyroidectomy has historically been performed on an inpatient basis out of fear of hemorrhage and transient but life-threatening hypocalcemia. An earlier favorable experience with outpatient surgery for a limited number of patients prompted our objective of an expanded evaluation of this practice. Retrospective analysis of a prospectively populated database. A consecutive single-surgeon series of patients undergoing thyroidectomy in an academic otolaryngology department between February 2003 and November 2007, including 91 patients assessed in a previous report. Clinical variables including age, gender, type of surgery, indications, and complications were obtained and analyzed. Principal outcome measures were length of hospital stay, incidence of complications, and rate of readmission. Four hundred eighteen patients underwent thyroid surgery during the study period. Two hundred eight were accomplished on an outpatient basis, 128 patients were observed under a 23-hour status, and 82 were admitted for a mean of 2.9 days (the latter two cohorts were grouped together and designated as inpatients). There were four complications in the outpatient group (1.9%) and 28 (13.3%) in the inpatient group (P < .001). Four individuals in the outpatient group (1.9%) required readmission compared with 5.7% (12/210) of those in the inpatient group, most commonly for transient hypocalcemia. The initial favorable experience with outpatient thyroid surgery has been validated in this expanded patient population of more than 200 patients. In rare instances, readmission may be required secondary to transient hypocalcemia. Modern surgical techniques, avoidance of drains, and prophylactic calcium supplementation have combined to make outpatient thyroidectomy safe in carefully selected patients.

Objective: To analyze the surgical characteristics of da Vinci robotic and endoscopic-assisted thyroidectomy and compare the clinical outcomes of da Vinci robotic and endoscopic-assisted gasless unilateral transaxillary approach for thyroid surgery. Methods: A retrospective analysis was conducted on patients who underwent da Vinci robotic or endoscopic-assisted thyroidectomyat the Head and Neck Surgery Department of Fudan University Shanghai Cancer Center between July 2020 and June 2024, with follow-up until December 2024. Data on clinicopathological characteristics, operative time, hospitalization costs, surgical complications, and postoperative incision satisfaction were collected and analyzed. Results: During the study period, a total of 618 da Vinci robot-assisted thyroid surgeries and 239 endoscope-assisted thyroid surgeries were performed. In terms of surgical approach, both the robot group and the endoscope group mainly used the unilateral axillary gasless approach: 598 cases (96.8%) in the robotic group and 161 cases (67.4%) in the endoscopic group. The proportion of patients undergoing extended surgical procedures, such as unilateral lobectomy plus ipsilateral central neck dissection (level Ⅵ) and lateral neck dissection, was higher in the robotic group than in the endoscopic group [8.9% (53/598) vs 0.6% (1/161), P<.001]. Regarding the scope of surgery, both groups mainly performed unilateral thyroid lobectomy with ipsilateral level Ⅵ lymph node dissection: 543 cases (87.9%) in the robotic group and 218 cases (91.2%) in the endoscopic group. For patients undergoing unilateral thyroid lobectomy with level Ⅵ lymph node dissection, there were 531 cases in the robotic group [average age (35.4±9.1) years, 92 male] and 154 cases in the endoscopic group [average age (34.5±9.0) years, 13 male]. The robotic group had higher proportions of males [17.3% (92/531) vs 8.4% (13/154)], higher BMI [(22.8±3.6) vs (21.8±3.0) kg/m2], larger tumor diameters [(7.2±3.6) vs (6.5±2.8) mm], higher total costs [(5.5±0.5) vs (2.5±0.7) ten thousand yuan], and more level Ⅵ lymph nodes removed [(3.1±2.3) vs (2.0±1.4)] than the endoscopic group (all P<0.05). The robotic group's surgeries were shorter [(87.4±35.3) vs (127.1±40.2) min], and they had a lower incidence of temporary postoperative hoarseness [1.13% (6/531) vs 3.89% (6/154)] compared to the endoscopic group (both P<0.05). There was no significant difference in postoperative scar satisfaction between the two groups (P>0.05). Conclusions: The gasless unilateral transaxillary approach and unilateral lobectomy plus ipsilateral central neck dissection (level Ⅵ) are the most common surgical approach and extent for da Vinci robotic and endoscopic-assisted thyroidectomy, respectively. Da Vinci robotic surgery is more frequently applied in male patients, higher BMI, larger tumors, and more extensive resections, and it offers superior recurrent laryngeal nerve protection compared to endoscopic systems. However, health economic factors must be considered in practical applications.

I enjoyed the article titled “Minimally invasive, nonendoscopic thyroid surgery” by Ferzli and colleagues in the May 2001 issue of the Journal. They have brought up a number of interesting points and have demonstrated their enthusiasm for a minimally invasive as compared to an endoscopic approach for resection of the thyroid and its lesion. The study included 84 individuals ranging in age from 18 to 95 years. They have described their technique well and have demonstrated a minimal complication rate in these patients. The article illustrates the incidence of follicular adenomas, papillary carcinomas, and multinodular goiters in this group. Comments were made regarding the mean hospital stay of 1 day, and five of their procedures were done on an outpatient basis with patients being discharged a few hours later. Seventy-eight of their patients were discharged as observation bed or 23-hour admits. I would like to comment on the location of the surgical procedure. I have performed 19 consecutive open thyroid procedures without division of the strap muscles at the Center for Surgery in Naperville, IL, a remote outpatient nonhospital surgicenter. Six of the patients had a papillary carcinoma and an additional six patients had colloid cysts or follicular adenomas. The patients ranged in age from 26 to 63, and 16 were women. Resected adenomatous masses measured up to 7 cm or larger. Seventeen of the 19 patients were discharged home 2 to 3 hours after surgery. One patient who had two procedures was admitted to the hospital because of anxiety, but was discharged the next morning. I believe it is more important to perform miniincision thyroidectomy rather than minithyroidectomy and would encourage the concept of same-day surgery using remote outpatient surgicenters and rapid discharge.