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Background <p>Thyroid lesions, both benign and malignant, are common worldwide. Although conventional open thyroidectomy remains effective, the visible cervical scar is a cosmetic concern, particularly for younger patients. Endoscopic thyroidectomy techniques such as the Axillo-Breast Approach (ABA) and Bilateral Axillo-Breast Approach (BABA) were developed to overcome this limitation. This study aimed to compare these two approaches with respect to postoperative health-related quality of life (QOL).</p> Methods <p>In this randomized controlled trial, 64 adult patients (&gt; 18&#xa0;years) with Bethesda category III or lower cytology and thyroid gland volume &lt; 40&#xa0;mL were randomized to undergo endoscopic hemithyroidectomy via either ABA or BABA. The primary outcome was postoperative QOL assessed using the Short Form-36 (SF-36) questionnaire and a thyroid-specific questionnaire at 2, 6, and 12&#xa0;weeks after surgery. Secondary outcomes included postoperative complications, duration of hospital stay, pain scores, conversion to open surgery, and ease of performing the procedure.</p> Results <p>At 6&#xa0;weeks, significantly higher scores were observed in the ABA group for Vitality (p = 0.045) and Social Function (p = 0.027), whereas no significant differences were identified in the remaining SF-36 domains. At 2&#xa0;weeks, ABA showed a trend toward higher general health and vitality scores. On thyroid-specific assessment at 2&#xa0;weeks, ABA was associated with significantly less neck and chest numbness (p = 0.0028) and better neck mobility (p = 0.004) compared to BABA; these differences resolved by 6–12&#xa0;weeks. Minor complications such as subcutaneous emphysema and ecchymosis were self-limiting. Pain scores, operative difficulty, and hospital stay were similar between groups.</p> Conclusions <p>Both ABA and BABA endoscopic hemithyroidectomy techniques were safe. No statistically significant differences were observed in most quality-of-life outcomes between the two approaches. ABA provided a short-term advantage in reducing early postoperative neck numbness and movement restriction, although these differences resolved during follow-up.</p>

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Axillo-breast versus bilateral axillo-breast endoscopic thyroidectomy: a randomized quality-of-life study

  • 期刊论文

  • 发表日期：

    2026年7月28日

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  • Shahidul haq Dar,
  • Kamal Kataria,
  • Anita Dhar,
  • Thirugnanasambandam Nelson,
  • Uttam Kumar Thakur,
  • Yashwant Rathore,
  • Rajeev Kumar,
  • Hitesh Verma,
  • Chirom Amit Singh,
  • K Devasenathipathy,
  • Yashdeep Gupta,
  • Shivam Pandey,
  • Shipra Agarwal,
  • Sunil Chumber

摘要

Background

Thyroid lesions, both benign and malignant, are common worldwide. Although conventional open thyroidectomy remains effective, the visible cervical scar is a cosmetic concern, particularly for younger patients. Endoscopic thyroidectomy techniques such as the Axillo-Breast Approach (ABA) and Bilateral Axillo-Breast Approach (BABA) were developed to overcome this limitation. This study aimed to compare these two approaches with respect to postoperative health-related quality of life (QOL).

Methods

In this randomized controlled trial, 64 adult patients (> 18 years) with Bethesda category III or lower cytology and thyroid gland volume < 40 mL were randomized to undergo endoscopic hemithyroidectomy via either ABA or BABA. The primary outcome was postoperative QOL assessed using the Short Form-36 (SF-36) questionnaire and a thyroid-specific questionnaire at 2, 6, and 12 weeks after surgery. Secondary outcomes included postoperative complications, duration of hospital stay, pain scores, conversion to open surgery, and ease of performing the procedure.

Results

At 6 weeks, significantly higher scores were observed in the ABA group for Vitality (p = 0.045) and Social Function (p = 0.027), whereas no significant differences were identified in the remaining SF-36 domains. At 2 weeks, ABA showed a trend toward higher general health and vitality scores. On thyroid-specific assessment at 2 weeks, ABA was associated with significantly less neck and chest numbness (p = 0.0028) and better neck mobility (p = 0.004) compared to BABA; these differences resolved by 6–12 weeks. Minor complications such as subcutaneous emphysema and ecchymosis were self-limiting. Pain scores, operative difficulty, and hospital stay were similar between groups.

Conclusions

Both ABA and BABA endoscopic hemithyroidectomy techniques were safe. No statistically significant differences were observed in most quality-of-life outcomes between the two approaches. ABA provided a short-term advantage in reducing early postoperative neck numbness and movement restriction, although these differences resolved during follow-up.