Hypoparathyroidism Risk After Total Endoscopic Thyroidectomy for Papillary Thyroid Cancer: A Comparison of the Transoral Vestibular and Breast Approaches

Figures & data

Table 1 Clinicopathologic Characteristics and Surgical Data According to Group

Characteristic	BA (n=101)	TOVA(n=20)	P value
Clinical characteristics
Age (years)	38.64±8.32	40.85±8.33	0.28
Sex (female/male)	101/0	20/0	–
Pathologic characteristics
Tumor Size (mean, cm)	0.81±0.62	0.87±0.55	0.70
Tumor Location (L/R/I/W)	7/12/0/1	40/45/4/12	0.48
Multiple tumors (Y/N)	20/81	2/18	0.30
RLN invasion (Y/N)	3/98	0/20	0.44
Capsule invasion (Y/N)	32/69	4/16	0.30
Vascular invasion (Y/N)	8/93	1/19	0.65
Lymphatic metastasis (Y/N)	48/53	9/11	0.84
Disease in background thyroid
Nodular goiter (Y/N)	20/81	4/16	0.98
Hashimoto thyroiditis (Y/N)	33/68	5/15	0.50
Surgical procedures
Central lymph node dissection (U/B)	35/66	5/15	0.40
Lymph node dissection (n)	7.82±5.34	9.40±4.56	0.22
Parathyroid autotransplantation (Y/N)	58/43	10/10	0.54
IONM	101/0	20/0	–
IONM signal weaken (Y/N)	10/91	2/18	0.99
Negative margin (Y/N)	101/0	20/0	–
Capsular disruption (Y/N)	0/101	0/20	–

Abbreviations: BA, breast approach; TOVA, transoral vestibular approach; L/R/I/W, left/right/isthmus/whole thyroid; Y/N, yes/no; U/B, unilateral/bilateral.

Table 2 Hypoparathyroidism Incidence and Concentrations of Parathyroid Hormone and Calcium Over Time According to Group

		BA (n=101)	TOVA (n=20)	P value
Hypoparathyroidism	Transient	64/37	2/18	<0.01
	Persistent	7/94	1/19	0.75
PTH
Preoperative	Mean	43.03±15.44	41.85±17.38	0.76
2 days post-op	Mean	11.75±11.84	27.38±12.13	<0.01
	A/N	64/37	2/18	<0.01
1 month post-op	Mean	27.95±17.40	33.86±13.96	0.16
	A/N	18/83	2/18	0.39
6 month post-op	Mean	30.46±15.35	34.69±16.48	0.27
	A/N	7/94	1/19	0.75
1 year post-op	Mean	30.82±15.36	37.45±19.94	0.10
	A/N	3/98	1/19	0.64
Calcium
Preoperative	Mean	2.34±0.07	2.36±0.08	0.34
2 days post-op	Mean	2.06±0.16	2.09±0.10	0.33
	A/N	68/33	7/11	0.01
1 month post-op	Mean	2.19±0.18	2.29±0.14	0.02
	A/N	22/79	3/17	0.49
6 month post-op	Mean	2.22±0.14	2.29±0.15	0.05
	A/N	14/87	2/18	0.64
1 year post-op	Mean	2.22±0.17	2.28±0.17	0.09
	A/N	17/84	2/18	0.44

Abbreviations: BA, breast approach; TOVA, transoral vestibular approach; PTH, parathyroid hormone; post-op, postoperatively; A/N, abnormal/normal.

Table 3 Univariate and Multivariate Analyses of Factors Associated with Transient and Persistent Hypoparathyroidism

Characteristics		Transient Hypoparathyroidism (n=66)				Persistent Hypoparathyroidism (n=8)
		Univariate		Multivariate		Univariate		Multivariate
		(Y/N)	P-value	HR (95% CI)	P-value	(Y/N)	P-value	HR (95% CI)	P-value
Age (years)	≤55	64/53	0.85		0.80	8/0	0.59		0.99
	>55	2/2				0/4
Different approaches	TOVA	2/18	<0.01	0.05 (0.01–0.23)	<0.01	1/19	0.75	–	0.94
	BA	64/37				7/94
Central lymph node dissection	Unilateral	20/20	0.56		0.51	5/35	0.11		0.09
	Bilateral	46/35				3/78
Parathyroid autotransplantation	Y	42/26	0.10		0.11	3/65	0.27		0.40
	N	24/29				5/48
Tumor size (cm)	>1	17/19	0.29		0.76	3/33	0.62		0.84
	≤1	49/36				5/80
Multiple tumors	Y	13/9	0.64		0.93	3/19	0.14		0.12
	N	53/46				5/94
RLN invasion	Y	1/2	0.46		0.42	0/3	0.64		0.99
	N	65/53				8/110
Capsule invasion	Y	17/19	0.29		0.35	3/33	0.62		0.92
	N	49/36				5/80
Vascular invasion	Y	5/4	0.95		0.91	0/9	0.41		0.99
	N	61/51				8/104
Lymphatic metastasis	Y	27/30	0.14		0.13	3/54	0.57		0.79
	N	39/25				5/59
Hashimoto thyroiditis	Y	21/17	0.92		0.76	4/34	0.24		0.25
	N	45/38				4/79
Nodular goiter	Y	12/12	0.62		0.82	1/23	0.59		0.98
	N	54/43				7/90

Abbreviations: Y/N, yes/no; HR, hazard ratio; CI, confidence interval; RLN, recurrent laryngeal nerve; TOVA, transoral vestibular approach; BA, breast approach.