Original ResearchPropensity score-matched analysis of the endoscopic bilateral axillo-breast approach (BABA) versus conventional open thyroidectomy in patients with benign or intermediate fine-needle aspiration cytology results, a retrospective study

- Many surgical approaches for thyroidectomy have been developed.
- Endoscopic bilateral axillo breast approach (BABA) offers excellent cosmetic result.
- The BABA has comparable rate of complications to conventional open thyroidectomy.
- The BABA has longer operative time and hospital stay which may increase the total medical expense.

BackgroundThe purpose of this study was to compare the surgical outcomes of endoscopic bilateral axillo-breast approach (BABA) to conventional open thyroidectomy (COT) in patients who had thyroid nodule(s) with a benign or intermediate fine-needle aspiration cytology (FNAC) results.Materials and methodsAll patients with benign or intermediate thyroid nodule(s) who underwent BABA (n = 95) or COT (n = 262) between 2008 and 2015 were reviewed. Then, 1:1 propensity score matching was performed, and 66 matched pairs were obtained. Surgical outcomes were then compared.ResultsBefore matching, patients in the BABA group were significantly younger (36.5 vs. 50.7 years, p < 0.000), predominantly female (97.9% vs. 69.8%, p < 0.000), had smaller tumours (2.1 vs. 2.8 cm, p = 0.002) and more commonly underwent hemithyroidectomy (88.4% vs. 70.6%, p < 0.000) than those in the COT group. After matching, all clinicopathological characteristics were equivalent. BABA was found to be significantly associated with longer operative time (125.3 vs. 79.8 min, p < 0.000), greater drainage volume (132.9 vs. 59.1 ml, p < 0.000), longer postoperative hospital stay (3.1 vs. 2.2 days, p < 0.000), and higher average total medical expense (4000 vs. 3200 US$). However, the incidence of complications did not differ between the groups.ConclusionBABA is comparable to COT in terms of complications and is safe and feasible when performed by experienced surgeons and for carefully selected patients who are concerned about neck scarring. However, the operative time and postoperative hospital stay are significantly longer, which may increase medical expenses.