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Postoperative Pain Following Transoral Thyroidectomy via Vestibular Approach and Cervical Thyroidectomy: A Systematic Review and Meta-Analysis.
Mirghani, Hyder; Alamrani, Bandar Ahmed; Alamrani, Fadi Olyan; Alasmari, Mohammed Abdullah S; Albalawi, Mohammed Ahmed I; Alquthami, Hatem Hamad M; Ali Alalawi, Ali Ahmed; Alzamhari, Omar Sabbah; Albalawi, Abdulaziz Nasser; Aljabri, Mohammad Omar; Albalawi, Turki Suleman; Mohammed Albalawi, Ahmed.
Afiliação
  • Mirghani H; Department of Internal Medicine, University of Tabuk, Tabuk, SAU.
  • Alamrani BA; Department of Ear, Nose, and Throat (ENT), King Fahad Specialist Hospital, Tabuk, SAU.
  • Alamrani FO; College of Medicine, University of Tabuk, Tabuk, SAU.
  • Alasmari MAS; College of Medicine, University of Tabuk, Tabuk, SAU.
  • Albalawi MAI; College of Medicine, University of Tabuk, Tabuk, SAU.
  • Alquthami HHM; College of Medicine, University of Tabuk, Tabuk, SAU.
  • Ali Alalawi AA; Department of Internal Medicine, King Fahad Specialist Hospital, Tabuk, SAU.
  • Alzamhari OS; College of Medicine, University of Tabuk, Tabuk, SAU.
  • Albalawi AN; College of Medicine, University of Tabuk, Tabuk, SAU.
  • Aljabri MO; Department of Emergency Medicine, King Khalid University Hospital, Tabuk, SAU.
  • Albalawi TS; College of Medicine, University of Tabuk, Tabuk, SAU.
  • Mohammed Albalawi A; College of Medicine, University of Tabuk, Tabuk, SAU.
Cureus ; 16(5): e59998, 2024 May.
Article em En | MEDLINE | ID: mdl-38854204
ABSTRACT
Transoral endoscopic thyroidectomy via the vestibular approach (TOETVA) represents a minimally invasive alternative to traditional open thyroidectomy (OT). The objective of this systematic review and meta-analysis was to comprehensively analyze and compare postoperative pain outcomes between conventional open thyroidectomy (COT) and TOETVA. We conducted a systematic search across multiple databases, including PubMed, Medline, Elton B. Stephens Company (EBSCO), and Google Scholar, to identify cohorts and randomized trials comparing postoperative pain outcomes between patients undergoing transoral endoscopic thyroidectomy via the vestibular approach (TOETVA) and those undergoing conventional thyroidectomy. The search period spanned from the earliest available article up to January 15, 2022. Keywords such as "scarless thyroidectomy," "endoscopic transoral via vestibular thyroidectomy," "conventional thyroidectomy," "transcervical thyroidectomy," "postoperative pain," and "visual analog pain score" were utilized to retrieve relevant studies. A total of 1,291 patients from 11 studies were included in our analysis, with 10 studies originating from Asia and one from Europe. Among these studies, seven were prospective, while four were retrospective. The primary outcome measure was postoperative pain. Various statistical tests were also performed for data analysis, including the Chi-square and random effects model. The Newcastle Ottawa Scale was used to assess the quality of studies. There was no significant statistical difference observed between the endoscopic transoral vestibular route and the conventional cervical approach in terms of visual analog scale (VAS) score, with an odds ratio of -0.37 and a 95% confidence interval ranging from -0.9 to 0.17. The overall effect had a P-value of 0.18. However, substantial heterogeneity was noted, with an I2 value for heterogeneity of 98% and a P-value for heterogeneity of less than 0.001. The Chi-square value was calculated as 364.02, and the main difference was 9. In comparison, TOETVA exhibited lower pain levels on the first day post-operation compared to conventional thyroidectomy, with an odds ratio of -1.36 and a 95% confidence interval ranging from -2.65 to -0.06. Transoral endoscopic thyroidectomy via the vestibular approach demonstrated superior outcomes compared to conventional thyroidectomy in terms of postoperative pain management on the first day following surgery. However, when considering overall pain management throughout the recovery period, no significant difference was observed between the two approaches. More extensive studies evaluating pain levels on the day of surgery and controlling for analgesic interventions are warranted.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Idioma: En Revista: Cureus Ano de publicação: 2024 Tipo de documento: Article

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Idioma: En Revista: Cureus Ano de publicação: 2024 Tipo de documento: Article