Subplatysmal or subfascial approach in totally endoscopic thyroidectomy has better postoperative efficacy for voice, sensory, swallowing symptoms and cosmetic result. Cohort study

After totally endoscopic thyroidectomy (TET), patients usually suffer from voice, sensory, swallowing symptoms and they are also concerned with the postoperative cosmetic result. We compared the effects of subfascial dissection method with the subplatysmal method in TET on postoperative symptoms and cervical appearance.143 female patients who underwent totally endoscopic thyroid surgery were assigned to the subplatysmal approach group and subfascial approach group. The patient's voice symptoms were assessed using the Voice Handicap Index (VHI) questionnaire. Sensory function was assessed with subjective pain and light touch sensation. Swallowing symptoms were assessed using the Swallow Impairment Score (SIS) questionnaire and the 3 oz water swallow test. Neck cosmetic effect was assessed by postoperative recovery time of the suprasternal fossa and subjective satisfaction questionnaire. Each variable was measured preoperatively, at 2 weeks, 3 months and 6 months after operation.In both groups, the subjective voice, sensory and swallowing symptoms deteriorated at 2 weeks and improved at 3 months postoperatively. Indicators of VHI, SIS and 3 oz water swallow test returned to the preoperative level at 6 months after operation. In the subfascial group, SIS was significantly better than that of the subplatysmal group (p = 0.005) at 2 weeks after operation. The recovery time of the suprasternal fossa in the subfascial group was delayed (p = 0.158), compared with the subplatysmal group.The subfascial approach may have certain advantages in swallowing symptoms basing on the swallowing impairment test. However, the subplatysmal approach and the subfascial approach may have the same cosmetic effect.