Comparison of transaxillary approach, retroauricular approach, and conventional open hemithyroidectomy: A prospective study at single institution

Background The aims of this study were to evaluate and compare the operative outcomes and postoperative subjective functional parameters of transaxillary (TA) and retroauricular (RA) approach thyroidectomy, with those of conventional hemithyroidectomy. Methods From May 2011 through December 2013, 153 patients who underwent hemithyroidectomy were categorized prospectively into 3 groups according to the surgical approach used (TA, RA, and conventional hemithyroidectomy groups). All patients underwent prospective acoustic and functional evaluation, using a comprehensive battery of functional assessments, preoperatively and postoperatively at 1 week, 1 month, 3 months, 6 months, and 12 months. Results Age at diagnosis was significantly lower in the TA (n = 50) and RA groups (n = 42) than in the conventional group (n = 61; P <.001). The frequency of occurrence of vocal cord paralysis, inadvertently excised parathyroid, and hematoma did not differ among the groups (P =.447,.519, and.069, respectively). Three months postoperatively, maximal vocal pitch was significantly higher in the RA group than in the conventional and TA groups (P =.021). Although the overall pain score was not different, the Dysphagia Handicap Index of the RA group at 1 month postoperatively was significantly higher (P <.001) than in the other groups. Chest paresthesia was significantly more severe in the TA group, especially at 3 months postoperative (P =.035). The cosmetic satisfaction score was significantly higher in the RA and TA groups than in the conventional group (P =.001 and 0.035, respectively) at 3 and 6 months postoperatively. Conclusion Both TA and RA hemithyroidectomy were followed by excellent surgical outcomes, especially with regard to cosmesis. However, delayed recovery of swallowing in RA and chest paresthesia in TA may be mitigating factors.