Comparison of postoperative pain between transoral and conventional thyroidectomy: a propensity score-matched analysis

• Published in: Surgical endoscopy Vol. 38; no. 3; pp. 1512 - 1522
• Main Authors: Park, Min Kyu, Nguyen, Van Cuong, Kim, Eugene, Song, Chang Myeon, Ji, Yong Bae, Jeong, Jin Hyeok, Tae, Kyung
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.03.2024; Springer Nature B.V
• Subjects: Abdominal Surgery; Body mass index; Dissection; Endoscopy; Gastroenterology; Gynecology; Hepatology; Humans; Lymphatic system; Medicine; Medicine & Public Health; Metastasis; Neck; Neck Dissection - adverse effects; Neck Dissection - methods; Pain; Pain, Postoperative - epidemiology; Pain, Postoperative - etiology; Pain, Postoperative - surgery; Patients; Proctology; Propensity Score; Questionnaires; Retrospective Studies; Robotic Surgical Procedures - adverse effects; Robotic Surgical Procedures - methods; Robotics; Surgery; Thyroid cancer; Thyroid Neoplasms - pathology; Thyroid Neoplasms - surgery; Thyroidectomy; Thyroidectomy - adverse effects; Thyroidectomy - methods; Propensity score matching; Postoperative pain; Transoral thyroidectomy; Endoscopic thyroidectomy; Robotic thyroidectomy
• ISSN: 0930-2794; 1432-2218; 1432-2218
• DOI: 10.1007/s00464-023-10656-z

Background The extent of postoperative pain following transoral thyroidectomy is not well-understood and remains a subject of debate. This study aims to analyze and compare postoperative pain levels between patients undergoing transoral and conventional transcervical thyroidectomy. Methods A prospective evaluation on postoperative pain was conducted in 310 patients undergoing conventional thyroidectomy and 194 undergoing transoral thyroidectomy. Pain levels were evaluated using the numerical rating scale (NRS, ranging from 0 to 10) through preoperative and postoperative questionnaires at specified time points: 1, 3, and 6 days, and 1 and 3 months following surgery. Propensity score-matched analysis was carried out based on six covariates: sex, age, body mass index, extent of thyroidectomy, tumor size, and central neck dissection. Results After propensity score matching based on the six covariates, 121 patient pairs were identified from each group. Within this matched cohort, postoperative pain scores significantly worsened 1 day after surgery but showed progressive recovery up to 3 months post-surgery in both groups. The transoral group exhibited higher postoperative pain scores than the conventional group from day 1 (4.43 ± 2.6 vs. 3.11 ± 2.5, p  < 0.001) to day 6 (1.76 ± 1.9 vs. 1.13 ± 1.6, p  = 0.016) post-surgery, with no significant difference noted at 1 month. Among transoral procedures, pain scores were significantly higher for the endoscopic approach compared to the robotic approach on days 1 (5.52 ± 2.3 vs. 4.29 ± 2.3, p  = 0.028) and 3 (3.52 ± 2.5 vs. 2.64 ± 2.0, p  = 0.047) post-surgery. Conclusions Postoperative pain was significantly higher in transoral thyroidectomy compared to conventional thyroidectomy up to 6 days post-surgery. Within the transoral group, the robotic procedure resulted in lower pain levels than the endoscopic approach during the early postoperative period. Graphic abstract