A Retrospective Meta-Analysis Study of Trans-axillary Hemithyroidectomy Versus Conventional Hemithyroidectomy: Surgical Efficacy and Safety

Hamed, Moatasum Hussein; Abdullah, Sameh; El-Erian, Alaa Mohamed; El-Hoofy, Ahmed Nabil; El-Shimy, Mohamed Ahmed; El-Sebaie, Mohamed Samir

doi:10.21608/asjs.2025.397277.1214

A Retrospective Meta-Analysis Study of Trans-axillary Hemithyroidectomy Versus Conventional Hemithyroidectomy: Surgical Efficacy and Safety

Document Type : Original Article

Authors

¹ Department of General & Endocrine Surgery, National Institute of Endocrinology, Cairo, Egypt

² Department of General & Bariatric Surgery, Ain Shams University, Cairo, Egypt

³ Department of General & Endocrine Surgery, Ain Shams University, Cairo, Egypt

10.21608/asjs.2025.397277.1214

Abstract

Introduction: Thyroid disease is common among women and increasingly prevalent globally. Surgery is often
required, with open thyroidectomy being the gold standard. However, cosmetic dissatisfaction from cervical scars
has led to interest in endoscopic alternatives. Since Gagner’s first endoscopic procedure, non-cervical techniques
like trans-axillary thyroidectomy have gained attention for hiding scars and improving quality of life.
Aim of work: We aimed to compare trans-axillary hemithyroidectomy and traditional open surgical approach
from the available literature regarding operative difficulties, feasibility, complication (intra -and post-operative),
post-operative pain and cosmesis.
Patients and methods: This systematic review and meta-analysis has been performed on seven papers in
accordance with the Cochrane Collaboration standards and adhered to the PRISMA declaration (Preferred Reporting
Items for Systematic Reviews and Meta-analyses).
Results: The endoscopic thyroidectomy group had significantly lower blood loss (MD = 1.29, 95% CI [0.32, 2.25],
p = 0.009) compared to the open group, while the open group had a significantly shorter operative time (MD =
37.6, 95% CI [42.77, 32.44], p < 0.00001). Insignificant variations have been detected in pain following surgery,
hospital stay, post-operative hematoma, or vocal cord paralysis. However, endoscopic thyroidectomy was superior
in cosmetic satisfaction (MD = 7.05, 95% CI [13.23, 0.88], p = 0.03), despite of high heterogeneity (I² = 98%).
Heterogeneity was low for most outcomes but significant for operative time (I² = 82%) and hospital stay (I² =
68%).
Conclusion: Trans-axillary endoscopic thyroidectomy is a safe and effective alternative with superior cosmetic
outcomes. Technique selection should consider clinical factors and patient preferences.

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