Feasibility, perceived aesthetic outcomes and patients’ interest in transoral endoscopic thyroidectomy (TOETVA) in a cohort of patients in the Thames Valley United Kingdom

Abstract

Abstract Introduction: Thyroid surgery techniques without visible scar have grown internationally with little traction in the UK. The aim was to assess the perception of neck scar after thyroid surgery, estimate the feasibility for transoral endoscopic thyroidectomy (TOETVA) and define the public demand for scarless thyroidectomy. Methods: A mixed cohort study approved by national ethics committee assessed retrospectively the feasibility of TOETVA based on current guidelines. A standardised questionnaire used Manchester Scar Scale (MSS) and explored patient-centred outcomes and views. Results: Out of 265 patients (75% women, median age 56 years) who underwent thyroid lobectomy for indeterminate nodules (n=160) or proven low-risk thyroid cancer (n=105), 64% would have been suitable for TOETVA, including 49% of cancers. Of 92 respondents, MSS was excellent (25%), good (56%; MSS<7) or poor (15%; MSS > 10). Negative scar perception preoperatively resulted in poor MSS scores post operatively (p<0.0001). Poor MSS impacted all individuals regardless of preoperative neck scar concerns (p<0.001). Worse MSS scores were significant in patients with complications or cancer recurrence concerns (p<0.002) independent of age (p=0.065) and gender (p=0.7118). Need for thyroid hormone replacement in 34% of patients didn’t correlate with to MSS. Patients’ interest in scarless technique didn’t correlate with MSS and appeared to be attributable to personal values, geographic accessibility, and intensity of aversion to complication (p<0.05). Overall, 29% of patients would consider a scarless technique and 31% opposed the idea. Conclusion: This study population showed comparable interest and feasibility for scarless thyroid surgery as international populations. How to respond to this need will become apparent in the coming years.