Comparison of Voice and Swallowing Changes After Thyroidectomy Using the Gasless Transaxillary, Transoral, and Conventional Transcervical Approaches: A Network Meta-analysis

Abstract

Purpose. This study evaluated voice and swallowing outcomes following thyroidectomy by using the gasless transaxillary (GTAA) and transoral (TOA) approaches compared with the conventional transcervical approach (CTA). Methods. A comprehensive search of the PubMed, EMBASE, and Cochrane Library databases was conducted through September 2024. Network meta-analyses were performed on 14 comparative studies, encompassing 1723 patients. Results. Voice handicap index (VHI)-10 scores, highest frequency, and frequency range deteriorated after surgery in all three methods. However, the postoperative voice outcomes of the GTAA and TOA were superior to the conventional approach at all follow-up points up to 3 months after the operation. Specifically, the VHI-10 scores of the GTAA and TOA were significantly lower than those of the CTA at 3 months postoperation. Other acoustic parameters, such as jitter, shimmer, noise-to-harmonic ratio, and intensity range, did not differ among the three methods. The postoperative swallowing impairment score (SIS)-6 of the GTAA and TOA were lower than that of the CTA. Specifically, the SIS-6 of the GTAA was significantly lower than those of the TOA and CTA at 3 months postoperation. Conclusions. The postoperative voice and swallowing outcomes, especially VHI-10, highest frequency, frequency range, and SIS-6, following remote-access thyroidectomy using the GTAA and TOA were superior to those observed with the conventional approach. Given the limited number of studies included, further research is needed to confirm these findings as new studies emerge, especially those with larger sample sizes, diverse populations, different approaches, and extended follow-up periods.