Research Article| Volume 58, ISSUE 3, P334-340, April 2020

Evaluation of the efficacy of postoperative antibiotic treatment in transoral endoscopic thyroidectomy: a prospective randomised controlled trial

  • J.W. Yi
    Corresponding author at: Inha University Hospital, 27, Inhang-ro, Jung-gu, Incheon, Republic of Korea. Tel: +82-32-890-2738; Fax: +82-32-890-3049.
    Department of Surgery, Inha University Hospital, Incheon, Republic of Korea

    Department of Surgery, Seoul National University Hospital, Seoul, Republic of Korea
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  • S.-j. Kim
    Department of Surgery, Seoul National University Hospital, Seoul, Republic of Korea
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  • K.E. Lee
    Department of Surgery, Seoul National University Hospital, Seoul, Republic of Korea
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Published:January 22, 2020DOI:


      Transoral endoscopic thyroid surgery (TOET) is a new, minimally-invasive approach that does not result in a scar in the anterior neck. To prevent infection of the surgical site from oral cavity flora into the thyroidectomy area, postoperative antibiotics are generally given orally for 3–7 days. However, there is no clinical evidence to support this approach. This study was an open-label, randomised, controlled trial to evaluate the clinical usefulness of postoperative antibiotics given orally to patients having TOET. Patients were randomly assigned to receive amoxicillin-clavulanate 625 mg orally three times a day for a week after operation (treated group) or no antibiotics (untreated group). Fifty patients – 25 treated and 25 untreated – were enrolled. Maximum body temperature, pulse rate, white blood cell count, and C-reactive protein concentrations did not differ between the two groups. Evaluation of the surgical site showed no significant differences between them. Seven patients in the treated group developed nausea, vomiting, and diarrhoea compared with none in the untreated group. The results suggest that postoperative oral antibiotics are not essential after TOET. Large-scale prospective series are required to confirm this finding.


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        • Choe J.H.
        • Kim S.W.
        • Chung K.W.
        • et al.
        Endoscopic thyroidectomy using a new bilateral axillo-breast approach.
        World J Surg. 2007; 31: 601-606
        • Ikeda Y.
        • Takami H.
        • Niimi M.
        • et al.
        Endoscopic thyroidectomy by the axillary approach.
        Surg Endosc. 2001; 15: 1362-1364
        • Witzel K.
        • von Rahden B.H.
        • Kaminski C.
        • et al.
        Transoral access for endoscopic thyroid resection.
        Surg Endosc. 2008; 22: 1871-1875
        • Wilhelm T.
        • Metzig A.
        Endoscopic minimally invasive thyroidectomy (eMIT): a prospective proof-of-concept study in humans.
        World J Surg. 2011; 35: 543-551
        • Anuwong A.
        Transoral endoscopic thyroidectomy vestibular approach: a series of the first 60 human cases.
        World J Surg. 2016; 40: 491-497
        • Giday S.A.
        • Dray X.
        • Magno P.
        • et al.
        Infection during natural orifice transluminal endoscopic surgery: a randomized, controlled study in a live porcine model.
        Gastrointest Endosc. 2010; 71: 812-816
        • Narula V.K.
        • Hazey J.W.
        • Renton D.B.
        • et al.
        Transgastric instrumentation and bacterial contamination of the peritoneal cavity.
        Surg Endosc. 2008; 22: 605-611
        • Dionigi G.
        • Rovera F.
        • Boni L.
        Commentary on: Witzel K, von Rahden BH, Kaminski C, et al. Transoral access for endoscopic thyroid resection.
        Surg Endosc. 2009; 23: 454-456
        • Miccoli P.
        • Materazzi G.
        • Berti P.
        Natural orifice surgery on the thyroid gland using totally transoral video-assisted thyroidectomy: report of the first experimental results for a new surgical method: are we going in the right direction?.
        Surg Endosc. 2010; 24: 957-960
        • Dionigi G.
        • Bacuzzi A.
        • Lavazza M.
        • et al.
        Transoral endoscopic thyroidectomy: preliminary experience in Italy.
        Updates Surg. 2017; 69: 225-234
        • Wang Y.
        • Yu X.
        • Wang P.
        • et al.
        Implementation of intraoperative neuromonitoring for transoral endoscopic thyroid surgery: a preliminary report.
        J Laparoendosc Adv Surg Tech A. 2016; 26: 965-971
        • Yi J.W.
        • Yoon S.G.
        • Kim H.S.
        • et al.
        Transoral endoscopic surgery for papillary thyroid carcinoma: initial experiences of a single surgeon in South Korea.
        Ann Surg Treat Res. 2018; 95: 73-79
        • Chai Y.J.
        • Chung J.K.
        • Anuwong A.
        • et al.
        Transoral endoscopic thyroidectomy for papillary thyroid microcarcinoma: initial experience of a single surgeon.
        Ann Surg Treat Res. 2017; 93: 70-75
        • Fu J.
        • Luo Y.
        • Chen Q.
        • et al.
        Transoral endoscopic thyroidectomy: review of 81 cases in a single institute.
        J Laparoendosc Adv Surg Tech A. 2018; 28: 286-291
        • Udelsman R.
        • Anuwong A.
        • Oprea A.D.
        • et al.
        Trans-oral vestibular endocrine surgery: a new technique in the United States.
        Ann Surg. 2016; 264: e13-e16
        • Ahn J.H.
        • Yi J.W.
        Transoral endoscopic thyroidectomy for thyroid carcinoma: outcomes and surgical completeness in 150 single-surgeon cases.
        Surg Endosc. 2020; 34: 861-867
        • Horan T.C.
        • Gaynes R.P.
        • Martone W.J.
        • et al.
        CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections.
        Am J Infect Control. 1992; 20: 271-274
        • Bartella A.K.
        • Kamal M.
        • Teichmann J.
        • et al.
        Prospective comparison of perioperative antibiotic management protocols in oncological head and neck surgery.
        J Craniomaxillofac Surg. 2017; 45: 1078-1082
        • Team RC
        R: a language and environment for statistical computing.
        R Foundation for Statistical Computing, Vienna, Austria2019
        • Tae K.
        • Ji Y.B.
        • Song C.M.
        • et al.
        Robotic and endoscopic thyroid surgery: evolution and advances.
        Clin Exp Otorhinolaryngol. 2019; 12: 1-11
        • Shan L.
        • Liu J.
        A systemic review of transoral thyroidectomy.
        Surg Laparosc Endosc Percutan Tech. 2018; 28: 135-138
        • Camenzuli C.
        • Schembri Wismayer P.
        • Calleja Agius J.
        Transoral endoscopic thyroidectomy: a systematic review of the practice so far.
        JSLS. 2018; 22 (e2018.00026)
        • Greenstein G.
        • Tarnow D.
        The mental foramen and nerve: clinical and anatomical factors related to dental implant placement: a literature review.
        J Periodontol. 2006; 77: 1933-1943
        • Wang C.
        • Zhai H.
        • Liu W.
        • et al.
        Thyroidectomy: a novel endoscopic oral vestibular approach.
        Surgery. 2014; 155: 33-38
        • Fachinetti A.
        • Chiappa C.
        • Arlant V.
        • et al.
        Antibiotic prophylaxis in thyroid surgery.
        Gland Surg. 2017; 6: 525-529
        • Leaper D.J.
        • Edmiston C.E.
        World Health Organization: global guidelines for the prevention of surgical site infection.
        J Hosp Infect. 2017; 95: 135-136
        • Yang K.
        • Ding B.
        • Lin C.
        • et al.
        The novel transvestibule approach for endoscopic thyroidectomy: A case series.
        Surg Laparosc Endosc Percutan Tech. 2016; 26: e25-8
        • Wilhelm T.
        • Wu G.
        • Teymoortash A.
        • et al.
        Transoral endoscopic thyroidectomy: current state of the art—a systematic literature review and results of a bi-center study.
        Transl Cancer Res. 2016; 5: S1521-S1530
        • Chand G.
        • Johri G.
        • Mishra S.K.
        Endoscopic thyroid surgery through trans-oral vestibular approach (TOVA): A case series and review of literature.
        Indian J Otolaryngol Head Neck Surg. 2018; 70: 162-166
        • Park J.O.
        • Sun D.I.
        Transoral endoscopic thyroidectomy: our initial experience using a new endoscopic technique.
        Surg Endosc. 2017; 31: 5436-5443