Background: Thyroid disease is a common endocrine disorder, and thyroid surgeries and postoperative complications have increased recently. This study aimed to explore the effectiveness of intraoperative nerve monitoring (IONM) in endoscopic thyroid surgery using subgroup analysis and determine confounding factors. Materials and Methods: Two researchers individually searched for relevant studies published till November, 2022 in the PubMed, Embase, Web of Science, and Cochrane Library databases. Eventually, eight studies met the inclusion criteria. Heterogeneity was assessed using the Cochran’s Q test, and a funnel plot was implemented to evaluate publication bias. Odds ratio or risk difference were calculated using fixed-effects models. The weighted mean difference of continuous variables was calculated. Subgroup analysis was performed according to the disease type. Results: Eight eligible papers included 915 patients and 1,242 exposed nerves. The frequencies of transient, permanent, and total recurrent laryngeal nerve (RLN) palsy were 2.64%, 0.19%, and 2.83%, respectively, in the IONM group and 6.15%, 0.75%, and 6.90%, respectively, in the conventional exposure group. In addition, analysis of the secondary outcome indicators for the average total length of surgery, localisation time of the RLN, recognition rate of the superior laryngeal nerve, and length of incision revealed that IONM reduced the localisation time of the RLN and increased the identification rate of the superior laryngeal nerve. Subgroup analysis showed that IONM significantly reduced the incidence of RLN palsy in patients with malignancies. Conclusions: The use of IONM significantly reduced the incidence of transient RLN palsy during endoscopic thyroid surgery, but it did not significantly reduce the incidence of permanent RLN palsy. However, reduction in the total RLN palsy was statistically significant. In addition, IONM can effectively reduce the location time of the RLN and increase the recognition rate of the superior laryngeal nerve. Therefore, the application of IONM for malignant tumours is recommended.

Background: Endoscopic thyroidectomy (ET) and robotic thyroidectomy (RT) yield similar perioperative outcomes. This study investigated how the learning curve (LC) affects perioperative outcomes between ET and RT, identifying factors that influence the LC. Materials and methods: Two researchers individually searched PubMed, EMBASE, Web of Science, and Cochrane Library for relevant studies published until February 2024. The Newcastle–Ottawa Scale assessed study quality. A random-effects model was used to compute the odds ratio and weighted mean difference (WMD). Poisson regression comparison of the number of surgeries (N _LC ) was required for ET and RT to reach the stable stage of the LC. Heterogeneity was measured using Cochran’s Q. Publication bias was tested using funnel plots, and sensitivity analysis assessed findings robustness. Subgroup analysis was done by operation type and patient characteristics. Results: This meta-analysis involved 33 studies. The drainage volume of ET was higher than that of RT (WMD=−17.56 [30.22, −4.49]). After reaching the N _LC , the operation time of ET and RT was shortened (ET: WMD=28.15 [18.04–38.26]; RT: WMD=38.53 [29.20–47.86]). Other perioperative outcomes also improved to varying degrees. Notably, RT showed more refined central lymph node resection (5.67 vs. 4.71), less intraoperative bleeding (16.56 ml vs. 42.30 ml), and incidence of transient recurrent laryngeal nerve injury (24.59 vs. 26.77). The N _LC of RT was smaller than that of ET (incidence-rate ratios [IRR]=0.64 [0.57–0.72]). CUSUM analysis (ET: IRR=0.84 [0.72–0.99]; RT: IRR=0.55 [0.44–0.69]) or a smaller number of respondents (ET: IRR=0.26 [0.15–0.46]; RT: IRR=0.51 [0.41–0.63]) was associated with smaller N _LC . In RT, transoral approach (IRR=2.73 [1.96–4.50]; IRR=2.48 [1.61–3.84]) and retroauricular approach (RAA) (IRR=2.13 [1.26–3.60]; IRR=1.78 [1.04–3.05]) had smaller N _LC compared to bilateral axillo-breast and transaxillary approach (TAA). In ET, the N _LC of RAA was smaller than that of TAA (IRR=1.61 [1.04–2.51]), breast approach (IRR=1.67 [1.06–2.64]), and subclavian approach (IRR=1.80 [1.03–3.14]). Conclusions: Rich surgical experience can improve surgical results of ET and RT. After reaching the N _LC , the perioperative outcomes of RT are better than those of ET. Study subjects, surgical approaches, and analysis methods can affect N _LC .

Evidence suggests a potential link between metabolic dysfunction and head and neck cancer (HNC). This study investigates the potential causal relationships between metabolic dysfunction and HNC using genetic data. While no significant causal associations were identified between metabolic indicators and HNC risk, the research revealed that inhibition of certain genes could reduce cancer risk. Specifically, inhibiting sodium/glucose cotransporter 2 (SLC5A2) was associated with a decreased risk of HNC and oropharyngeal cancer (OPC), while ATP-sensitive inward rectifier potassium channel 11 inhibition was linked to a reduced risk of oral cavity cancer. Additionally, inhibiting SLC5A1 and voltage-dependent L-type calcium channel subunit beta-2 showed a connection to lower OPC risk. These findings suggest that targeting these genes could offer promising therapeutic strategies for preventing and treating HNC, as well as improving both preoperative and postoperative management in affected patients.