Perioperative Outcomes of Endoscopic versus Open Operation in the Treatment of Hyperparathyroidism: A Systematic Review and Meta-analysis

Objective: Hyperparathyroidism can cause multiple organs damage, which is characterized by diversity and systemic. At present, there are mainly drug treatment and surgical treatment, among which surgical treatment has the highest cure rate. Surgical treatment mainly includes endoscopic and open surgery in clinical. This article systematically reviewed previously published trials on the two surgical methods, and provided an updated meta-analysis of the perioperative outcomes of different surgical methods on hyperparathyroidism. 
Methods: We searched 7 online databases home and abroad retrieval time till 3 February, 2021. We studied the influence of endoscopic and open surgery on the perioperative outcome of hyperparathyroidism. Data were processed with RevMan 5.3 and Stata 12.0. The methodological quality assessment of non-randomized clinical trials used risk of bias in non-randomised studies of interventions. The cochrane collaboration's tool for assessing bias risk was used to assess the quality of the included randomized controlled studies. The operation time, intraoperative blood loss, postoperative drainage volume and hospital stay were examined. Two authors exchanged and checked the extraction tables, and resolved any inconsistencies by discussing.
Results: A total of 4 studies were included, including 124 patients and 246 controls. The combined results of random-effect model: WMD (95% CI)=-12.96 minutes (-43.47, 17.54) , P=0.40. Similarly, intraoperative blood loss, postoperative drainage volume and hospital stay also showed significant heterogeneity (I2>50%), but the combined results were statistically significant. Meta-analysis results of the three indicators (WMD (95%CI)) were as follows: -10.59 (-15.64, -5.54) mL, P<0.001; -11.69 (-19.65, -3.73) mL, P=0.004; -1.02 (-1.88, -0.16) days, P=0.02. In addition to the operation time, intraoperative blood loss, postoperative drainage volume and hospital stay of the intervention group were significantly lower than the control group.
Conclusions: This paper concluded that endoscopic surgery showed certain advantages over open surgery in the treatment of hyperparathyroidism by performed the meta-analysis of clinical studies on the treatment of hyperparathyroidism, which the finding could provide theoretical guidance for clinical practice.