Anatomical study of surgical approaches for minimally invasive transoral thyroidectomy: eMIT and TOPP (original) (raw)
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Transoral thyroidectomy: advantages and limitations
Journal of endocrinological investigation, 2017
In this opinion paper of the Journal of Endocrinological Investigation, leading experts in the field report on their current clinical experience with a novel approach for thyroid gland surgery, namely, "transoral thyroidectomy" (TOT). This feasible and novel surgical procedure does not require visible incisions and is, therefore, a truly scarless surgery. Patients meeting the following criteria can be considered as candidates for TOT: (a) an ultrasonographically (US) estimated thyroid diameter ≤10 cm; (b) US-estimated gland volume ≤45 mL; (c) nodule size ≤50 mm; (d) presence of a benign tumor such as a thyroid cyst or a single- or multi-nodular goiter; (e) Bethesda 3 and/or 4 category and (f) papillary microcarcinoma without the evidence of metastasis. The procedure is conducted via a three-port technique at the oral vestibule using a 10-mm port for the 30° endoscope and two additional 5-mm ports for the dissecting and coagulating instruments. TOT is performed using conven...
Transoral thyroidectomy: A reflexive opinion on the technique
Archives of Endocrinology and Metabolism
W hen analyzing the literature published on thyroidectomy using a "timeline" we can observe that we have notoriously progressed from a procedure that was almost prohibited in the mid-nineteenth century due to complications to a point where it is considered safe, resolutive, and highly efficient. This progress is especially due to the advances in surgical techniques. Theodore Kocher (Nobel Prize in 1909 for his contribution to thyroidectomies) flawlessly described the anatomical basis for the success of this surgical technique 130 years ago. Besides this, advances in anesthetic procedures, surgical materials, and medications were fundamental to intraoperative and postoperative advances and patient management. With time, the knowledge on the different thyroid diseases has exponentially increased and serves as indicators for the extension of treatment and surgical procedures, all efforts should be directed to apply them into clinical practice (1). In the past twenty years, the introduction of new technologies such as the application of energy in surgical instruments and neuromonitoring brought advances to the procedure. These technologies helped providers to achieve a shorter surgical time, a shorter length of hospital stay, a reduction in the risk of bilateral laryngeal paralysis, and a reduced risk of intra and post-operative bleeding (2,3). In the last decade, stimulated by the current advances in endoscopic and robotic surgery, new approaches for thyroidectomy procedures were investigated to substitute the classic cervical incision, and are currently a theme for several scientific debates.
Transoral thyroidectomy: why is it needed?
Gland surgery, 2017
Transoral thyroidectomy (TOT) represents reasonably the desirable minimally invasive approach to the gland due to the scarless non-visible incisions, the limited distance between the gland and the access that minimize tissue dissection and respect of the surgical anatomical planes. Patients are routinely selected according to an extensive inclusion criteria: (I) ultrasonographically (US) estimated thyroid diameter not larger than 10 cm; (II) US gland volume ≤45 mL; (III) nodule size ≤50 mm; (IV) a benign tumor, such as a thyroid cyst, single-nodular goiter, or multinodular goiter; (V) follicular neoplasm; (VI) papillary microcarcinoma without lymph node metastasis. The operation is realized through median, central approach which allows bilateral exploration of the thyroid gland and central compartment. TOT is succeed both endoscopically adopting ordinary endoscopic equipments or robotically. In detail three ports are placed at the inferior oral vestibule: one 10-mm port for 30° endo...
Gland Surgery, 2017
Background: Numerous new approaches have been described over the years to improve the cosmetic outcomes of thyroid surgery. Transoral approach is a new technique that aims to achieve superior cosmetic outcomes by concealing the incision in the oral cavity. Methods: Transoral thyroidectomy through vestibular approach was performed in two institutions on cadaveric models. Procedure was performed endoscopically in one institution, while the robotic technique was utilized at the other. Results: Transoral thyroidectomy was successfully performed at both institutions with robotic and endoscopic techniques. All vital structures were identified and preserved. Conclusions: Transoral thyroidectomy has been performed in animal and cadaveric models, as well as in some clinical studies. Our initial experience indicates the feasibility of this approach. More clinical studies are required to elucidate its full utility.
Transoral Endoscopic Thyroidectomy: A Systematic Review of the Practice So Far
JSLS : Journal of the Society of Laparoendoscopic Surgeons, 2018
Background and Objectives: Thyroid disease largely affects young females, but the incidence is also increasing among males. In an effort to avoid the scarring of the neck that is synonymous with conventional thyroidectomy, endoscopic techniques have been developed over the years. The transoral endoscopic approach is the latest of these innovations that promises a scarless surgical outcome. This review evaluates whether this technique is safe and feasible in live patients and outlines the outcomes in published literature so far. Database: PubMed, Medline, BioMed Central, Cochrane Library, OVID and Web of Science were systematically searched by using a Medical Subject Heading (MeSH)optimized search strategy. The selection of papers followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines after setting strict inclusion and exclusion criteria. Sixteen studies were included in the final analysis. Discussion: This systematic review presents cases of 785 patients. Surgeons in 15 of the studies used a completely vestibular approach, whereas those in the remaining 2 used the floor of the mouth for primary access. Conversion to open surgery took place in 1.3%. In total, 4.3% of patients experienced transient laryngeal nerve palsy, whereas 0.1% had permanent recurrent incidences of the condition. Transient hypocalcemia occurred in 7.4% of cases, with no recorded permanent cases. Carbon dioxide embolism occurred in 0.6% of cases, and another 0.6% had a deep-seated neck infection. The complication rates within the review were deemed acceptable and the overall technique feasible. A prospective randomized controlled trial was proposed to compare this technique with conventional thyroidectomy.
Transoral thyroidectomy—from experiment to clinical implementation
Translational cancer research, 2017
As worldwide first group who initiated the transoral access to the thyroid we report on our personal experience and conceptual design in dealing with this innovative approach that was part of our Natural Orifice Surgery (NOS/NOTES) project which is the next step in the evolution of minimally invasive surgery. The transoral thyroidectomy is a safe method that represents a breakthrough for the patient and a paradigm shift in the history of thyroid surgery toward a scarless and hopefully also pain-free surgery.