Transoral thyroidectomy: advantages and limitations (original) (raw)
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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...
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.
Transoral thyroidectomy: A reflexive opinion on the technique
2021
Arch Endocrinol Metab. 2021;65/3 1 Universidade Estadual de Campinas, Campinas, SP, Brasil 2 Hospital do Servidor Público Estadual de São Paulo, São Paulo, SP, Brasil 3 Departamento de Cirurgia da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil 4 Instituto Nacional de Câncer, Rio de Janeiro, RJ, Brasil 5 Universidade Federal de São Paulo, Escola Paulista de Medicina, São Paulo, SP, Brasil 6 Departamento de Cirurgia, Laboratório de Investigação Médica (LIM-02), Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil 7 Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil 8 Universidade Federal do Rio Grande do Norte, Centro de Ciências da Saúde, Programa de Pós-graduação em Ciências da Saúde, Natal, RN, Brasil
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.
Indian Journal of Otolaryngology and Head & Neck Surgery, 2017
Endoscopic surgery is now standard of care for different Endocrine Disorders; the endoscopic thyroid surgery is becoming more popular and different approaches has been practice by many thyroid surgeon worldwide. Trans-orovestibular approach, based on the principle of natural orifice transluminal surgery is truly scar free thyroid surgery and has minimal dissection. We are presenting here three cases of benign solitary thyroid nodule operated endoscopically through trans-oro-vestibular approach in one male and two female patients. Described about the approach, challenges during surgery and outcome. These surgeries documented very few in literatures in live human patients. Transoral endoscopic thyroid surgery through vestibular approach is shortest and direct remote access approach. The need of limited dissection in this approach provides less complication and excellent cosmetic outcome in strictly selected patients.
Minimally invasive therapy & allied technologies : MITAT : official journal of the Society for Minimally Invasive Therapy, 2015
Anatomical study of surgical approaches of endoscopic minimally invasive thyroidectomy (eMIT) and transoral partial parathyroidectomy (TOPP) was conducted to evaluate their safety and feasibility. After performing an eMIT- and TOPP-procedure on fresh frozen human cadavers, a layer-by-layer dissection of the floor of the mouth and the anterior cervical region was carried out in five specimens. The blood vessels, nerves and muscles related to the surgical approach were exposed. The anterior region of the neck can be reached through the midline of the mouth floor and the suprahyoid muscles. No important nerves and vessels were found in the approach of eMIT. TOPP set up the space at the dorsal side of the thyroid gland and adjacent to the trachea. The hypoglossal nerve and the lingual nerve as well as their accompanying blood vessels were anatomically related to the approach and could be injured during the procedure. The surgical space is much limited in TOPP (<20 mm in diameter) and...
Transoral Endoscopic Thyroidectomy Vestibular Approach in the Management of Benign Thyroid Diseases
Current Advancements in Clinical Practice in Nigeria, 2024
Thyroidectomy, the surgical removal of the thyroid gland, has been a major procedure done by performing a Kocher's cervical incision. Despite the massive success recorded so far in these invasive thyroid surgical procedures, the post-operative scars have been a major setback, especially for young women, because of their unaesthetic and discomforting reasons. Currently, this surgical procedure has evolved, and it has seen major improvements in ensuring a scar-free and successful thyroid surgery. One of such evolutions is the adoption of the Transoral Endoscopic Thyroidectomy Vestibular Approach (TOETVA). This is a kind of Natural Orifice Transluminal Endoscopic Surgery (NOTES) whose approach explores the use of an optical surgical instrument through a native body orifice such as the mouth to access the thyroid gland. It is realized by making three internal incisions in the inferior vestibule. Although TOETVA comes with its complications, it has successfully eradicated the concerns of scarifications, improving cosmetic outcomes. While there are other minimally invasive procedures that have also evolved, such as Transaxilary Endoscopic Thyroidectomy (TAET), Minimally invasive video-assited thyroidectomy (MIVAT), Bilateral Axillo-Breast Approach (BABA), Retroauricular Approach, Submental Approach, and Transoral robotic thyroidectomy, TOETVA remains a leading approach and has gained traction in the medical world due to its advantages, including improved cosmetics, reduced postoperative pain, and shorter recovery time. This review aims to explore the key aspects of the procedure, including patient selection criteria, surgical technique, postoperative outcomes, and potential complications.
SiSli Etfal Hastanesi Tip Bulteni / The Medical Bulletin of Sisli Hospital, 2021
Objective: Transoral endoscopic thyroidectomy vestibular approach (TOETVA) is a scarless method that enables thyroidectomyusing natural orifice of the body. The opinion which is even common among TOETVA performing surgeons is that this surgery involves a small percentage of thyroidectomy applied patients. In this study, based on the currently accepted exclusion criteria, we aimed to determine what percentage of patients, who underwent thyroidectomy in an endemic area are actually suitable for TOETVA. Methods: Between January 2017 and December 2019, 1197 consecutive patients who underwent surgery for thyroid pathology in our clinic were analyzed retrospectively. Pre-operative evaluations were made according to the current exclusion criteria and as a result, patients with no previous neck surgery, no history of radiotherapy, no retrosternal thyroid extension, and none lymph node dissection operation been made and whose thyroid gland diameter is <10 cm and gland volume is not more than 45 ml, malignant nodule diameter is <2 cm, and benign nodule diameter is <4 cm are involved to this study by being considered appropriate for TOETVA procedure. Results: According to the criteria, 513 patients (42.8%) were found suitable for TOETVA. A total of 421 (82%) of these patients were female and 92 (18%) were male. The mean age was 46.2±13.2. A total of 192 (37%) of these patients were operated due to the benign reasons, and 321 (63%) of these patients operated due to the malignancy or suspicion of malignancy. Average nodule size was 1.9 cm, and the average thyroid volume was 23.8 ml among benign patients. Whereas among malignant patients, the average nodule size was 1.7 cm and the average thyroid volume was 21.8 ml. A total of 462 (90.1%) of the patients were applied to the total thyroidectomy and 51 (9.9%) of the patients were applied to the hemithyroidectomy. In the same period, 29 patients operated through TOETVA and 4 patients operated through bilateral axillary breast approach thyroidectomy. When the final pathology, results of the patients were examined, papillary thyroid carcinoma was seen in 301 (58.7%) patients, benign pathologies were seen in 192 (37.4%) patients, and 20 (3.9%) patients were diagnosed with other pathologies (follicular thyroid carcinoma, poorly differentiated carcinoma and Hürthle cell neoplasia, etc.). Conclusion: Although "patient willingness" factor could not be included in the study, TOETVA eligible patient repository is wider contrary to popular belief. In our humble opinion, TOETVA method is going to pursue its spread and become a part of the routine surgical training session due to its effectiveness in terms of credibility in today's world where cosmetic concerns gradually gain prominence.