Abstract
Objectives
Transoral endoscopic/robotic thyroidectomy vestibule approach (TOETVA/TORTVA) is a novel technology that has been proposed for the treatment of thyroid disease. Its adoption has increased because of its satisfying cosmetic effects. The primary aim of this systematic review was to assess the feasibility and safety of this approach, and the secondary aim was to discuss the indications for this technology.
Materials and methods
According to the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines, we searched Pubmed, Embase and the Cochrane databases for published studies on the feasibility and safety of TOETVA or TORTVA.
Results
11 articles containing 864 patients met the inclusion criteria after full-text screening, of which two were reports of randomized controlled trial (RCT), two were retrospective cohort studies and the remaining seven studies were case series. Only studies that evaluated the feasibility and safety of this approach were included. TOETVA/TORTVA was successfully performed in 857 out of the 864 cases (99.2%). The mean operative time ranged from 60.4 to 265.4 min. In most articles, blood loss was less than 50 mL and the mean hospital stay ranged from 1.1 to 8.2 days. The safety outcomes were presented in all articles. The total incidence of adverse events was 14.5%, of which the main complications were transient hypoparathyroidism (5.6%) and transient recurrent laryngeal nerve (RLN) injury (3.1%).
Conclusions
This review preliminarily suggests that TOETVA or TORTVA could be an effective and safe treatment for thyroidectomy. Due to the small sample size and low level of evidence, further large-scale, well-designed RCTs are required to validate our findings.
Similar content being viewed by others
References
Lee MC, Park H, Lee BC, Lee GH, Choi IJ (2016) Comparison of quality of life between open and endoscopic thyroidectomy for papillary thyroid cancer. Head Neck 38(S1):E827–E831
Lee J, Kwon IS, Bae EH, Chung WY (2013) Comparative analysis of oncological outcomes and quality of life after robotic versus conventional open thyroidectomy with modified radical neck dissection in patients with papillary thyroid carcinoma and lateral neck node metastases. J Clin Endocrinol Metab 98(7):2701–2708
Lirici MM, Hüscher CSG, Chiodini S, Napolitano C, Recher A (1997) Endoscopic right thyroid lobectomy. Surg Endosc 11(8):877–877
Ikeda Y, Takami H, Sasaki Y, Takayama J, Niimi M, Kan S (2003) Clinical benefits in endoscopic thyroidectomy by the axillary approach. J Am Coll Surg 196(2):189–195
Jia G, Tian Z, Xi H, Su F, Wang X, Gao X (2017) Comparison of the breast and areola approaches for endoscopic thyroidectomy in patients with microcarcinoma. Oncol Lett 13(1):231–235
Zhao X, Zhang NW, Zhu B (2011) Endoscopic thyroidectomy via breast approach versus conventional open thyroidectomy for benign thyroid tumor:a retrospective study. Chin J Pract Surg 31(5):423–425
Shimazu K, Shiba E, Tamaki Y, Takiguchi S, Taniguchi E, Ohashi S, Noguchi S (2003) Endoscopic thyroid surgery through the axillo-bilateral-breast approach. Surg Laparosc Endosc Percutaneous Tech 13(3):196
Lee KE, Kim E, Koo dH, Choi JY, Kim KH, Youn YK (2013) Robotic thyroidectomy by bilateral axillo-breast approach: review of 1,026 cases and surgical completeness. Surg Endosc 27(8):2955–2962
Wilhelm T, Metzig A (2011) Endoscopic minimally invasive thyroidectomy (eMIT): a prospective proof-of-concept study in humans. World J Surg 35(3):543–551. https://doi.org/10.1007/s00268-010-0846-0
Nakajo A, Arima H, Hirata M, Mizoguchi T, Kijima Y, Yoshinaka H, Natsugoe S (2012) Trans-oral video-assisted neck surgery (TOVANS)—a new trans-oral technique of endoscopic thyroidectomy with gasless pre-mandible approach. Surg Endosc Other Interv Techn 26:S211. https://doi.org/10.1007/s00464-012-2201-z
Wang C, Zhai H, Liu W, Li J, Yang J, Hu Y, Huang J, Yang W, Pan Y, Ding H (2014) Thyroidectomy: a novel endoscopic oral vestibular approach. Surgery 155(1):33–38. https://doi.org/10.1016/j.surg.2013.06.010
Anuwong A (2016) Transoral endoscopic thyroidectomy vestibular approach: a series of the first 60 human cases. World J Surg 40(3):491–497
Dionigi G, Bacuzzi A, Lavazza M, Inversini D, Boni L, Rausei S, Kim HY, Anuwong A (2017) Transoral endoscopic thyroidectomy: preliminary experience in Italy. Updat Surg 69(2):225–234. https://doi.org/10.1007/s13304-017-0436-x
Anuwong A, Ketwong K, Jitpratoom P, Sasanakietkul T, Duh QY (2018) Safety and outcomes of the transoral endoscopic thyroidectomy vestibular approach. JAMA Surg 153(1):21–27. https://doi.org/10.1001/jamasurg.2017.3366
Moher D, Liberati A, Tetzlaff J, Altman DG, The PRISMA Group (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Open Med 3(3):e123–e130
Phillips B, Ball C, Sackett D, Badenoch D, Straus SE, Haynes B, Dawes M, Howick J (2009) Oxford centre for evidence-based medicine levels of evidence (May 2001)
Higgins J, Green S, Collaboration C (2011) Cochrane Handbook for Systematic Reviews for Interventions. Cochrane Database Syst Rev 2011(2):S38
Slim K, Nini ED, Kwiatkowski F, Panis Y, Chipponi J (2015) Methodological index for non-randomized studies (minors): development and validation of a new instrument. ANZ J Surg 73(9):712–716
Yang J, Wang C, Li J, Yang W, Cao G, Wong H, Zhai H, Liu W (2015) Complete endoscopic thyroidectomy via oral vestibular approach versus areola approach for treatment of thyroid diseases. J Laparoendosc Adv Surg Tech Part A 25(6):470–476. https://doi.org/10.1089/lap.2015.0026
Udelsman R, Anuwong A, Oprea AD, Rhodes A, Prasad M, Sansone M, Brooks C, Donovan PI, Jannitto C, Carling T (2016) Trans-oral vestibular endocrine surgery: a new technique in the United States. Ann Surg 264(6):e13–e16. https://doi.org/10.1097/sla.0000000000002001
Yang K, Ding B, Lin C, Li W, Li X (2016) The novel transvestibule approach for endoscopic thyroidectomy: a case series. Surg Laparosc Endosc Percutan Tech 26(1):e25
Park JO, Sun DI (2017) Transoral endoscopic thyroidectomy: our initial experience using a new endoscopic technique. Surg Endosc 31(12):5436–5443. https://doi.org/10.1007/s00464-017-5594-x
Kim HY, Chai YJ, Dionigi G, Anuwong A, Richmon JD (2018) Transoral robotic thyroidectomy: lessons learned from an initial consecutive series of 24 patients. Surg Endosc 32(2):688–694. https://doi.org/10.1007/s00464-017-5724-5
Razavi CR, Khadem MGA, Fondong A, Clark JH, Richmon JD, Tufano RP, Russell JO (2018) Early outcomes in transoral vestibular thyroidectomy: robotic versus endoscopic techniques. Head Neck. https://doi.org/10.1002/hed.25323
Wang Y, Zhang Z, Zhao Q, Xie Q, Yan H, Yu X, Xiang C, Zhang M, Wang P (2018) Transoral endoscopic thyroid surgery via the tri-vestibular approach with a hybrid space-maintaining method: a preliminary report. Head neck. https://doi.org/10.1002/hed.25157
Jeong JJ, Sang-Wook Kang MD, Ji-Sup Yun MD, Sung TY, Lee SC, Yong SL, Kee-Hyun Nam MD, Hang SC, Chung WY, Park CS (2009) Comparative study of endoscopic thyroidectomy versus conventional open thyroidectomy in papillary thyroid microcarcinoma (PTMC) patients. J Surg Oncol 100(6):477
Liu S, Qiu M, Jiang DZ, Zheng XM, Zhang W, Shen HL, Shan CX (2009) The learning curve for endoscopic thyroidectomy: a single surgeon’s experience. Surg Endosc 23(8):1802–1806
Liao HJ, Dong C, Kong FJ, Zhang ZP, Huang P, Chang S (2014) The CUSUM analysis of the learning curve for endoscopic thyroidectomy by the breast approach. Surg Innov 21(2):221–228
Rosato L, Avenia N, Bernante P, De PM, Gulino G, Nasi PG, Pelizzo MR, Pezzullo L (2004) Complications of thyroid surgery: analysis of a multicentric study on 14,934 patients operated on in Italy over 5 years. World J Surg 28(3):271–276
Rd IW, Suh H, Fernandez-Ranvier G (2017) Transoral endoscopic thyroidectomy vestibular approach with intraoperative nerve monitoring. Surg Endosc 31(7):3030–3030
Chen HK, Chen CL, Wen KS, Lin YF, Lin KY, Uen YH (2017) Application of transoral continuous intraoperative neuromonitoring in natural orifice transluminal endoscopic surgery for thyroid disease: a preliminary study. Surg Endosc 32(Suppl 1):1–9
Vidal Fortuny J, Belfontali V, Sadowski SM, Karenovics W, Guigard S, Triponez F (2016) Parathyroid gland angiography with indocyanine green fluorescence to predict parathyroid function after thyroid surgery. Br J Surg 103(5):537–543
Lang BH, Wong CK, Hung HT, Wong KP, Mak KL, Au KB (2017) Indocyanine green fluorescence angiography for quantitative evaluation of in situ parathyroid gland perfusion and function after total thyroidectomy. Surgery 161(1):87–95
Yoo H, Chae BJ, Park HS, Kim KH, Kim SH, Song BJ, Jung SS, Bae JS (2012) Comparison of surgical outcomes between endoscopic and robotic thyroidectomy. J Surg Oncol 105(7):705–708
Lee S, Ryu HR, Park JH, Kim KH, Kang SW, Jeong JJ, Nam KH, Chung WY, Park CS (2011) Excellence in robotic thyroid surgery: a comparative study of robot-assisted versus conventional endoscopic thyroidectomy in papillary thyroid microcarcinoma patients. Ann Surg 253(6):1060–1066
Lee J, Lee JH, Nah KY, Soh EY, Chung WY (2011) Comparison of endoscopic and robotic thyroidectomy. Ann Surg Oncol 18(5):1439–1446
Funding
None.
Author information
Authors and Affiliations
Contributions
Each of the authors has contributed to reading and approving this manuscript.
Corresponding author
Ethics declarations
Informed consent
For this type of study formal consent is not required.
Conflict of interest
The authors declare that they have no conflict of interest.
Electronic supplementary material
Below is the link to the electronic supplementary material.
Rights and permissions
About this article
Cite this article
Chen, S., Zhao, M. & Qiu, J. Transoral vestibule approach for thyroid disease: a systematic review. Eur Arch Otorhinolaryngol 276, 297–304 (2019). https://doi.org/10.1007/s00405-018-5206-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00405-018-5206-y