Thyroidectomy: A novel endoscopic oral vestibular approach

doi:10.1016/j.surg.2013.06.010

Surgery

Volume 155, Issue 1, January 2014, Pages 33-38

https://doi.org/10.1016/j.surg.2013.06.010 Get rights and content

Background

To date, no report has discussed endoscopic thyroidectomy using the oral vestibular approach (ETOVA). The objective of this study was to evaluate the feasibility, safety, efficacy, and cosmetic results of endoscopic thyroidectomy involving this surgical approach.

Methods

Twenty-four patients with benign thyroid nodules were randomized into the ETOVA (n = 12) and the endoscopic thyroidectomy by areola approach (ETAA) groups (n = 12). Therapeutic effects were assessed at follow-up by physical examination. All patients were followed to evaluate thyroid function and scar formation from endoscopic treatment.

Results

Complete resection of all the lesions was performed endoscopically, and no conversion to open surgery was needed. There was no difference between the 2 groups with respect to surgical time (60.4 vs 59.6 min), blood loss (10.8 vs 13.8 mL), postoperative hospital stay (4.9 vs 4.6 d), or cost of surgery (17.6 vs 17.4 thousand yuan). Patients who underwent the areola approach had 3 scars, 10 × 2 mm, 5 × 1 mm, and 5 × 1 mm in size, all of which were visible at the 6-month follow-up. Patients in the ETOVA group did not have any scars. Follow-up showed a significant difference (P = .019) in the satisfaction score between the ETOVA (2.33 ± 0.65) and the ETAA group (1.58 ± 0.79). Imaging showed that all patients had complete resection and no residual disease. Severe complications such as subcutaneous accumulation of blood and fluid, superior or recurrent laryngeal nerve injury, and parathyroid dysfunction were not observed.

Conclusion

ETOVA was found to be safe and feasible and did not leave any scars; however, large-scale, randomized clinical trials are necessary for confirmation.

Section snippets

Patients

From November 2011 to June 2012, 24 consecutive patients were enrolled in a prospective, controlled clinical protocol approved by the ethical committee of the First Affiliated Hospital of Jinan University. All patients provided written informed consent before beginning the study and were randomly assigned to the treatment groups. Patients were informed of the potential risks and benefits of endoscopic thyroidectomy, and written consent was obtained. Twenty-four patients with a goiter underwent

Patients and complications

All lesions were completely resected endoscopically and conversion to open surgery was not needed. Surgical time, blood loss, cost of surgery, and length of postoperative hospital stay were not different between the 2 groups (P > .05). With ETOVA, there were only 2 cases in which the submandibular skin developed small areas of ecchymosis. These disappeared after 10 days. The other patients, did not develop subcutaneous accumulation of blood and fluid, or suffer vocal cord, superior or recurrent

Disscusion

In 1987, Dr Philippe Mouret of Lyon, France, performed the first successful laparoscopic cholecystectomy. This technique was effective, minimally invasive, and had desirable cosmetic results. In 1996, Gagner performed the first endoscopic parathyroid resection.²⁸ Currently, a variety of approaches for endoscopic thyroid surgery are available. All approaches except those through the floor of the mouth leave visible surgical scars, which can place great psychological stress on patients. Wilhelm

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Transoral endoscopic thyroidectomy vestibular approach in clinical practice
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Transoral endoscopic thyroidectomy vestibular approach: Results after 53 first cases
2023, Cirugia Espanola
La tiroidectomía endoscópica transoral por vía vestibular permite el acceso al tiroides sin cicatrices visibles y con el mejor resultado cosmético posible.
Estudio observacional prospectivo de 53 pacientes sometidos a tiroidectomía endoscópica transoral desde julio de 2017 hasta junio de 2021.
Cincuenta y dos casos (98,1%) fueron mujeres con una mediana de edad de 44 años. El nódulo tiroideo fue la indicación quirúrgica más frecuente (73,6%). Se realizaron 42 lobectomías,11 tiroidectomías totales y en 4 casos se asoció vaciamiento ganglionar del compartimento central izquierdo. La mediana de tiempo para la colocación de trócares fue de 14 min, y para la lobectomía, la tiroidectomía total y el vaciamiento ganglionar del compartimento central izquierdo, de 80, 140 y 30 min, respectivamente. La mediana de estancia hospitalaria fue de 2 días. Cuatro pacientes presentaron disfonía (7,5%), pero la laringoscopia solo confirmó lesión del recurrente en 2 casos, una de ellas permanente (1,6%). En los pacientes con tiroidectomía total la frecuencia de hipoparatiroidismo transitorio fue del 18,2% y el permanente de 0%. Dentro de las complicaciones asociadas al abordaje, en todos los pacientes se presentó anestesia de la región mentoniana transitoria y de intensidad variable.
La cirugía transoral es un abordaje de aplicación reciente en nuestra unidad. Los resultados en nuestros primeros pacientes muestran que es un abordaje eficaz y seguro cuando se realiza en pacientes bien seleccionados, con el mejor resultado cosmético y con complicaciones nuevas, asociadas al abordaje, transitorias en nuestra serie.
Transoral endoscopic thyroidectomy through vestibular approach allows access to the thyroid with the best cosmetic results as there are no visible scars.
Here we present a prospective observational study of 53 patients which underwent transoral endoscopic thyroidectomy from July 2017 to June 2021.
Fifty-two cases (98.1%) were women (median age 44 years old). Thyroid nodule was the main surgical indication accounting 73.6% of cases. We performed 42 lobectomies and 11 total thyroidectomies; 4 left central neck dissection were also associated. The median surgical time for port placement was 14 min, and for lobectomy, total thyroidectomy and left central neck dissection were 80, 140 and 30 min, respectively. The median of hospital stay was 2 days. Dysphonia was present in 4 patients (7.5%); however, laryngoscopy only confirmed laryngeal nerve impairment in 2 cases, one of them classified as permanent (1.6%). In those patients that underwent total thyroidectomy, the rate of transient hypoparathyroidism was 18.2% whereas permanent was 0%. Regarding complications associated to the new approach, transient chin numbness appeared in all patients with a variable degree of intensity.
Transoral surgery is a recent approach in our unit. Our results, based on the first 53 patients, show that it is a safe and effective approach when performed in appropriately selected patients offering the best cosmetic result. Besides, new complications associated to the approach has been shown to be transient.
Learning curve and volume outcome relationship of endoscopic trans-oral versus trans-axillary thyroidectomy; A systematic review and meta-analysis
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In the modern era, minimally invasive surgery is rapidly evolving and even replacing conventional open techniques in many surgical fields. Thyroidectomy was not an exception, with the introduction of multiple endoscopic thyroidectomy techniques. Trans-oral endoscopic trans-vestibular thyroidectomy (TOT) is a novel technique with promising outcomes. We conducted this meta-analysis to compare surgical outcomes and learning curves for TOT and other endoscopic thyroidectomy techniques.
A systematic review in PubMed, MEDLINE, and EMBASE databases was conducted searching for publications on TOT versus trans-axillary thyroidectomy (TAT). The primary endpoint was operative (OR) time. Secondary endpoints were number of harvested lymph nodes (LNs), estimated blood loss (EBL), recurrent laryngeal nerve (RLN) injury, hoarseness, seroma, infection, chyle leak, hypocalcemia, hospital length of stay (LOS), and Cost. We also investigated the learning curve for each technique. Leave-out-out analysis, meta-regression, and subgroup analysis were used. Random effect inverse variance method was utilized.
Among 3820 retrieved studies, 15 studies (10 unmatched and 5 matched), with 2173 (TOT: 1024(47.12%) and TAT:1149(52.87%)) patients, met the inclusion criteria. The operative time and harvested L. Ns number were higher in TOT versus TAT (standard mean difference (SMD) = 0.72 [95%CI 0.07; 1.37], P = 0.029 and SMD = 0.32 [95%CI 0.02; 0.62], P = 0.036 respectively) while less EBL in TOT versus TAT (SMD = −0.26 [-0.43; −0.09], P = 0.0018). All other outcomes showed no significant difference between both groups. Weighted mean values for TOT and TAT were 158.03 vs 144.97 min for OR time, 6.33 vs 5.16 for harvested LNs, and $5,919.05 vs $6,253.79 for the cost. Statistical significance in learning curve development was noticed ranging between 6 and 15 annual cases.
Trans-oral thyroidectomy is a safe and reliable technique with outcomes comparable to other endoscopic techniques. It provides better access to the central compartment with a more feasible LN dissection. Improvement in surgical outcomes is expected with growing learning curve and technique mastery
Advances in the assessment of cosmetic outcomes, sensory alteration in surgical areas, and health-related quality of life of endoscopic thyroidectomy
2024, World Journal of Surgical Oncology
Application and advantages of a joystick-controlled robotic scope holder in transoral endoscopic thyroidectomy vestibular approach: a comparative study
2024, Updates in Surgery
Transoral endoscopic parathyroidectomy, vestibular access (TOEPVA): a new word in domestic parathyroid gland surgery
2024, Endoscopic Surgery

View all citing articles on Scopus

: Supported by the Science and Technology Development Fund of Macao (No. 027/2010/A).

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Original CommunicationThyroidectomy: A novel endoscopic oral vestibular approach

Background

Methods

Results

Conclusion

Section snippets

Patients

Patients and complications

Disscusion

Ann Chir

J Am Coll Surg

Surg Oncol Clin North Am

Am J Surg

What is the evidence for endoscopic thyroidectomy in the management of benign thyroid disease?

World J Surg

Video-assisted hemithyroidectomy: surgical technique and early results

Chirurg

Minimally invasive, video-assisted parathyroid surgery for primary hyperparathyroidism

J Endocrinol Invest

Clinical evaluation of gasless endoscopic thyroid surgery

Surg Today

Video-assisted loboisthmectomy by the subclavicular approach. A case report

Wideochir Inne Tech Malo Inwazyjne

Gasless transaxillary robotic versus endoscopic thyroidectomy: exploring the frontiers of scarless thyroidectomy through a preliminary comparison study

Surg Endosc

Endoscopic thyroidectomy via bilateral axillo-breast approach (BABA): review of 512 cases in a single institute

Surg Endosc

Endoscopic axillo-breast approach for benign neck mass excision

Laryngoscope

Endoscopic thyroidectomy: a comparison of the trans-axilloareolar approach and the trans-thoracoareolar approach

Chin J Surg

Endoscopic lateral neck dissection via breast approach for papillary thyroid carcinoma: a preliminary report

Surg Endosc

Endoscopic thyroidectomy via chest and breasts approach in 500 cases

Chin J Otorhinolar Head Neck Surg

Original Communication
Thyroidectomy: A novel endoscopic oral vestibular approach