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Yulian ED, Panigoro SS, Melati PA. Retroauricular endoscopic thyroidectomy: initial single-institution experiences. Updates Surg 2024:10.1007/s13304-024-01855-x. [PMID: 38761336 DOI: 10.1007/s13304-024-01855-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 04/10/2024] [Indexed: 05/20/2024]
Abstract
Conventional thyroidectomy often results in visible scarring postoperatively. Endoscopic thyroidectomy offers the advantage of scarless surgery, especially beneficial for young adult women. The retroauricular approach uses a facelift incision well-known among surgeons and eliminates the need for gas insufflation due to the large working space. An early retrospective analysis was conducted on thirty-one individuals who underwent gasless retroauricular endoscopic thyroidectomy approach, focusing on isthmolobectomies (n = 26) and lobectomies (n = 5), with one case necessitating conversion to open thyroidectomy, from January 2016 to April 2017. Physical examination, laboratory, and histopathology findings were collected. The scar was evaluated using the Vancouver Scale System, while other surgical and oncological outcomes were documented and assessed. The average operative time was 154.2 ± 21.3 min, with an average bleeding volume of 69.2 ± 52.1 mL. The average length of stay was 4.7 ± 2.2 days. All complications occurred were temporary and all subjects remained in good condition throughout the follow-up period. Most subjects (65.6%) were very satisfied with the scar concealed in the retroauricular area. Retroauricular endoscopic thyroidectomy is a safe and feasible remote access technique with excellent postoperative results.
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Affiliation(s)
- Erwin Danil Yulian
- Faculty of Medicine Universitas Indonesia, Surgical Oncology Division, Department of Surgery, Dr. Cipto Mangunkusumo General Hospital, Jalan Pangeran Diponegoro No. 71, Kenari, Central Jakarta, 10430, Indonesia.
| | - Sonar Soni Panigoro
- Faculty of Medicine Universitas Indonesia, Surgical Oncology Division, Department of Surgery, Dr. Cipto Mangunkusumo General Hospital, Jalan Pangeran Diponegoro No. 71, Kenari, Central Jakarta, 10430, Indonesia
| | - Putri Arum Melati
- Faculty of Medicine, Universitas Indonesia, Research Assistant in Surgical Oncology Division, Department of Surgery, Dr. Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
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Dinç B, İlker Turan M, Rıza Gündüz U, Haluk Belen N. Transoral endoscopic thyroidectomy vestibular approach (TOETVA): Our outcomes from Turkey. Turk J Surg 2020; 36:340-346. [PMID: 33778392 PMCID: PMC7963300 DOI: 10.47717/turkjsurg.2020.4765] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 07/25/2020] [Indexed: 11/23/2022]
Abstract
OBJECTIVES The Transoral Endoscopic Thyroidectomy Vestibular Approach (TOETVA) was described in 2016 and had its case series published. This study aimed to present the largest TOETVA case series performed in Turkey. MATERIAL AND METHODS Data from 52 patients who underwent TOETVA procedure between February 2018 and October 2019 were analyzed retrospectively. Demographic data, duration of operation, blood loss, rate of conversion to open surgery, radiological findings, pathological outcomes, and complications were analyzed. RESULTS All patients were female. Mean duration of the operation was 192 ± 45 minutes, mean blood loss was 39 ± 47 mL, and the ratio of surgical site infection was 6% (3/50). In two (4%) patients, TOETVA was converted to open surgery. Temporary and permanent recurrent laryngeal nerve (RLN) paralysis was observed in 2 (4%) and 0 patients, respectively. Temporary and permanent hypoparathyroidism was observed in 10 (20%) and 0 patients, respectively. CONCLUSION TOETVA procedure is the most recently defined NOTES technique for endocrine surgery. In experienced healthcare centers, TOETVA can achieve outcomes similar and even better than the ones obtained with open surgery. The complication rates, durations of operation, surgical site infection, and blood loss parameters that we observed in our experience are similar to the ones reported in the literature.
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Affiliation(s)
- Bülent Dinç
- Clinic of General Surgery, Health Sciences University Antalya Training and Research Hospital, Antalya, Turkey
| | | | - Umut Rıza Gündüz
- Clinic of General Surgery, Health Sciences University Antalya Training and Research Hospital, Antalya, Turkey
| | - Nurhan Haluk Belen
- Clinic of General Surgery, Health Sciences University Antalya Training and Research Hospital, Antalya, Turkey
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Cai J, Fang F, Chen J, Xiang D. Unilateral Multifocality and Bilaterality Could Be Two Different Multifocal Entities in Patients with Papillary Thyroid Microcarcinoma. BIOMED RESEARCH INTERNATIONAL 2020; 2020:9854964. [PMID: 32714990 PMCID: PMC7355378 DOI: 10.1155/2020/9854964] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 06/04/2020] [Accepted: 06/12/2020] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Multifocality within an affected lobe (unilateral multifocality) or two lobes (bilaterality) is commonly denoted as multifocality without differentiation. Recently, there has been molecular evidence indicating that unilateral multifocality and bilaterality could be two different entities. However, few studies concerning the comparison between these two different multifocality entities have been reported. DESIGN A retrospective cohort study. METHODS From 2010 to 2013, in total, 949 consecutive patients with papillary thyroid microcarcinoma (PTMC) were enrolled and further divided into four groups based on multifocality status. Unilateral multifocality and bilaterality were analyzed by binary logistic regression along with other clinicopathological factors. RESULTS Unilateral multifocality, instead of bilaterality, was correlated with central neck metastasis (CNM) in both univariate and multivariate analyses. Group IV (unilateral multifocality and bilaterality coexist) had the highest CNM rate. Group III (unilateral multifocality) had a higher CNM rate than group II (bilaterality, single lesion in each lobe), with a significant difference (p = 0.032). Similar lateral neck metastasis tendency was observed among the four groups. In the multivariate analysis, only unilateral multifocality and bilaterality which coexisted were correlated with CNM. Moreover, 9 cases had a recurrence, with the recurrence rate ranking top in group IV (3.6%), second in group III (2.8%), and third in group II (1.2%). The difference was significant (p = 0.021). CONCLUSION Unilateral multifocality and bilaterality could be two different multifocal entities in patients with PTMC. Unilateral multifocality serving as a prognostic factor indicated a worse prognosis than bilaterality on neck metastasis. When the two factors coexisted in PTMC, patients had the highest risk of CNM and possibly local recurrence compared with those with either risk factor alone.
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Affiliation(s)
- Junbo Cai
- Department of General Surgery, Taizhou Municipal Hospital, Taizhou, Zhejiang, China
| | - Fang Fang
- Department of General Surgery, Taizhou Municipal Hospital, Taizhou, Zhejiang, China
| | - Jianbin Chen
- Department of General Surgery, Taizhou Municipal Hospital, Taizhou, Zhejiang, China
| | - Dapeng Xiang
- Department of General Surgery, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, Zhejiang, China
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Russell JO, Razavi CR, Shaear M, Chen LW, Lee AH, Ranganath R, Tufano RP. Transoral Vestibular Thyroidectomy: Current State of Affairs and Considerations for the Future. J Clin Endocrinol Metab 2019; 104:3779-3784. [PMID: 30860578 PMCID: PMC6656420 DOI: 10.1210/jc.2019-00116] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 03/06/2019] [Indexed: 12/30/2022]
Abstract
CONTEXT The transoral endoscopic thyroidectomy vestibular approach (TOETVA) is a recently described procedure for surgical management of select thyroid pathology that avoids a cutaneous scar. TOETVA is far from the first described remote-access approach to the thyroid. In fact, numerous such techniques have been described over the past 20 years, although none has gained widespread implementation in North America or Europe. However, with its rapid growth worldwide and excellent outcomes to date, TOETVA may succeed where these prior techniques have failed. EVIDENCE ACQUISITION The English literature was reviewed using the following keywords: transoral thyroidectomy, remote-access thyroidectomy, minimally invasive thyroidectomy, and TOETVA. Because three systematic reviews of this technique were recently conducted, this manuscript does not seek to provide a fourth. Rather, we summarize salient findings from these reviews and focus on candidates for the procedure, technique-specific characteristics that have led to early success with TOETVA, and prospects for the future. EVIDENCE SYNTHESIS TOETVA is the only thyroidectomy approach obviating the need for a cutaneous incision, and it offers several advantages over previously described remote-access thyroidectomy techniques. These include a favorable anatomic surgical perspective, a comparatively short learning curve, no requirement for expensive instrumentation, and a broad inclusion criterion. These characteristics have facilitated the excellent surgical outcomes to date. CONCLUSIONS TOETVA is a suitable surgical option with proven safety and feasibility for a carefully selected patient population. The potential value of the procedure outside enhanced cosmesis continues to be defined.
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Affiliation(s)
- Jonathon O Russell
- Division of Head and Neck Endocrine Surgery, Department of Otolaryngology – Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Christopher R Razavi
- Division of Head and Neck Endocrine Surgery, Department of Otolaryngology – Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Mohammad Shaear
- Division of Head and Neck Endocrine Surgery, Department of Otolaryngology – Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Lena W Chen
- Division of Head and Neck Endocrine Surgery, Department of Otolaryngology – Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Andrew H Lee
- Division of Head and Neck Endocrine Surgery, Department of Otolaryngology – Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Rohit Ranganath
- Division of Head and Neck Endocrine Surgery, Department of Otolaryngology – Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ralph P Tufano
- Division of Head and Neck Endocrine Surgery, Department of Otolaryngology – Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Prete FP, Marzaioli R, Lattarulo S, Paradies D, Barile G, d’Addetta MV, Tomasicchio G, Gurrado A, Pezzolla A. Transaxillary robotic-assisted thyroid surgery: technique and results of a preliminary experience on the Da Vinci Xi platform. BMC Surg 2019; 18:19. [PMID: 31074396 PMCID: PMC7402570 DOI: 10.1186/s12893-019-0473-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 01/04/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Robotic thyroidectomy by transaxillary approach (RATS) is regarded as a feasible and safe alternative procedure in selected patients with benign disease or thyroid cancer of low risk, facilitating thyroidectomy with respect to conventional endoscopic approach and offering improved cosmetic results. The Da Vinci Xi surgical system (Intuitive Surgical, Sunnyvale, CA, USA) presents technical advantages over its previous generations, including overhead docking, more compact robotic arms, extended range of motion, and ability for camera to be docked in any arm. This construct supports dissection in smaller spaces with less arm interference and improved view. We present an initial experience of RATS on DVSS Xi in an academic Centre in Italy. METHODS We conducted a prospective observational study, involving patients with thyroid disease and treated between April 2016 and January 2018. A modified thyroidectomy retractor (Modena retractor, CEATEC Medizintechnik, Germany) was used to lift a musculocutaneous flap and operate gasless. Instrument placement was recorded for each procedure. Each procedure description was broken down into three phases, creation of working space, machine docking with instrument positioning and endoscopic operating technique. Duration of cases was recorded. Patients selected were young women, BMI < 30, thyroid nodule < 5 cm, cytology TIR2 to TIR4 (TIR4:only nodules < 1 cm diameter). RESULTS Twelve RATS were performed within the learning curve for the robotic technique, 10 lobectomies and 2 total thyroidectomies. No patients required reintervention. Mean duration of surgery was 198.9 min for lobectomy and 210 for thyroidectomy. The same surgical team performed all procedures. No patients presented surgery-related complications, mean stay was 3 days. Decrease in operating time was observed after 8 cases along with more precise preparation of working space. Four arms were used in the first 10 procedures then only three. No recurrent laryngeal nerve dysfunction, no seroma or haematoma were recorded. One patient had transient hypocalcaemia after total thyroidectomy. CONCLUSIONS Since the early phases of a preliminary experience RATS appeared a safe alternative to open thyroidectomy. Uptake of technique was quick on Xi platform with few technical tweaks over techniques described for Si machines. Careful patient selection is crucial. TRIAL REGISTRATION Retrospectively registered on 20 july 2018 . TRIAL REGISTRATION NUMBER researchregistry4272. The Research Registry: https://www.researchregistry.com/browse-the-registry#home/registrationdetails/5b517f08dbc2045aefd7f9b4/.
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Affiliation(s)
- Francesco Paolo Prete
- Department of Emergency and Organ Transplant - Minimally invasive and Endocrine Surgery Unit, University Medical School of Bari, Bari, Italy
| | - Rinaldo Marzaioli
- Department of Emergency and Organ Transplant - Minimally invasive and Endocrine Surgery Unit, University Medical School of Bari, Bari, Italy
| | - Serafina Lattarulo
- Department of Emergency and Organ Transplant - Minimally invasive and Endocrine Surgery Unit, University Medical School of Bari, Bari, Italy
| | - Daniele Paradies
- Department of Emergency and Organ Transplant - Minimally invasive and Endocrine Surgery Unit, University Medical School of Bari, Bari, Italy
| | - Graziana Barile
- Department of Emergency and Organ Transplant - Minimally invasive and Endocrine Surgery Unit, University Medical School of Bari, Bari, Italy
- Department of Surgical Oncology – IRCCS Istituto Tumori “Giovanni Paolo II”, Bari, Italy
| | - Maria Vittoria d’Addetta
- Department of Emergency and Organ Transplant - Minimally invasive and Endocrine Surgery Unit, University Medical School of Bari, Bari, Italy
| | - Giovanni Tomasicchio
- Department of Emergency and Organ Transplant - Minimally invasive and Endocrine Surgery Unit, University Medical School of Bari, Bari, Italy
| | - Angela Gurrado
- Department of Biomedical Science and Human Oncology - Emergency, Digestive and Endocrine Surgery Unit, University Medical School of Bari, Bari, Italy
| | - Angela Pezzolla
- Department of Emergency and Organ Transplant - Minimally invasive and Endocrine Surgery Unit, University Medical School of Bari, Bari, Italy
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Xie QP, Xiang C, Wang Y, Yan HC, Zhao QZ, Yu X, Zhang ML, Wang P. The patterns and treatment of postoperative hemorrhage and hematoma in total endoscopic thyroidectomy via breast approach: experience of 1932 cases. Endocrine 2019; 63:422-429. [PMID: 30652236 DOI: 10.1007/s12020-018-01837-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Accepted: 12/31/2018] [Indexed: 11/30/2022]
Abstract
PURPOSE Postoperative hemorrhage and hematoma formation is a potentially lethal complication in thyroid surgery, although the patterns and treatment of hemorrhage after total endoscopic thyroidectomy (TET) via breast approach has not been reported previously. We aim to share our experience about postoperative bleeding. METHODS A retrospective analysis of 1932 patients who underwent TET from April 2008 to May 2018 in our institution was carried out. The patterns of postoperative hemorrhage and hematoma formation that need surgical treatment were summarized and focused on the relation to the source of bleeding and the time interval between first surgery and hemorrhage. Related risk factors were analyzed by univariate or multivariate analysis processes. RESULTS The overall rate of hemorrhage and hematoma occurrence was only 0.724% (14 in 1932 patients). Of them, 12 occurred in the first 24 h after surgery, and the other two occurred after withdrawal of the drainage tube. The principle independent risk factors for postoperative hemorrhage and hematoma were age (older than 35 years old) and lateral compartment dissection (LCD) revealed by multivariate regression. During re-exploration, obvious bleeding points were detected in 13 patients. Among them, 12 bled from the vessels in the main trocar cavity and another 1 bled from a broken vein located between the two heads of the sternocleidomastoid (SCM) muscle with LCD. CONCLUSIONS Hemorrhage after TET usually occurs within 24 h, and the main video trocar cavity was the area most likely to bleed. Age and LCD may increase the bleeding risk. Appropriate dissection level is the main solution to prevent postoperative hemorrhage.
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Affiliation(s)
- Qiu-Ping Xie
- The Department of Surgery, Zhejiang University School of Medicine Second Affiliated Hospital, Hangzhou, China
| | - Cheng Xiang
- The Department of Surgery, Zhejiang University School of Medicine Second Affiliated Hospital, Hangzhou, China
| | - Yong Wang
- The Department of Surgery, Zhejiang University School of Medicine Second Affiliated Hospital, Hangzhou, China
| | - Hai-Chao Yan
- The Department of Surgery, Zhejiang University School of Medicine Second Affiliated Hospital, Hangzhou, China
| | - Qun-Zi Zhao
- The Department of Surgery, Zhejiang University School of Medicine Second Affiliated Hospital, Hangzhou, China
| | - Xing Yu
- The Department of Surgery, Zhejiang University School of Medicine Second Affiliated Hospital, Hangzhou, China
| | - Mao-Lin Zhang
- The Department of Surgery, Zhejiang University School of Medicine Second Affiliated Hospital, Hangzhou, China
| | - Ping Wang
- The Department of Surgery, Zhejiang University School of Medicine Second Affiliated Hospital, Hangzhou, China.
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Tori M, Shimo T, Yoshidome K. Novel operative approach to double primary cancers of the breast and thyroid and its effects on cosmesis and the accuracy of follow-up examinations. Asian J Endosc Surg 2018; 11:185-188. [PMID: 29869842 DOI: 10.1111/ases.12426] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 07/09/2017] [Accepted: 07/25/2017] [Indexed: 11/29/2022]
Abstract
For the treatment of double primary cancer of the breast and thyroid, endoscopic thyroidectomy might be an excellent option in terms of cosmesis; however, it may not offer curability, and it makes the accuracy of follow-up examinations difficult. The postoperative scars after endoscopic thyroidectomy may modify the estimation of recurrence. To achieve improve cosmesis and the accuracy of follow-up examination, we developed a novel method for thyroid surgery: hybrid-type endoscopic thyroidectomy (HET). Here we report two cases of double primary cancer, one synchronous and the other metachronous. HET lobectomy and HET total thyroidectomy were performed in combination with some modifications of breast surgery. In each case, the postoperative course was uneventful, and cosmetic satisfaction was very high. Furthermore, there were no problems during the follow-up period. Based on our results, HET could become a standardized treatment of double primary cancers.
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Affiliation(s)
- Masayuki Tori
- Department of Endocrine Surgery and Department of Breast Surgery, Osaka Police Hospital, Osaka, Japan
| | - Toshirou Shimo
- Department of Endocrine Surgery and Department of Breast Surgery, Osaka Police Hospital, Osaka, Japan
| | - Katsuhide Yoshidome
- Department of Endocrine Surgery and Department of Breast Surgery, Osaka Police Hospital, Osaka, Japan
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Wang Y, Zhang Z, Zhao Q, Xie Q, Yan H, Yu X, Xiang C, Zhang M, Wang P. Transoral endoscopic thyroid surgery via the tri-vestibular approach with a hybrid space-maintaining method: A preliminary report. Head Neck 2018; 40:1774-1779. [PMID: 29603475 DOI: 10.1002/hed.25157] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Revised: 12/10/2017] [Accepted: 02/08/2018] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Transoral endoscopic thyroid surgery has been introduced in a few institutions. The purpose of this study was to present an innovative hybrid space-maintaining method for the tri-vestibular approach. METHODS Eighteen consecutive patients underwent transoral endoscopic thyroidectomy. Three incisions were made in the vestibule. The surgical space was maintained with CO2 insufflation along with a suspension device. Thyroidectomy and central neck dissection (CND) were performed safely and effectively. RESULTS The mean operation time was 124 minutes for a simple lobectomy, subtotal thyroidectomy, and isthmectomy in 8 patients, 172 minutes for hemithyroidectomy with ipsilateral CND in 8 patients, and 205 minutes for total thyroidectomy with ipsilateral CND in 7 patients. Transient superior laryngeal nerve (SLN) injury occurred in 3 patients and transient mental nerve injury was found in 1 patient. No evidence of recurrence or metastasis was found at follow-up. CONCLUSION This approach brings satisfactory cosmetic effect along with minimal invasion. Further study is needed to verify its validity.
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Affiliation(s)
- Yong Wang
- Department of Thyroid Surgery, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Ziyi Zhang
- Zhejiang University, School of Medicine, Hangzhou, China
| | - Qunzi Zhao
- Department of Thyroid Surgery, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Qiuping Xie
- Department of Thyroid Surgery, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Haichao Yan
- Department of Thyroid Surgery, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Xing Yu
- Department of Thyroid Surgery, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Cheng Xiang
- Department of Thyroid Surgery, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Maolin Zhang
- Department of Thyroid Surgery, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Ping Wang
- Department of Thyroid Surgery, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
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Endoscopic Thyroid Surgery Through Trans-oral Vestibular Approach (TOVA): A Case Series and Review of Literature. Indian J Otolaryngol Head Neck Surg 2018; 70:162-166. [PMID: 29456963 DOI: 10.1007/s12070-017-1174-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Accepted: 07/18/2017] [Indexed: 10/19/2022] Open
Abstract
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.
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Zhang LY, Zhao WX, Wang B, Yan SY, Wen J. Modified Tumescent Solution for Creating Working Space During Endoscopic Thyroidectomy. Surg Innov 2018; 25:105-109. [PMID: 29303067 DOI: 10.1177/1553350617752011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To study the feasibility of gas-liquid mixing tumescent solution for creating a working space (WS) in endoscopic thyroidectomy (ET). MATERIALS AND METHODS A prospective study was performed on 186 patients with thyroid tumor who had undergone ET via chest and breast approach. Patients were randomly divided into 2 groups to receive traditional tumescent solution as group A and modified tumescent solution (gas-liquid mixing tumescent solution) as group B. This study compares the following surgical outcome parameters between the 2 groups, including changes of blood pressure, heart rate, and oxygen saturation before and after creating a WS, time for creating a WS, operative time, hemorrhage volume for creating a WS, overall hemorrhage volume, overall postoperative drainage volume, postoperative pain score, postoperative hospitalization, number of retrieved lymph nodes, total serum calcium, serum parathyroid hormone, and cases of transient and permanent recurrent laryngeal nerve palsy. RESULTS No postoperative bleeding, permanent recurrent laryngeal nerve palsy, incision and surgical site infection, air embolism, flap injury occurred in both groups. The mean time for creating a WS and the whole operation in group B was significantly shorter than that in group A ( P < .05). There were no statistically significant differences in both groups in terms of other observation index ( P > .05). CONCLUSION The clinical application of gas-liquid mixing tumescent solution can effectively reduce the time for creating a WS and whole operative time, and worthy of being widely used in ET as a safe and effective technique.
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Affiliation(s)
- Li-Yong Zhang
- 1 Fujian Medical University Union Hospital, Fuzhou City, Fujian Province, China
| | - Wen-Xin Zhao
- 1 Fujian Medical University Union Hospital, Fuzhou City, Fujian Province, China
| | - Bo Wang
- 1 Fujian Medical University Union Hospital, Fuzhou City, Fujian Province, China
| | - Shou-Yi Yan
- 1 Fujian Medical University Union Hospital, Fuzhou City, Fujian Province, China
| | - Jia Wen
- 1 Fujian Medical University Union Hospital, Fuzhou City, Fujian Province, China
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Jitpratoom P, Ketwong K, Sasanakietkul T, Anuwong A. Transoral endoscopic thyroidectomy vestibular approach (TOETVA) for Graves' disease: a comparison of surgical results with open thyroidectomy. Gland Surg 2016; 5:546-552. [PMID: 28149798 DOI: 10.21037/gs.2016.11.04] [Citation(s) in RCA: 89] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND Transoral endoscopic thyroidectomy vestibular approach (TOETVA) provides excellent cosmetic results from its potential for scar-free operation. The procedure has been applied successfully for Graves' disease by the authors of this work and compared with the standard open cervical approach to evaluate its safety and outcomes. METHODS From January 2014 to November 2016, a total of 97 patients with Graves' disease were reviewed retrospectively. Open thyroidectomy (OT) and TOETVA were performed in 49 patients and 46 patients, respectively. For TOETVA, a three-port technique through the oral vestibule was utilized. The thyroidectomy was done endoscopically using conventional laparoscopic instruments and an ultrasonic device. Patient demographics and surgical variables, including operative time, blood loss, and complications, were investigated and compared. RESULTS TOETVA was performed successfully in all 45 patients, although conversion to open surgery was deemed necessary in one patient. All patient characteristics for both groups were similar. Operative time was shorter for the OT group compared to the TOETVA group, which totaled 101.97±24.618 and 134.11±31.48 minutes, respectively (P<<0.5). Blood loss was comparable for both groups. The visual analog scale (VAS) pain score for the TOETVA group was significantly lower than for the OT group on day 1 (2.08±1.53 vs. 4.57±1.35), day 2 (0.84±1.12 vs. 2.57±1.08) and day 3 (0.33±0.71 vs. 1.08±1.01) (P<<0.05). Transient recurrent laryngeal nerve (RLN) palsy was found in four and two cases of TOETVA and OT group, respectively. Transient hypocalcemia was found in ten and seven cases of TOETVA and OT group, respectively. No other complications were observed. CONCLUSIONS TOETVA is a feasible and safe treatment for Graves' disease in comparison to the standard open cervical approach. It is considered a viable alternative for patients who have been indicated for surgery with excellent cosmetic results.
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Affiliation(s)
- Pornpeera Jitpratoom
- Minimally Invasive and Endocrine Surgery Division, Department of Surgery, Police General Hospital, Bangkok, Thailand
| | - Khwannara Ketwong
- Minimally Invasive and Endocrine Surgery Division, Department of Surgery, Police General Hospital, Bangkok, Thailand
| | - Thanyawat Sasanakietkul
- Minimally Invasive and Endocrine Surgery Division, Department of Surgery, Police General Hospital, Bangkok, Thailand
| | - Angkoon Anuwong
- Minimally Invasive and Endocrine Surgery Division, Department of Surgery, Police General Hospital, Bangkok, Thailand
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Comparison of Bilateral Axillo-Breast Approach Robotic Thyroidectomy with Open Thyroidectomy for Graves' Disease. World J Surg 2016; 40:498-504. [PMID: 26754077 DOI: 10.1007/s00268-016-3403-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND There is an ongoing debate about whether robotic thyroidectomy (RT) is appropriate for Graves' disease. The aim of this study was to compare the safety of bilateral axillo-breast approach (BABA) RT with that of open thyroidectomy (OT) in patients with Graves' disease. METHODS From January 2008 to June 2014, 189 (44 BABA RT and 145 OT) patients underwent total thyroidectomy for Graves' disease. Recurrence of Graves' disease, intraoperative blood loss, hospital stay, and complication rates including recurrent laryngeal nerve (RLN) palsy and hypoparathyroidism were analyzed between BABA RT and OT groups, after propensity score matching according to age, gender, body mass index, surgical indication, the extent of operation, excised thyroid weight, and follow-up period. RESULTS No patient experienced recurrence of Graves' disease after median follow-up of 35.0 months. Intraoperative blood loss (151.8 ± 165.4 mL vs. 134.5 ± 75.4 mL; p = 0.534) and hospital stay (3.4 ± 0.7 day vs. 3.3 ± 0.7 day; p = 0.564) were not different between BABA RT and OT groups. Complication rates including transient RLN palsy (11.4 vs. 11.4%; p = 1.000), transient hypoparathyroidism (18.2 vs. 20.5%; p = 0.787), permanent RLN palsy (0 vs. 2.3%; p = 0.315), and permanent hypoparathyroidism (2.3 vs. 2.3%; p = 1.000) were also comparable between groups. CONCLUSIONS BABA RT for Graves' disease showed comparable surgical completeness and complications to conventional OT. BABA RT can be recommended as an alternative surgical option for patients with Graves' disease who are concerned about cosmesis.
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Xiang D, Xie L, Li Z, Wang P, Ye M, Zhu M. Endoscopic thyroidectomy along with bilateral central neck dissection (ETBC) increases the risk of transient hypoparathyroidism for patients with thyroid carcinoma. Endocrine 2016; 53:747-53. [PMID: 26886901 DOI: 10.1007/s12020-016-0884-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 02/01/2016] [Indexed: 01/01/2023]
Abstract
Increasing number of patients with thyroid carcinoma, especially young female patients, prefer to choose endoscopic thyroidectomy with bilateral central neck dissection (ETBC) for perfect cosmetic effects. However, the incidence of hypoparathyroidism after ETBC has not been well studied. Ninety six patients with papillary thyroid carcinoma were enrolled. All patients, including 49 ETBC and 47 open surgery patients, underwent total thyroidectomy with bilateral central neck dissection (CND). Some patients also underwent lateral neck dissection simultaneously. The incidence of hypoparathyroidism and parathyroid hormone (PTH) level were examined. Patients in the open surgery group had more advanced lesions, with larger tumor (p = 0.000), older age (p = 0.000), and more serious local involvement. The dissection extent of the open group was significantly larger than that of the ETBC group (p = 0.006). In contrast, the ETBC group with less dissection extent showed a significantly higher incidence of transient hypoparathyroidism than the open group (59.2 vs. 29.6 %, p = 0.004). The average PTH decline of the ETBC group was significantly higher than that of the open group on postoperative day 1 (POD1) (32.1 vs. 21.6 pg/ml, p = 0.010). Furthermore, the ETBC group had a significantly higher portion of patients with a PTH <10 pg/ml on POD1 (p = 0.001). One patient in the ETBC group developed permanent hypoparathyroidism. Autotransplantation and inadvertent removal rates of parathyroid did not differ between the two groups. Although generally considered a safe method for patients with thyroid carcinoma, ETBC may increase the risk of transient hypoparathyroidism compared with conventional open surgery.
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Affiliation(s)
- Dapeng Xiang
- Department of General Surgery, Second Affiliated Hospital School of Medicine, Zhejiang University, No. 88 Jiefang Avenue, Hangzhou, 310009, Zhejiang Province, China
| | - Liangqi Xie
- Department of Molecular and Cellular Biology, UC Berkeley, Berkeley, CA, USA
| | - Zhiyu Li
- Department of General Surgery, Second Affiliated Hospital School of Medicine, Zhejiang University, No. 88 Jiefang Avenue, Hangzhou, 310009, Zhejiang Province, China.
| | - Ping Wang
- Department of General Surgery, Second Affiliated Hospital School of Medicine, Zhejiang University, No. 88 Jiefang Avenue, Hangzhou, 310009, Zhejiang Province, China
| | - Mao Ye
- Department of General Surgery, Second Affiliated Hospital School of Medicine, Zhejiang University, No. 88 Jiefang Avenue, Hangzhou, 310009, Zhejiang Province, China
| | - Mingzhu Zhu
- Department of General Surgery, Second Affiliated Hospital School of Medicine, Zhejiang University, No. 88 Jiefang Avenue, Hangzhou, 310009, Zhejiang Province, China
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The experience of gasless endoscopic-assisted thyroidectomy via the anterior chest approach for Graves' disease. Eur Arch Otorhinolaryngol 2016; 273:3401-6. [PMID: 26965896 DOI: 10.1007/s00405-016-3971-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 03/05/2016] [Indexed: 10/22/2022]
Abstract
The aim of this study was to evaluate the safety, feasibility, effectiveness, and cosmesis of a gasless endoscopic-assisted thyroidectomy via the anterior chest in patients with Graves' disease. We retrospectively reviewed 38 patients with Graves' disease treated with thyroidectomy from November 2007 to June 2015. We analyzed clinical characteristics of patients, type of operation, operative indications, operative duration, length of postoperative hospital stay, and postoperative complications. The thyroidectomies were classified as total thyroidectomy (n = 12) or near-total thyroidectomy with a remnant of <1 g (n = 26). Surgical indications were recurrence after antithyroid drugs (ATDs) and unwillingness to undergo radioiodine therapy (n = 27), local compressive symptoms (n = 2), adverse drug reactions to ATDs (n = 5), and patient's preference (n = 4). Mean resection weight was 71.7 ± 16.2 g (range 44-109 g), mean operative duration 87.7 ± 17.3 min (range 66-136 min), intraoperative blood loss 70.6 ± 11.3 mL (range 43-92 mL), and drainage was 42.0 ± 8.5 mL (range 20-62 mL). Temporary postoperative recurrent laryngeal nerve palsy and temporary hypoparathyroidism occurred in 3 cases (7.89 %) each. Mean hospital stay was 2.5 ± 0.3 days (range 2-4 days). There was no recurrence of hyperthyroidism over the follow-up period of for 68.1 ± 5.6 months (range 6-89 months). All patients were satisfied with their cosmetic results. Gasless endoscopic-assisted thyroidectomy via the anterior chest approach for Graves' disease is a safe, feasible, and effective and provides an excellent cosmetic outcome procedure. It is a valid option in appropriately selected patients.
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Yan H, Wang Y, Wang P, Xie Q, Zhao Q. "Scarless" (in the neck) endoscopic thyroidectomy (SET) with ipsilateral levels II, III, and IV dissection via breast approach for papillary thyroid carcinoma: a preliminary report. Surg Endosc 2014; 29:2158-63. [PMID: 25427410 DOI: 10.1007/s00464-014-3911-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2013] [Accepted: 08/15/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Endoscopic thyroidectomy with level II dissection has previously been reported to be performed endoscopically via various approaches. However, very few reports were available regarding level II dissection performed via the breast approach. In this article, we reported a series of 12 papillary thyroid carcinoma (PTC) patients with scarless (in the neck) endoscopic thyroidectomy (SET) via breast approach to level II dissection and evaluated its feasibility and safety. METHODS Between January 2011 and March 2013, 12 PTC female patients with suspected lymph node metastasis at level II, III, or IV were selected for this procedure. After completing thyroidectomy and central compartment dissection, dissection of ipsilateral levels II, III, and IV was performed. The steps of endoscopic lateral neck dissection were similar to those of conventional surgery except that the lateral cervical compartment was exposed by splitting the sternocleidomastoid muscle (SCM) longitudinally and dividing between the strap muscles and the anterior margin of the SCM. RESULTS This procedure was carried out in all of the 12 patients (Table 1). Mean operative time was 243 min (range 165-355 min). Nine patients (75 %) had lymph node metastasis in the lateral compartment confirmed on the final pathological report. Mean lymph node yield (LNY) in the lateral compartment (including ipsilateral level II, III, and IV dissection) was 21.8 (range 5-42). Five patients (41.6 %) had lymph node metastasis in the ipsilateral level II. The mean LNY in the ipsilateral level II was 6.7 (range 1-14). In 1 of the 12 patients, bleeding from injury to the internal jugular vein in level II was encountered intraoperatively, and a 4-cm upper neck transverse incision was made to stop the bleeding. Average postoperative hospital stay was 5.0 days (range 3-7 days). Table 1 Original article on endoscopic lateral neck dissection (including level II) by other authors Author (Ref.) Year Mean age (years) Tumor size (cm) No. of patients M:F Tech. Type of operation Mean LNY in lateral zone Mean operative time (min) Postoperative bleeding Chyle leakage Mean PHS (days) Wu et al. [13] 2013 43.2 1.88 26 6:20 VAT SLND 8.3 137.7 None None 3.6 Lee et al. [8] 2013 40.2 1.39 62 5:57 Robot MRND 32.8 271.8 None None 6.9 Kang et al. [5] 2012 35.8 1.14 56 10:46 Robot MRND 31.1 277.4 1 5 6 Kang et al. [6] 2011 NA NA 36 NA Robot MRND 27.7 280.91 1 3 NA Kang et al. [4] 2009 NA NA 13 NA AP MRND/SLND 18.8 286 NA NA 5.3 Current article 31.2 1.67 12 0:12 SET SLND 21.8 243 None None 5 Ref. references, No. number, M male, F female, Tech. technique, LNY lymph node yield, PHS postoperative hospital stay, VAT video-assisted thyroidectomy, SLND selective lateral neck dissection, MRND modified radical neck dissection, AP axillary approach, NA not available CONCLUSIONS According to the present SET data, level II dissection by SET was a feasible and safe procedure. With reasonable costs and satisfactory cosmetic results, oncoplastic SET via breast approach might gain wider acceptance in the near future.
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Affiliation(s)
- Haichao Yan
- Department of Thyroid Surgery, Second Affiliated Hospital, Zhejiang University, Hangzhou, 310009, China,
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Endoscopic thyroidectomy via areola approach: summary of 1,250 cases in a single institution. Surg Endosc 2014; 29:192-201. [PMID: 24986013 DOI: 10.1007/s00464-014-3658-8] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2013] [Accepted: 04/20/2014] [Indexed: 10/25/2022]
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Kwon H, Koo DH, Choi JY, Kim E, Lee KE, Youn YK. Bilateral axillo-breast approach robotic thyroidectomy for Graves' disease: an initial experience in a single institute. World J Surg 2014; 37:1576-81. [PMID: 23558759 DOI: 10.1007/s00268-013-2027-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Bilateral axillo-breast approach (BABA) robotic thyroidectomy has shown excellent cosmetic and surgical outcomes. The aim of the present study was to evaluate the safety, feasibility, and initial outcome of this procedure in patients with Graves' disease. METHODS From June 2008 to July 2001, a total of 30 patients with Graves' disease were reviewed retrospectively. Patient demographics, operative indications, and surgical variables, including operative time, blood loss, excised thyroid weight, and complications, were collected and investigated. RESULTS The thyroidectomies were classified as total (n = 21), near-total (n = 6), or subtotal (n = 3). There were five indications for surgery: concomitant thyroid carcinoma or suspicious nodule (n = 22), recurrence after antithyroid medication (n = 2), local compressive symptoms (n = 1), patient's preference (n = 4), and side effects of antithyroid medication (n = 1). The mean operative time, console time, blood loss, and excised thyroid weight were 190 min (range: 105-298 min), 113 min (range: 60-227 min), 229 mL (range: 50-550 mL), and 36.6 g (range: 7.8-123.0 g), respectively. There were no cases of postoperative bleeding or conversions to open surgery. Postoperative transient hypoparathyroidism and vocal cord palsy occurred in 13 (43.3 %) and 4 (13.3 %) cases. Permanent hypoparathyroidism occurred in 1 (3.3 %) case. All patients were satisfied with the cosmetic outcomes. CONCLUSIONS BABA robotic thyroidectomy is a feasible and safe treatment for Graves' disease. It is recommended as an alternative for patients who are concerned by the cosmetic effects of traditional thyroidectomy.
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Affiliation(s)
- Hyungju Kwon
- Department of Surgery, Seoul National University Hospital and College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 110-744, South Korea.
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Noureldine SI, Yao L, Wavekar RR, Mohamed S, Kandil E. Thyroidectomy for Graves' disease: a feasibility study of the robotic transaxillary approach. ORL J Otorhinolaryngol Relat Spec 2014; 75:350-6. [PMID: 24457627 DOI: 10.1159/000354266] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2013] [Accepted: 07/08/2013] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Graves' disease (GD) is considered a relative contraindication for endoscopic approaches to the thyroid gland, due to a larger gland size and increased vascularity. METHODS A retrospective analysis of a single surgeon's experience was performed. We included all patients who underwent thyroidectomy for the treatment of GD over a 3-year period. RESULTS Twenty-five patients with GD were identified. Twelve of them underwent robotic thyroidectomy and 13 patients underwent conventional thyroidectomy. Age, gender, and BMI were similar in both groups (p > 0.05). The conventional approach allowed for resection of larger thyroid volumes (147.3 ± 153.6 ml), as compared to the robotic approach (62.3 ± 47.8 ml, p = 0.08). The average total operative times were similar in both groups (p = 0.98). There was no difference with respect to intraoperative blood loss (p = 0.49), duration of hospital stay (p = 0.38), and complication rates (p = 0.99). CONCLUSION Robotic thyroidectomy is feasible and can be safely performed in appropriately selected patients with GD.
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Affiliation(s)
- Salem I Noureldine
- Division of Endocrine and Oncological Surgery, Department of Surgery, Tulane University School of Medicine, New Orleans, La., USA
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Tsui DKK, Yau KK, Tang CN. Robotic thyroidectomy using the bilateral axillo-breast approach. SURGICAL PRACTICE 2013. [DOI: 10.1111/1744-1633.12020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- David Ka-Kin Tsui
- Department of Surgery; Pamela Youde Nethersole Eastern Hospital; Hong Kong
| | - Kwok-Kay Yau
- Department of Surgery; Pamela Youde Nethersole Eastern Hospital; Hong Kong
| | - Chung-Ngai Tang
- Department of Surgery; Pamela Youde Nethersole Eastern Hospital; Hong Kong
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Chen B, Wang Y, Xuan S, Zhang G, Hu S, Wachtel MS, Frezza EE. Endoscopic Thyroidectomy: The Development in a Chinese Center. J Laparoendosc Adv Surg Tech A 2012; 22:76-80. [PMID: 22044565 DOI: 10.1089/lap.2011.0336] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Bo Chen
- Department of General Surgery, Qilu Hospital of Shandong University, Jinan, China
| | - Yanlei Wang
- Department of General Surgery, Qilu Hospital of Shandong University, Jinan, China
| | - Shijin Xuan
- Department of Thyroid Surgery, Jinan Central Hospital affiliated with Shandong University, Jinan, China
| | - Guangyong Zhang
- Department of General Surgery, Qilu Hospital of Shandong University, Jinan, China
| | - Sanyuan Hu
- Department of General Surgery, Qilu Hospital of Shandong University, Jinan, China
| | - Mitchell S. Wachtel
- Department of Pathology, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Eldo E. Frezza
- Department of General Surgery, Texas Tech University Health Sciences Center, Lubbock, Texas
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Kandil E, Noureldine S, Abdel Khalek M, Alrasheedi S, Aslam R, Friedlander P, Holsinger F, Bellows C. Initial experience using robot- assisted transaxillary thyroidectomy for Graves’ disease. J Visc Surg 2011; 148:e447-51. [DOI: 10.1016/j.jviscsurg.2011.10.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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