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Ding Y, Qiu C, Zhu C, Li Y, Geng X, Lv G, Yan X, Ju F, Wang S, Wu W. Comparison of gasless transaxillary endoscopic thyroidectomy, endoscopic thyroidectomy via areola approach and conventional open thyroidectomy in patients with unilateral papillary thyroid carcinoma. World J Surg Oncol 2024; 22:148. [PMID: 38840176 PMCID: PMC11151600 DOI: 10.1186/s12957-024-03433-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 06/01/2024] [Indexed: 06/07/2024] Open
Abstract
BACKGROUND Gasless transaxillary endoscopic thyroidectomy (GTET) and endoscopic thyroidectomy via the areola approach (ETA) have emerged as minimally invasive surgical techniques for managing papillary thyroid carcinoma (PTC). This study aimed to assess the surgical efficacy of endoscopic thyroidectomy (ET) as compared to conventional open thyroidectomy (COT) in PTC patients. METHODS Between 2020 and 2022, 571 PTC patients underwent unilateral thyroidectomy accompanied by ipsilateral central lymph node dissection. This cohort comprised 72 patients who underwent GTET, 105 ETA, and 394 COT. The analysis encompassed a comprehensive examination of patient clinicopathologic characteristics and postoperative complaints. Furthermore, the learning curve of GTET was evaluated using the cumulative summation (CUSUM) method. RESULTS Patients in the ET group exhibited a lower mean age and a higher proportion of female individuals. Operation time in the ET group was significantly longer. No significant differences were observed in the incidence of postoperative complications among the three groups. With regard to postoperative complaints reported three months after surgery, GTET demonstrated superior alleviation of anterior chest discomfort and swallowing difficulties. Patients who underwent ET reported significantly higher cosmetic satisfaction levels. Additionally, the learning curve of GTET was 27 cases, and the operation time during the mature phase of the learning curve exhibited a significant reduction when compared to ETA. CONCLUSIONS The findings of this study affirm the safety and feasibility of employing GTET and ETA for the surgical management of PTC. GTET presents an attractive surgical option, particularly for patients with unilateral PTC who place a premium on cosmetic outcomes.
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Affiliation(s)
- Yu Ding
- Department of Thyroid Surgery, The Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University, Changzhou Jiangsu, 213000, China
| | - Chenjie Qiu
- Department of General Surgery, Changzhou Hospital of Traditional Chinese Medicine, Changzhou Jiangsu, 213000, China
| | - Chunfu Zhu
- Department of Thyroid Surgery, The Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University, Changzhou Jiangsu, 213000, China
| | - Yuan Li
- Department of Thyroid Surgery, The Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University, Changzhou Jiangsu, 213000, China
| | - Xiang Geng
- Department of Thyroid Surgery, The Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University, Changzhou Jiangsu, 213000, China
| | - Guojun Lv
- Department of Thyroid Surgery, The Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University, Changzhou Jiangsu, 213000, China
| | - Xiaoyi Yan
- Department of Thyroid Surgery, The Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University, Changzhou Jiangsu, 213000, China
| | - Feng Ju
- Department of Thyroid Surgery, The Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University, Changzhou Jiangsu, 213000, China
| | - Shijia Wang
- Department of Thyroid Surgery, The Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University, Changzhou Jiangsu, 213000, China
| | - Wenze Wu
- Department of Thyroid Surgery, The Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University, Changzhou Jiangsu, 213000, China.
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Huo J, Xu Y, Yu J, Guo Y, Hu X, Ou D, Qu R, Zhao L. Endoscopic thyroidectomy via areola approach for stage T1 papillary thyroid carcinoma: feasibility, safety, and oncologic outcomes. Front Endocrinol (Lausanne) 2023; 14:1212490. [PMID: 38075056 PMCID: PMC10702212 DOI: 10.3389/fendo.2023.1212490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 11/08/2023] [Indexed: 12/18/2023] Open
Abstract
Purpose To evaluate the feasibility, safety, and oncologic outcomes associated with endoscopic thyroidectomy via the areolar approach (ETAA), compared with conventional open thyroidectomy (COT) for the treatment of stage T1 papillary thyroid carcinoma (PTC). Methods Between January 2021 and June 2022, a total of 1204 patients diagnosed with PTC underwent screening, out of which 138 patients were selected for inclusion in the study population after propensity score matching (92 patients in the ETAA group and 46 patients in the COT group). The study included the collection and analysis of clinicopathologic characteristics, intraoperative outcomes, postoperative outcomes, complications, and follow-up data using R software. Results The operative time for the ETAA group was longer than that for the COT group (160.42 ± 32.21 min vs. 121.93 ± 29.78 min, p < 0.0001). However, there were no significant differences between the two groups in terms of intraoperative blood loss, the extent of surgical resection, the number of dissected lymph nodes, the number of metastatic lymph nodes, and the rate of parathyroid autotransplantation. Postoperative drainage and C-reactive protein levels were higher in the ETAA group than in the COT group, but there were no significant differences in 24-hour visual analogue scale scores, white blood cell counts, drainage duration, or postoperative hospital stay. Complication rates were similar between the two groups, and no permanent recurrent laryngeal nerve palsy or hypoparathyroidism was observed. Patients who underwent ETAA reported greater cosmetic satisfaction and quality of life than those who underwent COT. During the follow-up phase, only one patient in the COT group developed lateral cervical lymph node involvement requiring reoperation. Conclusion ETAA is a safe and feasible surgical method for patients with stage T1 PTC, providing results similar to COT in terms of oncologic completeness, while avoiding neck scars, with excellent cosmetic effects. Clinical trial registration Chinese Clinical Trial Registry center, identifier ChiCTR2300077109.
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Affiliation(s)
- Jinlong Huo
- Department of General Surgery, Digestive Disease Hospital, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
- Department of Breast and Thyroid Surgery, The Third Affiliated Hospital of Zunyi Medical University (The First People’s Hospital of Zunyi), Zunyi, Guizhou, China
| | - Yaxuan Xu
- Department of General Surgery, Digestive Disease Hospital, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
| | - Jie Yu
- Department of General Surgery, Digestive Disease Hospital, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
| | - Youming Guo
- Department of Breast and Thyroid Surgery, The Third Affiliated Hospital of Zunyi Medical University (The First People’s Hospital of Zunyi), Zunyi, Guizhou, China
| | - Xiaochi Hu
- Department of Breast and Thyroid Surgery, The Third Affiliated Hospital of Zunyi Medical University (The First People’s Hospital of Zunyi), Zunyi, Guizhou, China
| | - Dong Ou
- Department of Oncology, The Third Affiliated Hospital of Zunyi Medical University (The First People’s Hospital of Zunyi), Zunyi, Guizhou, China
| | - Rui Qu
- Department of Breast and Thyroid Surgery, The Third Affiliated Hospital of Zunyi Medical University (The First People’s Hospital of Zunyi), Zunyi, Guizhou, China
| | - Lijin Zhao
- Department of General Surgery, Digestive Disease Hospital, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
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Ruan J, Dai B, Zhao JG, Tao L, He F. The usefulness and utilization of Gold-finger retractor for endoscopic thyroid surgery. Front Endocrinol (Lausanne) 2023; 14:1228657. [PMID: 37795372 PMCID: PMC10546332 DOI: 10.3389/fendo.2023.1228657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 09/04/2023] [Indexed: 10/06/2023] Open
Abstract
Aims In endoscopic surgery, the visual field is frequently obstructed by muscles, blood, and even smoke. To overcome this problem, we have developed a new detachable Gold-finger retractor for narrow-space surgery. Methods Gold-finger retractor was used in 30 patients to facilitate surgical field exposure and smoke discharge, while in 27 patients, percutaneous silk thread suspension was employed for the same purpose. Both groups underwent endoscopic unilateral thyroidectomy and unilateral central lymph node dissection via oral vestibular microincision combined with the axillary-assisted approach. A comparative analysis was conducted to evaluate the efficacy of the Gold-finger retractor and silk thread suspension in relation to intraoperative exposure effect, surgical fluency, surgeon's comfort, operation time, postoperative complications, and length of hospital stay. This analysis was based on surgical video recordings and postoperative indicators. Results With Gold-finger retractor support, surgeons were able to perform meticulous operations. Complication rates were similar between the two groups, and no serious complications occurred. The number of lymph nodes dissected in the Gold-finger group was significantly greater than that in the routine group (12.43 ± 6.18 and 5.7 ± 2.95, respectively). Further analysis of surgeons' comfort (visibility and convenience in peeling) revealed that the Gold-finger group was significantly better. Electrosurgery smoke was removed effectively with Gold-finger, and the operation time was significantly reduced. Conclusion In thyroid surgery, Gold-fingers enhance visual field resolution, avoid muscle cutting, save time, and improve the surgical experience.
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Affiliation(s)
- Jian Ruan
- Department of Thyroid and Breast Surgery, Wuhan No. 1 Hospital, Wuhan, China
| | - Bin Dai
- Department of Hepatobiliary Surgery, Wuhan No. 1 Hospital, Wuhan, China
| | - Jian Guo Zhao
- Department of Thyroid and Breast Surgery, Wuhan No. 1 Hospital, Wuhan, China
| | - Long Tao
- Department of Thyroid and Breast Surgery, Wuhan No. 1 Hospital, Wuhan, China
| | - Fan He
- Department of Thyroid and Breast Surgery, Wuhan No. 1 Hospital, Wuhan, China
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Li P, Fang Y, Ye B, Jin R, Wang X. The necessity of resection of suprasternal fossa fat in total endoscopic thyroidectomy via the areola approach. Updates Surg 2023:10.1007/s13304-023-01516-5. [PMID: 37097598 DOI: 10.1007/s13304-023-01516-5] [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: 01/31/2023] [Accepted: 04/17/2023] [Indexed: 04/26/2023]
Abstract
The identification of a lower boundary for the central lymph node (CLN) of the neck in total endoscopic thyroidectomy via the areola approach (ETA) is important for its radical dissection. We found that resection of the suprasternal fossa fat (SFF) was beneficial for exposing the lower boundary and preventing suprasternal swelling after the operation. This retrospective analysis included 470 papillary thyroid carcinoma (PTC) cases, with some treated by unilateral lobectomy, some by central lymph node dissection (CLND) through ETA (n = 193), and the others by conventional open thyroidectomy (COT, n = 277). The main observation indicators included the total number of CLNs, CLND operative time, visualization of the upper pole of the thymus before removing the CLN, and postoperative suprasternal swelling. The SFF retention group and COT group had a similar percentage of women (78.65% vs. 79.42%, P = 0.876) lower than that in the SFF resection group (95.19%, P < 0.001). The percentage of the visualized upper pole of the thymus before CLN removal was notably higher in the SFF resection group than that in the SFF retention group (63.46 vs. 29.21%, P < 0.001) but notably lower than that in the COT group (63.46% vs. 100%, P < 0.001). A total of 43.82% and 23.1% of patients in the SFF retention and COT groups showed suprasternal swelling, respectively. No patient exhibited such swelling in the SFF resection group (23.1% vs. 0, P < 0.001). Resection of SFF in ETA easily identified the lower boundary for CLND and prevented suprasternal fossa swelling.
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Affiliation(s)
- Ping Li
- Department of Maxillofacial and Ear, Nose and Throat Oncology, Tianjin Medical University Cancer Institute and Hospital, Tianjin, People's Republic of China.
- National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Tianjin, People's Republic of China.
- Key Laboratory of Cancer Prevention and Therapy, Tianjin, People's Republic of China.
| | - Yan Fang
- Department of Maxillofacial and Ear, Nose and Throat Oncology, Tianjin Medical University Cancer Institute and Hospital, Tianjin, People's Republic of China
- National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Tianjin, People's Republic of China
- Key Laboratory of Cancer Prevention and Therapy, Tianjin, People's Republic of China
| | - Beibei Ye
- Department of Maxillofacial and Ear, Nose and Throat Oncology, Tianjin Medical University Cancer Institute and Hospital, Tianjin, People's Republic of China
- National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Tianjin, People's Republic of China
- Key Laboratory of Cancer Prevention and Therapy, Tianjin, People's Republic of China
| | - Rui Jin
- Department of Maxillofacial and Ear, Nose and Throat Oncology, Tianjin Medical University Cancer Institute and Hospital, Tianjin, People's Republic of China
- National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Tianjin, People's Republic of China
- Key Laboratory of Cancer Prevention and Therapy, Tianjin, People's Republic of China
| | - Xudong Wang
- Department of Maxillofacial and Ear, Nose and Throat Oncology, Tianjin Medical University Cancer Institute and Hospital, Tianjin, People's Republic of China.
- National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Tianjin, People's Republic of China.
- Key Laboratory of Cancer Prevention and Therapy, Tianjin, People's Republic of China.
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Guan B, Chen Y, Wu Z, Chong TH, Ming WK, Wang C, Huang S, Lee WJ, Yang J. Combined Laparoscopic Bariatric Surgery and Thyroidectomy: A Proof-of-Concept Study. Bariatr Surg Pract Patient Care 2023. [DOI: 10.1089/bari.2022.0045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023] Open
Affiliation(s)
- Bingsheng Guan
- Department of Gastrointestinal Surgery, First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Yanya Chen
- Department of Basic Nursing, School of Nursing, Jinan University, Guangzhou, China
- Department of Infectious Diseases and Public Health, Jockey Club College of Veterinary Medicine and Life Sciences, City University of Hong Kong, China
| | - Zhenpeng Wu
- Department of Gastrointestinal Surgery, First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Tsz Hong Chong
- Department of Thyroid Surgery, First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Wai-kit Ming
- Department of Infectious Diseases and Public Health, Jockey Club College of Veterinary Medicine and Life Sciences, City University of Hong Kong, China
| | - Cunchuan Wang
- Department of Gastrointestinal Surgery, First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Shifang Huang
- Department of Intensive Care Unit, First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Wei-Jei Lee
- Department of Surgery, Min-Sheng General Hospital, Taoyuan, Taiwan, China
| | - Jingge Yang
- Department of Gastrointestinal Surgery, First Affiliated Hospital of Jinan University, Guangzhou, China
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Li P, Qin H, Jin R, Zheng W, Fan P, Lyu PF. The global status and hotspots of research in the field of trans-oral endoscopic thyroidectomy (TOET) from 2008 to 2022. Front Surg 2023; 10:1120442. [PMID: 37181597 PMCID: PMC10174433 DOI: 10.3389/fsurg.2023.1120442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Accepted: 03/20/2023] [Indexed: 05/16/2023] Open
Abstract
Purpose In this study, the aim was to comprehensively analyze the current status, hotspots, and trends of trans-oral endoscopic thyroidectomy (TOET) through bibliometric analysis and by presenting the field atlas. Methods Web of Science Core Collection database was adopted to screen studies regarding TOET published between January 1, 2008 and August 1, 2022. The evaluation covered the criteria total number of studies, keywords, and contributions from countries/regions, institutions, journals, and authors. Results A total of 229 studies were covered. SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES is the largest publication in the field of TOET. The three countries that contributed the most studies were Korea, China, and the USA. The most frequently occurring core keywords in the field of TOET are vestibular approach, outcomes, experience, safety, robotic thyroidectomy, scar, video-assisted thyroidectomy and quality-of-life. The seven clusters were generated in this study: intraoperative monitoring of the laryngeal return nerve (# 0), learning curve (# 1), postoperative quality of life (# 2), central lymph node dissection and safety (# 3), complications (# 4), minimally invasive surgery (# 5), and robotic surgery (# 6). Conclusion The main research topics in the field of TOET place focuses on learning curves, laryngeal nerve monitoring, carbon dioxide gas bolus, chin nerve injury, surgical complications, and surgical safety. In the future, more academics will focus on the safety of the procedure and reducing complications..
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Affiliation(s)
- Ping Li
- Department of Maxillofacial and Ear, Nose and Throat Oncology, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
- National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Tianjin, China
- Key Laboratory of Cancer Prevention and Therapy, Tianjin, China
| | - Hao Qin
- Department of Breast Surgery, The First Affiliated Hospital of Hainan Medical University, Haikou, China
| | - Rui Jin
- Department of Maxillofacial and Ear, Nose and Throat Oncology, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
- National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Tianjin, China
- Key Laboratory of Cancer Prevention and Therapy, Tianjin, China
| | - Wuping Zheng
- Department of Thyroid and Breast Surgery, The Second Affiliated Hospital of Hainan Medical University, Haikou, China
- Correspondence: Peng-fei Lyu Pingming Fan Wuping Zheng
| | - Pingming Fan
- Department of Breast Surgery, The First Affiliated Hospital of Hainan Medical University, Haikou, China
- Correspondence: Peng-fei Lyu Pingming Fan Wuping Zheng
| | - Peng-fei Lyu
- Department of Breast Surgery, The First Affiliated Hospital of Hainan Medical University, Haikou, China
- Correspondence: Peng-fei Lyu Pingming Fan Wuping Zheng
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Moreno Llorente P, Pascua-Solé M, García Barrasa A, Francos Martínez JM, Muñoz de Nova JL, Fernández Ranvier G, Vidal Fortuny J. Transoral endoscopic thyroidectomy vestibular approach: Results after 53 first cases. Cir Esp 2023; 101:35-42. [PMID: 35896141 DOI: 10.1016/j.cireng.2022.07.010] [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: 09/14/2021] [Accepted: 10/21/2021] [Indexed: 01/17/2023]
Abstract
INTRODUCTION Trans Oral Endoscopic Thyroidectomy through Vestibular Approach (TOETVA) allows access to the thyroid with the best cosmetic results as there are no visible scars. METHODS Here we present a prospective observational study of 53 patients which underwent TOETVA from July 2017 to June 2021. RESULTS Fifty-two cases (98.1%) cases 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 (CND) were also associated. The median surgical time for port placement was 14 min and for lobectomy, total thyroidectomy and left CND were 80, 140 and 30 min, respectively. The median of hospital stay was 2 days. Dysphonia was present in 4 patients; 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. CONCLUSTIONS 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.
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Affiliation(s)
- Pablo Moreno Llorente
- Unidad de Cirugía Endocrina, Hospital Universitari de Bellvitge, Universidad de Barcelona (UB), L'Hospitalet de Llobregat, Barcelona, Spain.
| | - Mireia Pascua-Solé
- Unidad de Cirugía Endocrina, Hospital Universitari de Bellvitge, Universidad de Barcelona (UB), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Arantxa García Barrasa
- Unidad de Cirugía Endocrina, Hospital Universitari de Bellvitge, Universidad de Barcelona (UB), L'Hospitalet de Llobregat, Barcelona, Spain
| | - José Manuel Francos Martínez
- Unidad de Cirugía Endocrina, Hospital Universitari de Bellvitge, Universidad de Barcelona (UB), L'Hospitalet de Llobregat, Barcelona, Spain
| | - José Luis Muñoz de Nova
- Unidad de Cirugía Endocrina, Mama y Pared Abdominal, Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario de La Princesa, Madrid, Spain
| | | | - Jordi Vidal Fortuny
- Swiss Medical Network, Genolier, Switzerland; Grupo Hirslanden, Lausanne, Switzerland
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Li Y, Liu Z, Song Z, Wang Y, Yu X, Wang P. Comparison of the endoscopic thyroidectomy via areola approach and open thyroidectomy: A propensity score matched cohort study of 302 patients in the treatment of papillary thyroid non-microcarcinoma. Front Oncol 2023; 13:1081835. [PMID: 36925920 PMCID: PMC10012860 DOI: 10.3389/fonc.2023.1081835] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 02/13/2023] [Indexed: 03/04/2023] Open
Abstract
Background The endoscopic thyroidectomy via areola approach (ETAA) is widely used in patients with benign thyroid tumors and papillary thyroid microcarcinoma (PTMC). Its safety and complication rates are reported to be similar to open thyroidectomy (OT). This study aimed to evaluate the safety and feasibility of ETAA, compared with OT, in patients with papillary thyroid non-microcarcinoma (PTNMC). Methods We retrospectively reviewed all patients with PTNMC who underwent ETAA or OT in our hospital from January 2017 to December 2021. A total of 302 patients were matched at a ratio of 1:1 by the propensity score matching (PSM) analysis and surgical outcomes. Safety and feasibility were analyzed between two groups. Results Before PSM, patients in the ETAA group were younger (p < 0.001) and had a larger proportion of female patients (p < 0.001) with a lower BMI (p < 0.001) compared with the OT group. The ETAA group also had a higher proportion of unilateral thyroidectomy (p = 0.002). PSM was used to create a highly comparable control group. After PSM, the ETAA group had a longer operative time (p < 0.001), larger blood loss (p = 0.046) and total drainage amount (p = 0.035), with higher C-reactive protein (p = 0.023) and better cosmetic outcomes (p < 0.001). There were no significant differences in the following clinicopathologic characteristics: number of dissected positive lymph nodes, rate of recurrent laryngeal nerve signal weakened, parathyroid autotransplantation, postoperative pain, hospital stay, complications, and oncologic completeness. There was no patient converted to OT in the ETAA group and two patients suffered from persistence/recurrence in the follow-up. Conclusion ETAA is a safe and feasible surgical approach for patients with PTNMC.
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Affiliation(s)
- Yujun Li
- Department of Thyroid Surgery, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, Zhejiang, China
| | - Zhaodi Liu
- Department of Thyroid Surgery, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, Zhejiang, China
| | - Zhuolin Song
- Department of Thyroid Surgery, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, Zhejiang, China
| | - Yong Wang
- Department of Thyroid Surgery, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, Zhejiang, China
| | - Xing Yu
- Department of Thyroid Surgery, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, Zhejiang, China
| | - Ping Wang
- Department of Thyroid Surgery, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, Zhejiang, China
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Yuan Y, Sun C, Yin T, Shao C, Pan B, Lu D, Hou S, Lowe S, Bentley R, Chen S, Huang C, Cheng C, Li Y, King B, Zhou Q, Yan C, Zhang F. Comparison of endoscopic thyroidectomy by complete areola approach and conventional open surgery in the treatment of differentiated thyroid carcinoma: A retrospective study and meta-analysis. Front Surg 2022; 9:1000011. [PMID: 36605164 PMCID: PMC9807756 DOI: 10.3389/fsurg.2022.1000011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 12/05/2022] [Indexed: 12/24/2022] Open
Abstract
Background The feasibility of endoscopic thyroidectomy by complete areola approach (ETCA) remains controversial. This study was conducted by combining our clinical data with the data obtained from a systematic review literature search to examine the effectiveness and safety of ETCA compared with conventional open thyroidectomy (COT) in differentiated thyroid carcinoma (DTC). Methods A total of 136 patients with a diagnosis of DTC who underwent unilateral thyroidectomy with central neck dissection from August 2020 to June 2021 were enrolled. The enrolled patients were divided into the ETCA group (n = 73) and the COT group (n = 63). The operative time, intraoperative bleeding volume, number of removed lymph nodes, number of metastatic lymph nodes, postoperative drainage volume, length of postoperative hospital stay, postoperative parathyroid hormone (PTH) levels, and complications were analyzed. Then, a systemic review and comprehensive literature search were conducted by using PubMed, Google Scholar, Embase, Web of Science, CNKI, Wanfang, and VIP database up to June 2022. Review Manager software version 5.3 was used for the meta-analysis. Results The results of clinical data showed that there were significant differences between the two groups in the operative time, intraoperative bleeding volume, removed lymph nodes, and postoperative drainage volume. There were no statistical differences in the length of postoperative hospital stay, number of metastatic lymph nodes, postoperative PTH level, and complications. In the systematic review and meta-analysis, 2,153 patients from fourteen studies (including our data) were ultimately included. The results of the meta-analysis found that ETCA had a longer operative time, larger postoperative drainage volume, and lower intraoperative bleeding volume. In terms of the length of postoperative hospital stay, the number of removed lymph nodes, and surgical complications, there was no significant difference between the two groups. Conclusion ETCA poses lower surgical bleeding and better cosmetic appearance compared with COT, while the length of operation and postoperative drainage in ETCA is less favorable compared with COT. In addition, ETCA is not inferior to COT in terms of the postoperative hospitalization stay, the number of removed lymph nodes, and surgical complications. Given its overall advantages and risks, ETCA is an effective and safe alternative for patients with cosmetic concerns.
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Affiliation(s)
- Yuquan Yuan
- Department of Breast and Thyroid Surgery, Chongqing General Hospital, Chongqing, China,Graduate School of Medicine, Chongqing Medical University, Chongqing, China
| | - Chenyu Sun
- Department of Medicine, AMITA Health Saint Joseph Hospital Chicago, Chicago, IL, United States
| | - Tingjie Yin
- Department of Breast and Thyroid Surgery, Chongqing General Hospital, Chongqing, China
| | - Cong Shao
- Department of Breast and Thyroid Surgery, Chongqing General Hospital, Chongqing, China
| | - Bin Pan
- Department of Breast and Thyroid Surgery, Chongqing General Hospital, Chongqing, China,Graduate School of Medicine, Chongqing Medical University, Chongqing, China
| | - Dengwei Lu
- Department of Breast and Thyroid Surgery, Chongqing General Hospital, Chongqing, China,Graduate School of Medicine, Chongqing Medical University, Chongqing, China
| | - Shaodong Hou
- Department of Breast and Thyroid Surgery, Chongqing General Hospital, Chongqing, China,Graduate School of Medicine, North Sichuan Medical College, Nanchong, China
| | - Scott Lowe
- College of Osteopathic Medicine, Kansas City University, Kansas, MO, United States
| | - Rachel Bentley
- College of Osteopathic Medicine, Kansas City University, Kansas, MO, United States
| | - Shuya Chen
- Foundation Program, Newham University Hospital, London, England, United Kingdom
| | - Christy Huang
- California Health Sciences University College of Osteopathic Medicine, Clovis, CA, United States
| | - Ce Cheng
- Hematology and Medical Oncology, St. Joseph Mercy Ann Arbor Hospital, Ypsilanti, MI, United States
| | - Yaru Li
- Internal Medicine, Swedish Hospital, Chicago, IL, United States
| | - Bethany King
- Internal Medicine, Mercy One Des Moines Medical Center, Des Moines, IA, United States
| | - Qin Zhou
- Radiation Oncology, Mayo Clinic, Rochester, MN, United States
| | - Cunye Yan
- Department of Breast and Thyroid Surgery, Chongqing General Hospital, Chongqing, China,Correspondence: Cunye Yan Fan Zhang
| | - Fan Zhang
- Department of Breast and Thyroid Surgery, Chongqing General Hospital, Chongqing, China,Graduate School of Medicine, Chongqing Medical University, Chongqing, China,Correspondence: Cunye Yan Fan Zhang
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Wang Y, Fu Y, Wu G, Luo Y, Yan C, Fu J, Lin S. Initial Experience With Transoral Endoscopic Thyroidectomy via the Submental and Vestibular Approach for the Treatment of Thyroid Cancer: A Retrospective Cohort Study. Front Surg 2022; 9:882150. [PMID: 35937595 PMCID: PMC9346076 DOI: 10.3389/fsurg.2022.882150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 05/16/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundTransoral endoscopic thyroidectomy vestibular approach is feasible and safe but has some unavoidable limitations, such as sensory changes in the center of the chin region. We aim to report our initial experience in performing transoral endoscopic thyroidectomy via the submental and vestibular approach for the treatment of thyroid cancer.Patients and MethodsThis retrospective cohort study included patients with thyroid cancer confirmed by fine-needle aspiration who underwent endoscopic thyroidectomy and central lymph node dissection via the submental and vestibular approaches between November 2019 and January 2020. Patients’ clinicopathological characteristics, operation details, and postoperative complications were analyzed.ResultsFifteen surgeries were performed successfully. The mean ± standard deviation age of the patients was 37 ± 10.8 years, the average duration of surgery was 146.5 ± 34.6 min, and the median intraoperative blood loss was 11.1 ± 6.3 mL. None of the surgeries were converted to open thyroidectomy. According to postoperative pathology, all cases involved papillary thyroid carcinoma or papillary thyroid microcarcinoma. One patient developed transient recurrent laryngeal nerve paralysis. No patient developed skin numbness at the center of the chin region.ConclusionsTransoral endoscopic thyroidectomy via the submental and vestibular approach is effective and safe in patients with thyroid cancer and does not lead to skin numbness at the center of the chin region. This technique is beneficial for surgeons less experienced in performing transoral thyroid surgery as it involves using a short and direct route to the thyroid gland, which can reduce the difficulty in establishing the first operative space to some extent.
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Affiliation(s)
- Yuanyuan Wang
- Department of Thyroid Surgery, Zhengzhou University First Affiliated Hospital, Zhengzhou, China
| | - Yilong Fu
- Department of General Surgery, Zhongshan Hospital, Xiamen University, Xiamen, China
| | - Guoyang Wu
- Department of General Surgery, Zhongshan Hospital, Xiamen University, Xiamen, China
- Correspondence: Guoyang Wu
| | - Yezhe Luo
- Department of General Surgery, Zhongshan Hospital, Xiamen University, Xiamen, China
| | - Chaolong Yan
- Department of General Surgery, Zhongshan Hospital, Xiamen University, Xiamen, China
| | - Jinbo Fu
- Department of General Surgery, Zhongshan Hospital, Xiamen University, Xiamen, China
| | - Suqiong Lin
- Department of General Surgery, Zhongshan Hospital, Xiamen University, Xiamen, China
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11
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Sun P, Zhan J, Chong TH, Li J, Wang C. Endoscopic central lymph node dissection of thyroid cancer via chest-breast approach: results, indications, and strategies. Surg Endosc 2022; 36:4239-4247. [PMID: 35169879 DOI: 10.1007/s00464-021-08758-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 09/27/2021] [Indexed: 01/29/2023]
Abstract
BACKGROUND Surgery for thyroid cancer via endoscopic approach was still controversial. Herein, we report the indications, strategies for operative techniques, as well as results for endoscopic central lymph node dissection of thyroid cancer via chest-breast approach (ETCB-CLND). METHODS A retrospective analysis was conducted on the cases of DTC, whom underwent ETCB-CLND from January 2013 to June 2020. Three hundred and twenty-three cases underwent ETCB-CLND (endoscopic group) and 267 cases underwent open surgery (open group). General characteristic, surgical results, thyroglobulin (Tg), radioactive iodine uptake (RAIU), radioactive technetium uptake (RATU), radionuclide imaging of the thyroid residual area (RITRA), and radionuclide imaging of suspicious lymph nodes metastasis (RISLNM) were analyzed and compared between the two groups. RESULTS The age of the endoscopic group were lower than that of the open group. The operation time of lobectomy in endoscopic group were longer than that in open group. The gender distribution (P = 0.831), operation time of total thyroidectomy (P = 0.311), intraoperative blood loss (P = 0.672), postoperative hospital stay (P = 0.852), tumor size (P = 0.259), number of cases of lymph node metastasis (P = 0.618), number of dissected lymph nodes (P = 0.681), number of metastatic lymph nodes (P = 0.723), and complications (P = 0.749) did not differ significantly between groups, nor did the surgical range (P = 0.661), Tg at 1 month (P = 0.61) and 1 year (P = 0.67) after surgery, before (P = 0.589) and after (P = 0.593) radioiodine therapy, RAIU-2 h/24 h (P = 0.906/0.582), RATU (P = 0.532), (99mTc 15 min:P = 0.503; 131I 24 h:P = 0.377; 131I 3d:P = 0.919), RISLNM (none: P = 0.887; central: P = 0.630; lateral: P = 0.659). CONCLUSION The rational and normative application of the endoscopic technique in central lymph node dissection of DTC is safe, feasible, and consistent with the principle of radical tumor cure for selected cases by well-trained surgeons.
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Affiliation(s)
- Peng Sun
- Department of Thyroid Surgery, Jinan University First Affiliated Hospital, No. 613 Huangpu Road West, Guangzhou, Guangdong, People's Republic of China.
| | - Jialin Zhan
- Department of Dermatology and STD, Jinan University First Affiliated Hospital, Guangzhou, China
| | - Tsz Hong Chong
- Department of Thyroid Surgery, Jinan University First Affiliated Hospital, No. 613 Huangpu Road West, Guangzhou, Guangdong, People's Republic of China
| | - Jinyi Li
- Department of Thyroid Surgery, Jinan University First Affiliated Hospital, No. 613 Huangpu Road West, Guangzhou, Guangdong, People's Republic of China.
| | - Cunchuan Wang
- Department of General Surgery, Jinan University First Affiliated Hospital, Guangzhou, China
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Vardaxi C, Tsetsos N, Koliastasi A, Poutoglidis A, Sapalidis K, Triaridis S, Printza A. Swallowing disorders after thyroidectomy: a systematic review and meta-analysis. Eur Arch Otorhinolaryngol 2022; 279:4213-4227. [PMID: 35438344 DOI: 10.1007/s00405-022-07386-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 04/01/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE Swallowing disorders following thyroidectomy are common, even after surgery without confirmed complications. The purpose of the current systematic review is to investigate the prevalence of dysphagia at various time points after thyroidectomy, at the whole spectrum of it (total/partial, open/endoscopic, for benign/malignant disease). METHODS The literature available at PubMed, SciELO and Cochrane Library databases was reviewed, according to PRISMA guidelines, using the terms "dysphagia", "swallowing disorder", "deglutition disorder", "thyroidectomy" and "thyroid surgery" in the appropriate combinations. A quantitative synthesis of the results followed. RESULTS The systematic review of the literature resulted in 35 articles, which met the inclusion criteria and were analyzed regarding their type, sample, follow-up and results regarding post-thyroidectomy dysphagia in multiple follow-up times. A significant increase of swallowing impairment compared to baseline was recorded shortly after surgery. Dysphagia reverted to pre-operative levels 2-3 months later. Dysphagia continued to be reported in a significantly lower proportion of patients, even 1 year after surgery. No significant difference was noticed between open and endoscopic thyroid surgery at 2-3 months post-surgery. CONCLUSIONS The swallowing disorders reported after thyroidectomy should be expected, but are not always detectable through objective methods. This should not lead to underestimation of symptoms, since the patients' quality of life is negatively affected by the symptomatology.
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Affiliation(s)
- Chrysoula Vardaxi
- 1st Department of Otorhinolaryngology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54124, Thessaloniki, Greece
- Department of Otorhinolaryngology, "G. Papanikolaou" General Hospital, 57010, Thessaloniki, Greece
| | - Nikolaos Tsetsos
- Department of Otorhinolaryngology, "G. Papanikolaou" General Hospital, 57010, Thessaloniki, Greece
| | - Aikaterini Koliastasi
- Department of Food Science and Technology, International Hellenic University, Sindos Campus, 57400, Thessaloniki, Greece
| | - Alexandros Poutoglidis
- Department of Otorhinolaryngology, "G. Papanikolaou" General Hospital, 57010, Thessaloniki, Greece
| | - Konstantinos Sapalidis
- 3rd Department of Surgery, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54124, Thessaloniki, Greece
| | - Stefanos Triaridis
- 1st Department of Otorhinolaryngology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54124, Thessaloniki, Greece
| | - Athanasia Printza
- 1st Department of Otorhinolaryngology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54124, Thessaloniki, Greece.
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13
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Wang A, Fu W, Deng Y, He L, Zhang W. False-Positive 131I Uptake After Transareola Endoscopic Thyroidectomy in a Patient With Papillary Thyroid Carcinoma. Clin Nucl Med 2022; 47:324-325. [PMID: 35025806 DOI: 10.1097/rlu.0000000000004019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT False-positive 131I accumulation in patients with thyroid carcinoma could be due to various etiologies. Herein, we reported a case of papillary thyroid carcinoma in a 36-year-old woman. She underwent a 131I radiotherapy after a transareola endoscopic total thyroidectomy. 131I scintigraphy showed a high uptake in the thyroid bed. Surprisingly, increased activity was also noted in the right areola area. This activity corresponding to the entry site of endoscope revealed on the following SPECT/CT.
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Affiliation(s)
| | - Wenhui Fu
- Department of Nuclear Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou
| | - Ying Deng
- Department of Nuclear Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou
| | - Limeng He
- Department of Nuclear Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou
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Chen Y, Wang C, Bai B, Ye M, Ma J, Zhang J, Li Z. Drainage Tube Placement May Not Be Necessary During Endoscopic Thyroidectomy Bilateral Areola Approach: A Preliminary Report. Front Surg 2022; 9:860130. [PMID: 35356502 PMCID: PMC8960029 DOI: 10.3389/fsurg.2022.860130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 02/15/2022] [Indexed: 01/19/2023] Open
Abstract
Background The endoscopic thyroidectomy bilateral areola approach (ETBAA) improved cosmetic outcomes significantly and is now widely applied. The usage of drainage tubes is controversial in conventional open thyroidectomy (COT), but studies about drainage placement decisions during ETBAA are still limited. This study aimed to determine the feasibility of having no drainage tube applied during ETBAA on patients with papillary thyroid carcinoma. Methods The clinical data of patients undergoing ETBAA from July 2018 to May 2021 was retrospectively collected. The patients were divided into two groups based on drain placement: no-drain and drain. The two groups were matched at a ratio of 1:1. Fifty-five patients from each group were finally included. Postoperative complications and follow-up data were compared between the two groups. Results No significant difference was observed between the two groups in the incidence of postoperative complications, including hemorrhage, surgical site infection, and subcutaneous seroma. Compared with the drain group, the operation time of the no-drain group was significantly shorter [(107.75 ± 24.59) min vs. (119.91 ± 34.05) min, P < 0.05]. The total and postoperative hospital stay was significantly shorter in the no-drain group [(2.40 ± 0.71) days vs. (4.78 ± 1.33) days, P < 0.001, (2.04 ± 0.19) days vs. (2.15 ± 0.36) days, P < 0.05], and the costs of surgical consumables were also significantly lower [(6,820.83 ± 164.29) CNY vs. (7,494.13 ± 216.7) CNY, P < 0.05]. The postoperative pain score of the no-drain group was significantly lower than the drain group [(1.58 ± 0.63) vs. (1.89 ± 0.76), P < 0.05]. Conclusions No drainage applied during ETBAA on papillary thyroid carcinoma is safe and feasible. This practice does not increase the risk of postoperative complications, but it does shorten the operation time and hospital stay, as well as reduce medical costs. Furthermore, it alleviates the suffering of patients.
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Affiliation(s)
- Yukai Chen
- Department of Thyroid Surgery, Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Chengchen Wang
- Department of General Surgery, International Medical Center of Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Binglong Bai
- Department of Thyroid Surgery, Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Mao Ye
- Department of Thyroid Surgery, Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Junjie Ma
- Department of Thyroid Surgery, Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Jingying Zhang
- Department of Thyroid Surgery, Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
- *Correspondence: Jingying Zhang
| | - Zhiyu Li
- Department of Thyroid Surgery, Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
- Zhiyu Li
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Guo T, Wu Z, He J, Liu D, Wan H, Li Y, Peng S, Xu A. Gasless endoscopic thyroidectomy via modified areola approach with a simple flap-lifting technique. Front Endocrinol (Lausanne) 2022; 13:1028805. [PMID: 36619584 PMCID: PMC9816138 DOI: 10.3389/fendo.2022.1028805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 11/29/2022] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE Studies have shown that carbon dioxide (CO2) insufflation during endoscopic thyroidectomy is associated with many risks. Recently, we have designed a simple lifting tool using Kirschner wire. We aimed to use this tool for flap-lifting in modified areola approach endoscopic thyroidectomy and compare it with conventional CO2 insufflation. METHODS In a prospective study, patients who underwent endoscopic thyroidectomy via modified areola approach were randomly assigned into gasless (n = 20) or CO2 groups (n = 22). Pre-operative variables included age, gender, tumor diameter, and clinical diagnosis. Intra-operative hemodynamic monitoring included mean arterial pressure, heart rate, pulse oximetry, end-tidal carbon dioxide (ET-CO2) and arterial pH. Other intra-operative details included total operative time, operative blood loss, conversion from endoscopic surgery to open surgery, intra-operative events, and endoscope video score. Postoperatively, the hospital stay, drainage volume, and complications were recoded. RESULTS Patient characteristics were not different between the two groups. During the operation, ET-CO2 levels were significantly higher in the CO2 group (P < 0.05), whereas arterial pH levels were significantly lower (P < 0.05). The CO2 group had longer operation time and higher endoscope clarity VAS score than gasless group. Hospital stay, drainage volume, and postoperative complications did not differ significantly between the two groups (P > 0.05). CONCLUSIONS The gasless endoscopic thyroidectomy we performed via our Kirschner wire hook was safe, feasible, and yielded good results.
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Affiliation(s)
- Tao Guo
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
- Anhui Public Health Clinical Center, Hefei, Anhui, China
| | - Zehui Wu
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Juntong He
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
- Anhui Public Health Clinical Center, Hefei, Anhui, China
| | - Defeng Liu
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
- Anhui Public Health Clinical Center, Hefei, Anhui, China
| | - Hong Wan
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
- Anhui Public Health Clinical Center, Hefei, Anhui, China
| | - Yangyang Li
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
- Anhui Public Health Clinical Center, Hefei, Anhui, China
| | - Shihao Peng
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
- Anhui Public Health Clinical Center, Hefei, Anhui, China
| | - Aman Xu
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
- *Correspondence: Aman Xu,
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Tiroidectomía endoscópica transoral por vía vestibular: resultados de los 53 primeros casos. Cir Esp 2021. [DOI: 10.1016/j.ciresp.2021.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Transoral thyroidectomy vestibular approach versus non-transoral endoscopic thyroidectomy: a comprehensive systematic review and meta-analysis. Surg Endosc 2021; 36:1739-1749. [PMID: 34750702 DOI: 10.1007/s00464-021-08836-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 10/19/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND To conduct a meta-analysis to compare the short-term outcomes of transoral thyroidectomy vestibular approach (TOTVA) with non-transoral endoscopic thyroidectomy (NTET). METHODS MEDLINE, EMBASE, science citation index expanded, and the Cochrane Central Register of Controlled Trials in the Cochrane Library from January 2007 to January 2021 were searched for relevant literature. The evaluated endpoints were intra-operative and post-operative outcomes. RESULTS Ten eligible, non-randomized comparative studies involving 1677 patients were included. Meta-analysis results revealed that TOTVA was associated with significantly longer operative time [weighted mean differences (WMD), 22.60; 95%confidence interval (CI), 7.51-37.69; P = 0.003]. No significant differences were found between TOTVA group and NTET group in terms of post-operative outcomes. CONCLUSION TOTVA appears to be an equally feasible and safe surgical procedure as NTET for patients with benign thyroid nodules and selected differentiated thyroid carcinomas.
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18
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Comparison of the transoral endoscopic thyroidectomy vestibular approach and open thyroidectomy: A propensity score-matched analysis of surgical outcomes and safety in the treatment of papillary thyroid carcinoma. Surgery 2021; 170:1680-1686. [PMID: 34284897 DOI: 10.1016/j.surg.2021.06.032] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 06/10/2021] [Accepted: 06/21/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND The transoral endoscopic thyroidectomy vestibular approach has been demonstrated to have similar surgical outcomes as open thyroidectomy for selected papillary thyroid carcinomas. This study aimed to evaluate and compare the surgical outcomes and safety of the transoral endoscopic thyroidectomy vestibular approach with those of open thyroidectomy in the treatment of papillary thyroid carcinoma with a diameter between >1 cm and ≤3.5cm. METHODS We retrospectively reviewed all patients who had papillary thyroid carcinoma that was between >1 cm and ≤3.5 cm in diameter and who had undergone the transoral endoscopic thyroidectomy vestibular approach (n = 96) or an open thyroidectomy (n = 425) from January 2017 to June 2020. We then performed 1:1 propensity score matching, yielding 78 matched pairs. Afterward, surgical outcomes and follow-up data were compared between the 2 matched groups. RESULTS Compared with the matched open thyroidectomy group, the papillary thyroid carcinoma group had a significantly longer operative time (P < .001), more blood loss (P < .05), higher postoperative white blood cell count (P < .05), higher C-reactive protein (P < .001), more total drainage volume (P < .001), increased surgical cost (P < .05), better cosmetic satisfaction (P <.001), lower scar self-consciousness (P < .001), and better quality of life (P < .001). We observed no significant differences in the incidence of other outcomes, including the number of retrieved lymph nodes and metastatic central lymph nodes, the rate of intraoperative recurrent laryngeal nerve signal weakened and parathyroid autotransplantation, visual analog scale scores for pain, drainage duration, postoperative hospital stay, rate of complications, and oncologic completeness. We observed no conversion to open thyroidectomy and no intraoperative capsular disruption in the transoral endoscopic thyroidectomy vestibular approach group. There was 1 case of persistent nodal disease in the transoral endoscopic thyroidectomy vestibular approach group. No recurrence was observed in the 2 groups during the follow-up period. CONCLUSION The transoral endoscopic thyroidectomy vestibular approach is feasible in selected patients with papillary thyroid carcinoma, not only because it is cosmetically advantageous but also because it is surgical and oncologically safe and may be an optional surgical method for treating papillary thyroid carcinomas having a diameter between >1 cm and ≤3.5 cm.
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Endoscopic Thyroidectomy With Level Vb Dissection Via a Chest-breast Approach: Technical Updates for Selective Lateral Neck Dissection. Surg Laparosc Endosc Percutan Tech 2021; 31:342-345. [PMID: 33900224 DOI: 10.1097/sle.0000000000000887] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 10/26/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine the feasibility of endoscopic thyroidectomy with level Vb dissection using a chest-breast approach. METHODS Lateral neck level Vb dissection by endoscopic surgery using a chest-breast approach was performed as an update to the previously reported endoscopic selective lateral neck dissection. The demographic data, surgical outcomes, and adverse events were analyzed. RESULTS A total of 12 cases were performed successfully, and no patient was converted to the open procedure. The sex ratio was 16/2 (female/male). The average age and primary lesion diameter were 36.3±5.8 years old, and 1.97±0.58 cm, respectively. The average total and lateral lymph nodes dissection time of duration was 154.6±17.0 and 276.3±19.2 minutes, respectively. The lymph node ratio (mean number of metastasis/total number of dissected nodes) at levels II, III+IV, VI, and Vb were 1.6±1.4/6.8±2.0, 5.8±2.4/14.4±3.6, 3.2±1.1/6.5±1.9, and 0.8±0.9/5.8±1.6, respectively. One of 12 patients had lymphatic leakage and 2 of 12 patients had transient hypocalcemia. There was no incidence of uncontrolled bleeding, mental nerve injury, permanent hypoparathyroidism, permanent recurrent laryngeal nerve injury, skin bruise on neck, infection, asphyxia/dyspnea, large blood vessel injury or other complications like tracheal injury, esophageal injury, etc., nor was there any death or recurrence in either of the 2 groups during a short follow-up period. CONCLUSIONS It is feasible to perform endoscopic thyroidectomy with level Vb dissection using a chest-breast approach. Such strategy represents another option for selective papillary thyroid carcinoma patients with levels II, III, IV, and Vb lymph node metastasis.
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Sun P, Mak TK, Li J, Wang C. Endoscopic Left Central Lymph Node Dissection of Thyroid Cancer: Safe, Feasible, and Relatively Easy. Surg Innov 2021; 28:747-753. [PMID: 33830818 DOI: 10.1177/1553350620983640] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose. The purpose of this study was to explore the feasibility of left central lymph node dissection (CLND) in endoscopic thyroidectomy via chest-breast approach (ETCB). Methods. Retrospective analysis of 57 cases of left CLND (group A) via ETCB, 35 cases of open left CLND (group B), and 90 cases of right CLND via ETCB (Group C) were performed from October 2014 to October 2019. Surgical data, complications, and follow-up data were compared among group A and group B, group A and group C, respectively. Results. There were no significant differences between group A and group B in intraoperative blood loss, tumor size, lymph node (LN) metastasis rate, dissected LN number, metastatic LN number, serum thyroglobulin (sTg), radioactive iodine uptake (RAIU), radioactive technetium uptake (RATU), radionuclide imaging of the residual area (RITRA), and radionuclide imaging of suspicious lymph node metastasis (RISLNM). There were no significant differences between group A and group C in age, operation time, intraoperative blood loss, postoperative hospital stay, tumor size, LN metastasis rate, dissected LN number, metastatic LN number, hypoparathyroidism, sTg, RAIU, RATU, RITRA, and RISLNM. There were 5 cases of temporary recurrent laryngeal nerve (RLN) palsy and 1 case of recurrence in group C. Besides, 1 case of lymphatic leakage was in group A. Conclusion. For selected cases, endoscopic left CLND is safe, feasible, efficient, and more easier than endoscopic right CLND.
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Affiliation(s)
- Peng Sun
- Department of Thyroid Surgery, 162698Jinan University First Affiliated Hospital, Guangzhou, China
| | - Tsz Kin Mak
- Department of General Surgery, 162698Jinan University First Affiliated Hospital, Guangzhou, China
| | - Jinyi Li
- Department of Thyroid Surgery, 162698Jinan University First Affiliated Hospital, Guangzhou, China
| | - Cunchuan Wang
- Department of General Surgery, 162698Jinan University First Affiliated Hospital, Guangzhou, China
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Deroide G, Honigman I, Berthe A, Branger F, Cussac-Pillegand C, Richa H, Anuwong A. Trans oral endoscopic thyroidectomy (TOETVA): First French experience in 90 patients. J Visc Surg 2021; 158:103-110. [PMID: 33676861 DOI: 10.1016/j.jviscsurg.2021.02.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Thyroidectomy techniques using extracervical approaches have grown in popularity for about 20 years and their feasibility has now been demonstrated. We wanted to evaluate one of these new approaches: the anterior vestibular endoscopic approach (TOETVA). The aim of this study was to evaluate the results of an initial series patients who underwent an anterior trans-vestibular endoscopic oral thyroidectomy. METHODS From February 2018 to September 2020, this technique was offered to patients aged 18 to 70, ASA I or II, who presented with an indication for thyroid surgery and who wished to avoid cervical scars. The approach was through the anterior vestibule of the mouth and the specimen was extracted either transorally or via the axilla depending on its size. Apart from the first ten cases, all patients underwent recurrent nerve neuromonitoring. The patients were operated on by two surgeons experienced in thyroid surgery. All the patients had follow-up visits on D15, D30 and at 2 months. The pre- and intra-operative data, length of stay and complications were evaluated. RESULTS A total of 90 consecutive patients (87 women) aged 46±12.4 years (18 to 69) with a mean BMI of 24.4±4 were included. The indications for surgery included 11 papillary cancers, 5 oncocytic nodules, 15 toxic nodules, 13 cases of Graves disease and 46 symptomatic goiters and/or nodules. The mean pre-operative diameter of the nodules was 3.61±1.99 (0.44 to 7.3) cm. The interventions performed were 44 lobo-isthmectomies, 41 total thyroidectomies and 5 isthmectomies. The mean operating time was 134±45min (40 to 255). On D1, the post-operative ionized calcium was 1.09±0.11mmol/L (4.3685±0.44mg/dL) (normal 0.8-1.15mmol/L) (3.206-4.609mg/dL)) and the total serum calcium was 2.07±0.11mmol/L 8.296±0.44mg/dL (normal 2.2-2.5mmol/L) (8.817-10.019mg/dL). Five patients underwent conversion from endoscopic to open cervical approach (5.5%). The complications were seven cases of transient recurrent nerve palsy (7.8%), eight cases of hypoparathyroidism (19%) including six transient and two permanent, one skin burn and 26 cases of transient chin numbness related to the electrocautery (29%). Ten patients (11%) presented with transient post-operative skin ecchymosis that resolved within 7-10 days. A spontaneous pneumo-mediastinum was observed on chest CT in three patients and evolved favorably. No hematoma, or surgical site infection, or complications related to axillary extraction were observed. All the patients declared themselves satisfied post-operatively and at the end of the follow-up. CONCLUSION The TOETVA route of entry is a safe and reliable technique in well-selected patients wishing to avoid a cervical scar.
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Affiliation(s)
- G Deroide
- Franco-British Hospital Institute, 4, Rue Kleber Hôpital Franco-Britannique, 92300 Levallois, France; Clinique Lambert Ramsay, La garenne Colombes, France.
| | - I Honigman
- Polyclinique de Saint-Jean-de-Luz, Saint-Jean-de-Luz, France
| | - A Berthe
- Clinique Lambert Ramsay, La garenne Colombes, France
| | - F Branger
- Franco-British Hospital Institute, 4, Rue Kleber Hôpital Franco-Britannique, 92300 Levallois, France; Clinique Lambert Ramsay, La garenne Colombes, France
| | - C Cussac-Pillegand
- Franco-British Hospital Institute, 4, Rue Kleber Hôpital Franco-Britannique, 92300 Levallois, France
| | - H Richa
- Franco-British Hospital Institute, 4, Rue Kleber Hôpital Franco-Britannique, 92300 Levallois, France
| | - A Anuwong
- Police General Hospital, Bangkok, Thailand
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Kumar C, Lohani KR, Kataria K, Ranjan P, Dhar A, Srivastava A. Endoscopic thyroidectomy: Which one is the better technique for the beginners? J Minim Access Surg 2021; 17:337-341. [PMID: 32964885 PMCID: PMC8270042 DOI: 10.4103/jmas.jmas_184_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Introduction: Endoscopic thyroidectomy is an advanced procedure and has a long learning curve. Most commonly employed approach is combined axillary-breast approach (ABA). Recently, transoral endoscopic thyroidectomy vestibular approach (TOETVA) is being popularised as a scarless procedure. However, it is not established whether TOETVA or ABA approach is better to begin with. Purpose: The purpose of the study was to compare the initial experience of TOETVA and ABA with respect to difficulties and outcomes. Methodology: A prospective non-randomised interventional study was conducted including the initial ten patients in each group who underwent hemithyroidectomy for benign solitary thyroid nodule. Sigma plot version 12.3 was used for the statistical analysis. Results: All the patients were female and comparable with respect to age (33.2 vs. 28.2 years) and size of nodule (2.7 vs. 3 cm) (TOETVA vs. ABA). The operative time (121 vs. 138.5 min, P = 0.34) and blood loss (50 vs. 60 ml, P = 0.9) were similar in both the groups. Even though the flap raising time was significantly less with TOETVA group (29.3 vs. 47.2 min, P < 0.001), it was associated with more difficulty in approaching upper pole (P = 0.02) and lower pole (P < 0.001), more intra-operative events (30% vs. 10%, P = 0.58) and conversions to open (20% vs. 10%, P = 1). Similarly, post-operative pain scoring was more with TOETVA (3 vs. 2, P = 0.04). Hospital stay was similar in both the groups (2.5 vs. 3 days, P = 1). Patients in both the groups had both overall and cosmetic satisfaction. Conclusions: Axillary-breast approach should be preferred to start learning the endoscopic thyroidectomy, as it is easier and safer than transoral endoscopic vestibular approach.
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Affiliation(s)
- Chitresh Kumar
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India
| | - Kush Raj Lohani
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India
| | - Kamal Kataria
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India
| | - Piyush Ranjan
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India
| | - Anita Dhar
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India
| | - Anurag Srivastava
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India
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23
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Zhang Z, Xia F, Li X. Ambulatory Endoscopic Thyroidectomy via a Chest-Breast Approach Has an Acceptable Safety Profile for Thyroid Nodule. Front Endocrinol (Lausanne) 2021; 12:795627. [PMID: 34987479 PMCID: PMC8721221 DOI: 10.3389/fendo.2021.795627] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 12/01/2021] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION With the growing esthetic requirements, endoscopic thyroidectomy develops rapidly and is widely accepted by practitioners and patients to avoid the neck scar caused by open thyroidectomy. Although ambulatory open thyroidectomy is adopted by multiple medical centers, the safety and potential of ambulatory endoscopic thyroidectomy via a chest-breast approach (ETCBA) is poorly investigated. MATERIAL AND METHODS Patients with thyroid nodules who received conventional or ambulatory ETCBA at Xiangya hospital, Central South University from January 2017 to June 2020 were retrospectively included. The incidence of postoperative complications, 30-days readmission rate, financial cost, duration of hospitalization, mental health were mainly investigated. RESULTS A total of 260 patients were included with 206 (79.2%) suffering from thyroid carcinoma, while 159 of 260 received ambulatory ETCBA. There was no statistically significant difference in the incidence of postoperative complications (P=0.249) or 30-days readmission rate (P=1.000). In addition, The mean economic cost of the ambulatory group had a 29.5% reduction compared with the conventional group (P<0.001). Meanwhile, the duration of hospitalization of the ambulatory group was also significantly shorter than the conventional group (P<0.001). Patients received ambulatory ETCBA showed a higher level of anxiety (P=0.041) and stress (P=0.016). Subgroup analyses showed consistent results among patients with thyroid cancer with a 12.9% higher complication incidence than the conventional ETCBA (P=0.068). CONCLUSION Ambulatory ETCBA is as safe as conventional ETCBA for selective patients with thyroid nodules or thyroid cancer, however with significant economic benefits and shorter duration of hospitalization. Extra attention should be paid to manage the anxiety and stress of patients who received ambulatory ETCBA.
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Affiliation(s)
| | - Fada Xia
- *Correspondence: Xinying Li, ; Fada Xia,
| | - Xinying Li
- *Correspondence: Xinying Li, ; Fada Xia,
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24
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Pros and Cons of Transoral Endoscopic Thyroidectomy Via Vestibular Approach: A Comparative Study. Surg Laparosc Endosc Percutan Tech 2020; 31:331-336. [PMID: 33252576 DOI: 10.1097/sle.0000000000000875] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 08/11/2020] [Indexed: 12/22/2022]
Abstract
OBJECTIVE The objective of this study was to explore the feasibility and safety of transoral endoscopic thyroidectomy via vestibular approach (TOETVA) compared with endoscopic thyroidectomy via bilateral areola approach (ETBAA) in the treatment of patients with benign thyroid nodules. MATERIALS AND METHODS From January 2017 to December 2018, 60 patients who received TOETVA were enrolled as the research group; 65 patients who underwent ETBAA were included as the control group. A retrospective study was performed using the clinical data for these cases. All patients were diagnosed with benign nodules by preoperative examinations. Parameters including surgical trauma, complications, cosmetic satisfaction, and postoperative discomfort were compared between the 2 groups. RESULTS All operations were completed without incident. There were significant differences in operation time (137.8±18.7 vs. 95.7±17.2 min), intraoperative blood loss (16.8±9.1 vs. 24.6±16.6 mL), drainage volume (123.1±20.9 vs. 153.6±40.2 mL), C-reactive protein level (7.2±5.2 vs. 9.0±4.7 mg/L), drainage time (3.2±0.6 vs. 3.9±1.3 d), postoperative hospital stay (3.3±0.8 vs. 4.1±1.5 d), and sense of skin tension on the neck (0% vs. 10.8%) between the TOETVA and ETBAA groups (P<0.05). There were no significant differences in pain score, incidence of recurrent laryngeal nerve injury, transient hypoparathyroidism, infection, inadvertent parathyroidectomy, or swallow discomfort between the 2 groups. The cosmetic satisfaction score in the TOETVA group was significantly higher than that in the ETBAA group at 1 month after surgery (9.8±0.5 vs. 9.4±0.9, P<0.05), but at 3 months after the operation, the difference was not statistically significant. CONCLUSIONS TOETVA was accompanied by less surgical trauma and skin tension on the neck than ETBAA, and the cosmetic effect of this approach was better than that of ETBAA in the early postoperative period. TOETVA for benign thyroid nodules is safe and feasible. However, there are disadvantages with TOETVA, such as a long surgical period. More cases and further research are needed to delve further into this approach.
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25
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Wang Y, Zhou S, Liu X, Rui S, Li Z, Zhu J, Wei T. Transoral endoscopic thyroidectomy vestibular approach vs conventional open thyroidectomy: Meta‐analysis. Head Neck 2020; 43:345-353. [PMID: 33043571 DOI: 10.1002/hed.26486] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 08/24/2020] [Accepted: 09/21/2020] [Indexed: 02/05/2023] Open
Affiliation(s)
- Yichao Wang
- Department of Thyroid, Parathyroid Surgery Center West China Hospital, Sichuan University Chengdu China
| | - Shengliang Zhou
- West China School of Medicine, West China Hospital, Sichuan University Chengdu China
| | - Xueting Liu
- Department of Evidence‐Based Medicine and Clinical Epidemiology West China Hospital, Sichuan University Chengdu China
| | - Shu Rui
- Department of Thyroid, Parathyroid Surgery Center West China Hospital, Sichuan University Chengdu China
| | - Zhihui Li
- Department of Thyroid, Parathyroid Surgery Center West China Hospital, Sichuan University Chengdu China
| | - Jingqiang Zhu
- Department of Thyroid, Parathyroid Surgery Center West China Hospital, Sichuan University Chengdu China
| | - Tao Wei
- Department of Thyroid, Parathyroid Surgery Center West China Hospital, Sichuan University Chengdu China
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26
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Li J, Li S, Liu C, Xi H, Liu P, Chen Z, Wei B, Chen L, Qiao Z. Advantages of intraoperative nerve monitoring in endoscopic thyroidectomy for papillary thyroid carcinoma. Minerva Surg 2020; 76:165-172. [PMID: 32975382 DOI: 10.23736/s2724-5691.20.08317-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND This study aimed to evaluate the feasibility and effectiveness of intraoperative nerve monitoring (IONM) for reducing the recurrent laryngeal nerve (RLN) injury risk during central compartment lymph node dissection in endoscopic thyroidectomy of papillary thyroid carcinoma (PTC). METHODS The prospective cohort consisted of 69 patients diagnosed with PTC undergoing endoscopic thyroidectomy via the areola approach with (N.=42) or without IONM (N.=27). Multiple logistic regression models were used to assess the association between IONM and postoperative temporary vocal cord palsy or number of retrieved lymph nodes. RESULTS IONM was a protective factor against temporary RLN injury. IONM use was positively correlated with number of retrieved lymph nodes (β=1.563, P=0.003). After adjustment for operation type, the result remained significant (β=1.581, P<0.001). CONCLUSIONS IONM use reduced the risk of temporary vocal cord palsy and increased the number of retrieved lymph nodes in endoscopic thyroidectomy via the areola approach for patients with PTC.
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Affiliation(s)
- Jiyang Li
- Department of General Surgery, Chinese PLA General Hospital, Beijing, China.,General Surgery Institute, Chinese PLA General Hospital, Beijing, China
| | - Shaoqing Li
- Department of General Surgery, Chinese PLA General Hospital, Beijing, China.,General Surgery Institute, Chinese PLA General Hospital, Beijing, China
| | - Chen Liu
- Department of Otorhinolaryngology, Head and Neck Surgery, Chinese PLA General Hospital, Beijing, China
| | - Hongqing Xi
- Department of General Surgery, Chinese PLA General Hospital, Beijing, China
| | - Peifa Liu
- Department of General Surgery, Chinese PLA General Hospital, Beijing, China
| | - Zhida Chen
- Department of General Surgery, Chinese PLA General Hospital, Beijing, China
| | - Bo Wei
- Department of General Surgery, Chinese PLA General Hospital, Beijing, China.,General Surgery Institute, Chinese PLA General Hospital, Beijing, China
| | - Lin Chen
- Department of General Surgery, Chinese PLA General Hospital, Beijing, China.,General Surgery Institute, Chinese PLA General Hospital, Beijing, China
| | - Zhi Qiao
- Department of General Surgery, Chinese PLA General Hospital, Beijing, China -
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27
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Endoscopic Lateral Neck Dissection (IIA, IIB, III, and IV) Using a Breast Approach: Outcomes From a Series of the First 24 Cases. Surg Laparosc Endosc Percutan Tech 2020; 31:66-70. [PMID: 32925819 DOI: 10.1097/sle.0000000000000849] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 07/10/2020] [Indexed: 01/13/2023]
Abstract
INTRODUCTION In order to avoid large neck scar caused by conventional lateral neck dissection. We have explored and introduced endoscopic lateral neck dissection (IIA, IIB, III, and IV) using a breast approach. Now, we summarized and shared the outcomes of the first 24 cases. MATERIALS AND METHODS All the patients were treated in our institute from January 2017 to May 2018, and followed-up for more than 1 year. The details of patients and this technique have been summarized and analyzed retrospectively. RESULTS A series of first 24 cases were successfully managed with this technique, and no cases were converted to an open approach. Among these 24 patients, levels III + IV dissection had been performed in 6 patients and levels II+III+IV dissection had been performed in 18 patients. The mean age, body mass index, and sex were 39.3±10.5 years old, 24.1±3.5, and 2 male/22 female, respectively. The average operative time of total operation and lateral neck dissection was 238.8±37.2 minutes and 128.8±21.1 minutes, respectively. The mean dissected lateral lymph nodes were 5.9±2.2 (level II) in 18 cases and 15.9±3.9 (levels III+IV) in 24 cases. In addition, with no severe complications to date, such as asphyxia, main nerves injury (cervical plexus, vagus nerve, etc.), and permanent hypoparathyroidism, nor permanent recurrent laryngeal nerve injury, and so on. However, unexpectedly, had some mild and common complications like transient hypocalcemia in 4 cases (16.67%), transient horse 1 case (4.2%), controllable lymphatic leakage in 2 cases (8.3%), and controllable jugular vein injury in 2 cases (8.3%). One year after the operation, 1 case found lung metastasis but no local recurrence. In other 23 patients, no recurrence/metastasis and the average of serum thyroglobulin is 3.2±3.8 ng/mL. CONCLUSIONS This technique can yield adequate oncological dissection for selected patients. Endoscopic thyroidectomy along with lateral neck dissection using a breast approach may provide an option for selected patients who favor avoiding a visible neck incision.
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28
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Qiu TY, Lau J, Wong O, Oh HB, Boon TW, Parameswaran R, Ngiam KY. Preoperative scar perception study comparing 'scarless' in the neck endoscopic thyroidectomy with open thyroidectomy: a cross-sectional study. Ann R Coll Surg Engl 2020; 102:737-743. [PMID: 32820638 DOI: 10.1308/rcsann.2020.0174] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION Open thyroidectomy is the most common approach to thyroid surgery. However, 'scarless' (in the neck) endoscopic thyroidectomy, consisting of endoscopic and robotic surgery, is progressively being adopted for its perceived cosmetic benefits. This study aims to determine the patient's preferred surgical approach and to identify the factors that influence their decision. MATERIALS AND METHODS A pilot study consisting of 100 patients with a surgical thyroid disorder were prospectively recruited from a single tertiary centre. An interviewer-administered survey was conducted. Demographic, socioeconomic status, scar perception and an adapted body image scale were evaluated to identify factors that shaped the patient's perception of the surgical approach. RESULTS The mean age of participants was 54.5 ± 13.0 years; 72% were women and 87% Chinese. Of the 100 patients, 75 patients considered scarless endoscopic thyroidectomy as their preferred surgical approach while 25 patients opted for open thyroid surgery. Improvement in scar perception score between scarless endoscopic thyroidectomy and open thyroid surgery is associated with an increased willingness to choose scarless endoscopic thyroidectomy. The mean body image scale score was 6.9 ± 2.8, indicating no statistical difference between the surgical approaches. On multivariate analysis, improvement in scar perception score (odds ratio 3.38, 95% confidence interval 1.11-10.29) and having surgeon recommendation (odds ratio 6.38, 95% confidence interval 1.80-22.63) were independently associated with interest in scarless endoscopic thyroidectomy. CONCLUSION Patients interest in undergoing scarless endoscopic thyroidectomy is driven by improved scar perception and surgeon's recommendation compared with open thyroid surgery.
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Affiliation(s)
- T Y Qiu
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Jwl Lau
- National University Hospital, National University Health System, Singapore
| | - O Wong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - H B Oh
- Ng Teng Fong General Hospital, National University Health System, Singapore
| | - T W Boon
- National University Hospital, National University Health System, Singapore
| | - R Parameswaran
- National University Hospital, National University Health System, Singapore
| | - K Y Ngiam
- National University Hospital, National University Health System, Singapore
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Nguyen HX, Nguyen HX, Nguyen HV, Nguyen LT, Nguyen TTP, Le QV. Transoral Endoscopic Thyroidectomy by Vestibular Approach with Central Lymph Node Dissection for Thyroid Microcarcinoma. J Laparoendosc Adv Surg Tech A 2020; 31:410-415. [PMID: 32706603 DOI: 10.1089/lap.2020.0411] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Background: The transoral endoscopic thyroidectomy by vestibular approach (TOETVA) has been developed for thyroid microcarcinoma (TMC) treatment worldwide, with low rate of complications and excellent oncological results. However, this approach has still not been routinely performed. Thus, in this study, we aim to demonstrate the feasibility and safety of this technique in the clinical practice. Methods: In this prospective cohort study, 29 patients diagnosed TMC and clinically node negative underwent thyroidectomy and prophylactic central lymph node dissection by TOETVA. The clinicopathologic characteristics, surgical outcomes, and cosmetic results were evaluated. Results: The mean age was 34.7 ± 8.5 years. Three patients had underlying Grave's disease. Thyroid lobectomy with isthmusectomy was performed in the majority of cases (72.4%). All patients underwent prophylactic central node dissection. The mean number of retrieved central node was 7.8 ± 3.7 (3-19). Seven patients (24.1%) had lymph node metastasis in postoperative pathology. Among them, the mean number of metastatic lymph nodes was 2.1 ± 1.7 (1-5). The mean operative time was 121.2 ± 22.6 minutes. Four patients experienced transient hoarse and 1 patient had hematoma. Visual analog scale score on first postoperative day was 2.8 ± 1.4 (0-5). Most of patients were satisfied with cosmetic outcome. Conclusions: The TOETVA is new technique for TMC in Vietnam. The initial results of oncology, postoperative complications, and cosmetic supported the application of TOETVA in TMC.
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Affiliation(s)
- Hau Xuan Nguyen
- Department of Oncology, Hanoi Medical University, Hanoi, Vietnam
- Department of Oncology and Palliative Care, Hanoi Medical University Hospital, Hanoi, Vietnam
| | - Hien Xuan Nguyen
- Department of Oncology, Hanoi Medical University, Hanoi, Vietnam
| | - Hung Van Nguyen
- Department of Oncology and Palliative Care, Hanoi Medical University Hospital, Hanoi, Vietnam
| | | | | | - Quang Van Le
- Department of Oncology, Hanoi Medical University, Hanoi, Vietnam
- Department of Oncology and Palliative Care, Hanoi Medical University Hospital, Hanoi, Vietnam
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30
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Zhang D, Zhang J, Dionigi G, Li F, Wang T, Li H, Liang N, Sun H. Recurrent Laryngeal Nerve Morbidity: Lessons from Endoscopic via Bilateral Areola and Open Thyroidectomy Technique. World J Surg 2020; 43:2829-2841. [PMID: 31367782 DOI: 10.1007/s00268-019-05092-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND AND AIM Elucidating the mechanism of recurrent laryngeal nerve (RLN) injuries through intraoperative electromyographic (EMG) and laryngeal examination approaches may deepen our knowledge regarding its prevention strategies. To date, no studies have been reported on the mechanism of RLN injury caused by endoscopic thyroidectomy via bilateral areola approach (ETBAA). METHODS Both intraoperative EMG profiles and postoperative laryngeal examination were used to investigate the mechanisms of RLN injury and compare the safety aspects between ETBAA and open thyroidectomy approach (OTA). RESULTS This study examined 1420 nerves at risk. The mean follow-up period was 17 ± 4 (range 6-48) months. The incidence of vocal cord paralysis was 4.1% (59/1420). The number of cases with decreased EMG signals and vocal cord palsy was higher in ETBAA group than in OTA group (P < 0.05). The left RLNs in ETBAA group were at higher risk compared to the right nerves. CONCLUSIONS The results of the current study indicate that ETBAA exhibits higher risk of RLN injury. The topic includes a video.
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Affiliation(s)
- Daqi Zhang
- Division of Thyroid Surgery, Jilin Provincial Key Laboratory of Surgical Translational Medicine, Jilin Provincial Precision Medicine Laboratory of Molecular Biology and Translational Medicine on Differentiated Thyroid Carcinoma, China-Japan Union Hospital of Jilin University, 126 Xiantai Blvd, Changchun City, Jilin Province, People's Republic of China
| | - Jiao Zhang
- Division of Thyroid Surgery, Jilin Provincial Key Laboratory of Surgical Translational Medicine, Jilin Provincial Precision Medicine Laboratory of Molecular Biology and Translational Medicine on Differentiated Thyroid Carcinoma, China-Japan Union Hospital of Jilin University, 126 Xiantai Blvd, Changchun City, Jilin Province, People's Republic of China
| | - Gianlorenzo Dionigi
- Division for Endocrine and Minimally Invasive Surgery, Department of Human Pathology in Adulthood and Childhood ''G. Barresi'', University Hospital G. Martino, University of Messina, Via C. Valeria 1, 98125, Messina, Italy
| | - Fang Li
- Division of Thyroid Surgery, Jilin Provincial Key Laboratory of Surgical Translational Medicine, Jilin Provincial Precision Medicine Laboratory of Molecular Biology and Translational Medicine on Differentiated Thyroid Carcinoma, China-Japan Union Hospital of Jilin University, 126 Xiantai Blvd, Changchun City, Jilin Province, People's Republic of China
| | - Tie Wang
- Division of Thyroid Surgery, Jilin Provincial Key Laboratory of Surgical Translational Medicine, Jilin Provincial Precision Medicine Laboratory of Molecular Biology and Translational Medicine on Differentiated Thyroid Carcinoma, China-Japan Union Hospital of Jilin University, 126 Xiantai Blvd, Changchun City, Jilin Province, People's Republic of China
| | - Hongbo Li
- Division of Thyroid Surgery, Jilin Provincial Key Laboratory of Surgical Translational Medicine, Jilin Provincial Precision Medicine Laboratory of Molecular Biology and Translational Medicine on Differentiated Thyroid Carcinoma, China-Japan Union Hospital of Jilin University, 126 Xiantai Blvd, Changchun City, Jilin Province, People's Republic of China
| | - Nan Liang
- Division of Thyroid Surgery, Jilin Provincial Key Laboratory of Surgical Translational Medicine, Jilin Provincial Precision Medicine Laboratory of Molecular Biology and Translational Medicine on Differentiated Thyroid Carcinoma, China-Japan Union Hospital of Jilin University, 126 Xiantai Blvd, Changchun City, Jilin Province, People's Republic of China.
| | - Hui Sun
- Division of Thyroid Surgery, Jilin Provincial Key Laboratory of Surgical Translational Medicine, Jilin Provincial Precision Medicine Laboratory of Molecular Biology and Translational Medicine on Differentiated Thyroid Carcinoma, China-Japan Union Hospital of Jilin University, 126 Xiantai Blvd, Changchun City, Jilin Province, People's Republic of China.
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31
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Nguyen HX, Nguyen LT, Nguyen HV, Nguyen HX, Trinh HL, Nguyen TX, Le QV. Comparison of Transoral Thyroidectomy Vestibular Approach and Unilateral Axillobreast Approach for Endoscopic Thyroidectomy: A Prospective Cohort Study. J Laparoendosc Adv Surg Tech A 2020; 31:11-17. [PMID: 32486890 DOI: 10.1089/lap.2020.0272] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Background: Various approaches for endoscopic thyroidectomy have been developed recently that improve the cosmetic outcome, and some are even scar free. In this study, we compared the safety and surgical outcomes of transoral endoscopic thyroidectomy vestibular approach (TOETVA) and unilateral axillobreast approach (UABA) thyroid surgery performed by a single surgeon. Materials and Methods: We conducted a prospective cohort study among 101 patients undergoing endoscopic thyroidectomy from 2018 to 2019 in our institution. The factors analyzed included patients' clinical characteristics, types and time of operation, blood loss, hospital stay, postoperative complications, and cosmetic satisfaction. Results: Among 101 patients, 51 underwent TOETVA and 50 had UABA surgery. UABA has shorter operative time for lobectomy (91.7 ± 16.5 minutes versus 50.4 ± 6.8 minutes, P < .001), whereas TOETVA is associated with less postoperative pain (visual analogue scale score day 1 of 4.6 ± 1.0 versus 5.8 ± 1.0, P < .001). There were no significant differences between TOETVA and UABA groups regarding rates of transient recurrent laryngeal nerve injury (9.8% versus 2.0%, P = .205) and hypothyroidism (11.5% versus 2.0%, P = .112), in which all patients fully recovered 6 months after surgery and most of them were satisfied with the cosmetic result. Conclusions: Both TOETVA and UABA have been shown to be effective and safe surgical options for endoscopic thyroid surgery, as well as gave excellent cosmetic result. Each approach has its own advantages and disadvantages, and choice of technique should be tailored for each individual, and patient preference should be integrated in the treatment plan.
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Affiliation(s)
- Hau Xuan Nguyen
- Department of Oncology, Hanoi Medical University, Hanoi, Vietnam.,Department of Oncology and Palliative Care, Hanoi Medical University Hospital, Hanoi, Vietnam
| | | | - Hung Van Nguyen
- Department of Oncology and Palliative Care, Hanoi Medical University Hospital, Hanoi, Vietnam
| | - Hien Xuan Nguyen
- Department of Oncology, Hanoi Medical University, Hanoi, Vietnam
| | - Huy Le Trinh
- Department of Oncology, Hanoi Medical University, Hanoi, Vietnam.,Department of Oncology and Palliative Care, Hanoi Medical University Hospital, Hanoi, Vietnam
| | | | - Quang Van Le
- Department of Oncology, Hanoi Medical University, Hanoi, Vietnam.,Department of Oncology and Palliative Care, Hanoi Medical University Hospital, Hanoi, Vietnam
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Karakas E, Klein G, Schopf S. Transoral thyroid surgery vestibular approach: does size matter anymore? J Endocrinol Invest 2020; 43:615-622. [PMID: 31989449 DOI: 10.1007/s40618-019-01149-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 11/19/2019] [Indexed: 01/29/2023]
Abstract
BACKGROUND Various approaches for endoscopic and minimally invasive thyroid operations have been reported, with some becoming popular to date. The aim of these procedures is to reduce and prevent visible scars in the neck. This led to the transoral endoscopic thyroidectomy vestibular approach (TOETVA) technique applicable in small thyroid specimen. To amend TOETVA and to broaden the indication for transoral thyroid surgery, our aim was to combine the TOETVA with the retroauricular endoscopic cephalic access thyroid surgery (EndoCATS) facelift approach. METHODS After successful implementation of the TOETVA technique in 2017, we evaluated the transoral technique regarding feasibility and safety in well-selected patients in Germany and Austria. With the combination of TOETVA and EndoCATS, we were able to optimize the extraction process of the specimen by avoiding damage to the thyroid capsule and to broaden the indication of transoral surgery by operating on thyroid glands with higher volume. Patients' characteristics, surgical outcome and complications were determined. RESULTS Seventy-one transoral procedures were performed in 70 patients. The TOETVA procedure was performed in 60 patients, and 10 female patients underwent TOVARA with transoral thyroid lobe mobilization and removal of the specimen via the retroauricular access. Overall, median operation time was 205 min (range 96-370 min) and permanent RLNP rate was 1% accordant to 99 nerves at risk (39 hemithyroidectomies, 29 total thyroidectomies, 2 parathyroid resections, and 1 thyroglossal cyst resection). No conversion to conventional open surgery was necessary. Long-term mental nerve injury occurred in two patients. No infection was identified. CONCLUSIONS Transoral thyroid and parathyroid surgery via the vestibular approach is both feasible and safe in Western Europe. The combination of the TOETVA with the retroauricular endoscopic cephalic access thyroid surgery (EndoCATS) facelift approach, called TOVARA, is a promising opportunity to allow for thyroid surgery without a visible scar in specimen with volume of more than 40 ml also.
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Affiliation(s)
- E Karakas
- Department of General, Abdominal and Endocrine Surgery, Hospital Maria Hilf, Alexianer GmbH, 47805, Krefeld, Germany.
- University of Marburg, Marburg, Germany.
| | - G Klein
- Department of Surgery, Hospital Wiener Neustadt, Wiener Neustadt, Austria
| | - S Schopf
- Department of General, Abdominal and Vascular Surgery, Hospital Agatharied GmbH, Hausham, Germany
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Guo F, Wang W, Zhu X, Xiang C, Wang P, Wang Y. Comparative Study Between Endoscopic Thyroid Surgery via the Oral Vestibular Approach and the Areola Approach. J Laparoendosc Adv Surg Tech A 2020; 30:170-174. [PMID: 31621490 DOI: 10.1089/lap.2019.0562] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Affiliation(s)
- Fangdong Guo
- Department of Breast and Thyroid Surgery, The Affiliated Zhongshan Hospital of Dalian University, Dalian, China
| | - Wenrui Wang
- Department of Breast and Thyroid Surgery, Dezhou People's Hospital of Shandong Province, Dezhou, China
| | - Xiaoyu Zhu
- Department of Breast and Thyroid Surgery, The Affiliated Zhongshan Hospital of Dalian University, Dalian, China
| | - Cheng Xiang
- Department of Thyroid Surgery, The Second Affiliated Hospital of Zhejiang University College of Medicine, Hangzhou, China
| | - Ping Wang
- Department of Thyroid Surgery, The Second Affiliated Hospital of Zhejiang University College of Medicine, Hangzhou, China
| | - Yong Wang
- Department of Thyroid Surgery, The Second Affiliated Hospital of Zhejiang University College of Medicine, Hangzhou, China
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How Should the Surgical Approach In Thyroidectomy Be Selected? A Prospective Study Comparing the Trauma of 3 Different Thyroidectomy Surgical Approaches. Surg Laparosc Endosc Percutan Tech 2019; 30:22-25. [PMID: 31855923 PMCID: PMC7012342 DOI: 10.1097/sle.0000000000000743] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Objective: To compare the trauma of 3 different surgical approaches and provide a reference for clinicians in choosing the operative procedure. Patients and Methods: A total of 150 patients were divided into the total endoscopic thyroidectomy (TET), endoscopic-assisted thyroidectomy (EAT), and conventional open thyroidectomy (COT) groups, with 50 patients in each group. The peripheral blood C-reactive protein (CRP) levels at different postoperative time points, operative time, intraoperative blood loss, postoperative drainage volume, postoperative pain, degree of satisfaction with the incision appearance, postoperative extubation time, and swallowing discomfort 3 months after surgery were compared among the groups that received different surgical approaches. Results: The operative time of TET was longer than that of COT and EAT. The intraoperative blood loss was significantly lower in the TET and EAT groups than in the COT group. The postoperative drainage volume was lowest after EAT and highest after TET. The extubation time was significantly shorter after EAT than after TET and COT. The 6-hour CRP level was significantly higher after TET than after EAT and COT, and the 24-hour CRP level was better in the EAT group than in the other 2 groups. The CRP levels at 72 hours postoperatively were lowest in the EAT group and highest in the TET group. Postoperative pain was significantly lower after EAT than after TET and COT. Cosmetic satisfaction was highest in the TET group and lowest in the COT group. Swallowing discomfort was lowest in the EAT group and highest in the TET group. There was a positive correlation between the drainage volume on the first postoperative day, the drainage tube removal time, dysphagia, and the CRP level in each period. There was a positive correlation between pain, cosmetic satisfaction and CRP in 2 of the time periods. Conclusions: All 3 types of thyroidectomy are safe and reliable in benign tumor resection. Therefore, in clinical practice, the age, sex, and cosmetic needs of the patients, and the oncological safety should all be considered to provide patients with the most appropriate recommendations. In view of oncological safety, TET should be carefully selected for malignant tumor resection.
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Gryaznov SE, Shulutko AM, Melkonyan GG, Semikov VI, Tolstykh MP, Madoyan MR. [Transoral endoscopic thyroid surgery]. Khirurgiia (Mosk) 2019:18-27. [PMID: 31825339 DOI: 10.17116/hirurgia201912118] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To analyze own initial experience of transoral thyroid surgery. MATERIAL AND METHODS There were 7 patients thyroid nodules who underwent surgery for the period from March 2018 to May 2019. All patients signed an informed consent to be included in the study. Surgical approach was performed through three incisions in the lower arch of the vestibule of the mouth with deployment of 10 mm endoscope and two 5 mm tools. Gas insufflation was used. All patients were females aged 43.3±11.8 years. Thyroidectomy was performed in 2 cases, hemithyroidectomy - in 5 patients. Dimensions of nodules varied from 10 to 42 mm. RESULTS Mean time of hemithyroidectomy and thyroidectomy was 206.4±63.8 and 232±37.5 min, respectively. Papillary carcinoma was histologically verified in 1 case. Injuries of recurrent laryngeal nerve, postoperative hypocalcemia and local complications were absent. Drainage was not applied. Postoperative hospital-stay was 3.7±1.1 days. CONCLUSION Transoral approach to the thyroid gland is technically feasible with standard endoscopic instruments, safe for important anatomical structures and more precise due to the optical capabilities of endoscopic equipment. Any types of procedures are possible. Undoubtedly, aesthetic outcome is also favorable.
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Affiliation(s)
- S E Gryaznov
- Municipal Clinical Hospital #4 of the Moscow Department of Health, Moscow, Russia
| | - A M Shulutko
- Sechenov First Moscow State Medical University of the Ministry of Health of Russia, Moscow, Russia
| | - G G Melkonyan
- Municipal Clinical Hospital #4 of the Moscow Department of Health, Moscow, Russia; Russian Medical Academy of Continuous Professional Education of the Ministry of Health of Russia, Moscow, Russia
| | - V I Semikov
- Sechenov First Moscow State Medical University of the Ministry of Health of Russia, Moscow, Russia
| | - M P Tolstykh
- Evdokimov Moscow State University of Medicine and Dentistry of the Ministry of Health of Russia, Moscow, Russia
| | - M R Madoyan
- Pirogov Russian National Research Medical University of the Ministry of Health of the Russia, Moscow, Russia
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Sun P, Chen W, Mak TK, Chong TH, Li J, Yang J, Wang C. Right Central Lymph Node Dissection in Thyroidectomy: Can Endoscopic Chest-Breast Approach Be Used? J Laparoendosc Adv Surg Tech A 2019; 30:308-314. [PMID: 31746665 DOI: 10.1089/lap.2019.0527] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: The purpose of this research was to investigate the feasibility and strategies of right central lymph node dissection (CLND) in endoscopic thyroidectomy through chest-breast approach. Materials and Methods: Retrospective analysis on the conduction of 68 cases of endoscopic thyroidectomy through chest-breast approach with right side CLND (endoscopic group) and 31 cases of thyroidectomy through low-neck collar cervical approach with right side CLND (open group) from July 2014 to February 2019. The intraoperative and postoperative data were compared between the two groups. Results: All the surgeries in open group were successfully completed as well as the endoscopic group without any intraoperative conversion into open surgery. There were no difference in sizes of tumor, incidence of lymph node metastasis, number of dissected and metastatic lymph nodes, and postoperative hospitalization days between the two groups. Temporal hypoparathyroidism occurred in both groups with endoscopic group to be 24 cases and open group to be 15 cases but no case in both groups suffering from permanent hypoparathyroidism, recurrent laryngeal nerve injury, lymphatic leakage, or death. One case in endoscopic group was treated with secondary surgery for lateral cervical lymph node metastasis and no evidence of recurrence or metastasis was found in other cases during postoperative follow-up. Conclusions: With strict control in surgical indications and contraindications, endoscopic surgery is safe and feasible for selected cases with the same effect as open surgery on dissection of lymph nodes in the right central region, which is in line with the principle of radical treatment of tumors.
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Affiliation(s)
- Peng Sun
- Department of General Surgery, First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Wenhui Chen
- Department of General Surgery, First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Tsz Kin Mak
- Department of General Surgery, First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Tsz Hong Chong
- Department of General Surgery, First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Jinyi Li
- Department of General Surgery, First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Jingge Yang
- Department of General Surgery, First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Cunchuan Wang
- Department of General Surgery, First Affiliated Hospital of Jinan University, Guangzhou, China
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The Transareola Endoscopic Approach Yields Adequate Oncological Dissection as Open Approach in the Treatment of Papillary Thyroid Carcinoma. Surg Laparosc Endosc Percutan Tech 2019; 29:489-492. [PMID: 31584497 DOI: 10.1097/sle.0000000000000729] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE This study aimed to evaluate and discuss whether the transareola endoscopic surgery has similar outcome outcomes to open surgery in the treatment of papillary thyroid carcinoma (PTC). METHOD A total of 102 patients with PTC were enrolled in this study. Among them, 53 patients were treated by transareola endoscopic surgery (endoscopic group) and 49 patients were treated by open surgery (open group). Some specific factors, including thyroglobulin (Tg), radioactive iodine uptake (RAIU), postoperative nuclide imaging in thyroid area, postoperative nuclide imaging of lymph nodes suspicious for metastasis (PNILNSM), etc. were analyzed and compared between the 2 groups. RESULTS There were no significant differences between the 2 groups regarding body mass index (22.9±3.4 vs. 24.0±3.3, P=0.103), operation time (173.3±43.2 vs. 158.8±47.9 min, P=0.110), intraoperative blood loss (41.8±19.4 vs. 35.8±31.0 mL, P=0.251, P=0.251), tumor diameter (19.0±6.8 vs. 20.2±7.2 mm, P=0.400), and overall complications (11.3% vs. 10.2%, P=0.868). No significant difference was found in the specific factors between the 2 groups concerning RAIU-2h/24h (2.44±1.34 vs. 2.58±1.65%/2.83±3.75 vs. 2.35±3.44%, P=0.646/ P=0.506), number of dissected lymph nodes (4.4±1.4 vs. 4.6±1.5, P=0.595), Tg before radioiodine therapy (4.46±5.50 vs. 5.60±8.36; P=0.495), Tg after radioiodine therapy (1.03±1.93 vs. 1.11±1.61, P=0.812, P=0.812), postoperative nuclide imaging in thyroid area (1.76±1.50 vs. 2.19±1.85 cm, P=0.195), PNILNSM before radioiodine (none: 79.2% vs. 83.7%, P=0.566; central: 17.0% vs. 12.2%, P=0.653; lateral: 1.9% vs. 4.1%, P=0.450; central+lateral: 1.9% vs. 0%, P=1.000), and PNILNSM after radioiodine (none: 94.3% vs. 95.9%, P=0.111; central: 3.8% vs. 2.0%, P=1.000; lateral: 0 vs. 2.0%, P=0.480; central+lateral: 1.9% vs. 0%, P=1.000). CONCLUSIONS Transareola endoscopic total thyroidectomy and central lymph nodes dissection are safe and effective. According to the evaluated postoperative specific factors, this technique achieves similar outcomes to open surgery in selected patients with PTC.
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Fama F, Zhang D, Pontin A, Makay Ö, Tufano RP, Kim HY, Sun H, Dionigi G. Patient and Surgeon Candidacy for Transoral Endoscopic Thyroid Surgery. Turk Arch Otorhinolaryngol 2019; 57:105-108. [PMID: 31360931 DOI: 10.5152/tao.2019.18191] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 02/26/2019] [Indexed: 11/22/2022] Open
Abstract
The transoral thyroidectomy (TT) is a feasible novel surgical procedure that does not need visible incisions, a truly cutaneous scar-free surgery. Inclusion criteria are (a) patients who have a ultrasonographically (US) estimated thyroid diameter not larger than 10 cm, (b) US estimated gland volume ≤45 mL, (c) nodule size ≤50 mm, (d) a benign tumor, such as a thyroid cyst, single-nodular goiter, or multinodular goiter, (e) follicular neoplasm, and (f) papillary microcarcinoma without evidence of metastasis. The procedure is carried out through a three-port technique placed at the oral vestibule; one 10-mm port for a 30° endoscope and two additional 5-mm ports for dissecting and coagulating instruments. CO2 insufflation pressure is set at 6 mmHg. An anterior cervical subplatysmal space is created from the oral vestibule down to the sternal notch, laterally to the sternocleidomastoid muscle medial edges. TT is done fully endoscopically using conventional endoscopic instruments.
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Affiliation(s)
- Fausto Fama
- Division for Endocrine and Minimally Invasive Surgery, Department of Human Pathology in Adulthood and Childhood "G. Barresi", University Hospital G. Martino, University of Messina, Messina, Italy
| | - Daqi Zhang
- Division of Thyroid Surgery, China-Japan Union Hospital Of Jilin University, Jilin Provincial Key Laboratory of Surgical Translational Medicine, Jilin Provincial Precision Medicine Laboratory of Molecular Biology and Translational Medicine on Differentiated Thyroid Carcinoma, Jilin, China
| | - Alessandro Pontin
- Division for Endocrine and Minimally Invasive Surgery, Department of Human Pathology in Adulthood and Childhood "G. Barresi", University Hospital G. Martino, University of Messina, Messina, Italy
| | - Özer Makay
- Department of General Surgery, Ege University School of Medicine, İzmir, Turkey
| | - Ralph P Tufano
- Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University School of Medicine, Baltimore, USA
| | - Hoon Yub Kim
- Department of Surgery, KUMC Thyroid Center, Korea University Hospital, Korea University College of Medicine, Seoul, Korea
| | - Hui Sun
- Division of Thyroid Surgery, China-Japan Union Hospital Of Jilin University, Jilin Provincial Key Laboratory of Surgical Translational Medicine, Jilin Provincial Precision Medicine Laboratory of Molecular Biology and Translational Medicine on Differentiated Thyroid Carcinoma, Jilin, China
| | - Gianlorenzo Dionigi
- Division for Endocrine and Minimally Invasive Surgery, Department of Human Pathology in Adulthood and Childhood "G. Barresi", University Hospital G. Martino, University of Messina, Messina, Italy
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Comparison of transoral endoscopic thyroidectomy vestibular approach, total endoscopic thyroidectomy via areola approach, and conventional open thyroidectomy: a retrospective analysis of safety, trauma, and feasibility of central neck dissection in the treatment of papillary thyroid carcinoma. Surg Endosc 2019; 34:268-274. [DOI: 10.1007/s00464-019-06762-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2018] [Accepted: 03/18/2019] [Indexed: 11/25/2022]
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Jamikorn T, Anuwong A. Transoral Endoscopic Thyroidectomy (TOETVA). CURRENT OTORHINOLARYNGOLOGY REPORTS 2019. [DOI: 10.1007/s40136-019-00250-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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The Learning Curve for Surgeons Regarding Endoscopic Thyroidectomy via the Oral-vestibular Approach. Surg Laparosc Endosc Percutan Tech 2019; 28:380-384. [PMID: 30222694 DOI: 10.1097/sle.0000000000000578] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND For selected patients, endoscopic thyroidectomy via the oral-vestibular approach (ETOVA) can be used to achieve a very good esthetic effect. This study aimed to assess the learning curve for ETOVA and identify improvements. PATIENTS AND METHODS This retrospective study evaluated the outcomes of 101 patients who underwent ETOVA by surgeons A and B. The patients were classified according to whether they had undergone surgery during the primary or advanced stage of the learning curve, respectively. Proficiency with the procedure in various types of cases and the operation time, operative blood loss, hospital stay length, and postoperative complications were analyzed. RESULTS In total, 56 and 45 patients were treated by surgeons A and B, respectively. For both surgeons, the operation times decreased considerably after 20 cases. Statistically significant differences with respect to stage were observed in terms of operation time (P<0.05) and drainage tube reservation (P<0.05). By contrast, significant differences were not observed between stages in terms of operative blood loss (P>0.05) or postoperative hospital stay length (P>0.05). The total postoperative complication rate was low and comparable with that of open surgery. CONCLUSIONS The specific learning curve identified for ETOVA suggests that surgeons with sufficient endoscopic surgery experience could achieve a stable proficiency after ∼20 cases. A standardized training program and exposure to more cases would reduce the learning curve.
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Central Lymph Node Dissection by Endoscopic Bilateral Areola Versus Open Thyroidectomy. Surg Laparosc Endosc Percutan Tech 2019; 29:e1-e6. [DOI: 10.1097/sle.0000000000000579] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Guo Y, Qu R, Huo J, Wang C, Hu X, Chen C, Liu D, Chen W, Xiong J. Technique for endoscopic thyroidectomy with selective lateral neck dissection via a chest-breast approach. Surg Endosc 2018; 33:1334-1341. [PMID: 30569419 DOI: 10.1007/s00464-018-06608-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 11/28/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Endoscopic thyroidectomy has been widely accepted because it can effectively avoid neck scarring. However, there are seldom reports concerning completely endoscopic lateral neck dissection approaches. In this study, we introduced a technique for performing endoscopic thyroidectomy with lateral neck dissection via a chest-breast approach. METHODS We retrospectively reviewed 18 patients who underwent endoscopic total thyroidectomy along with levels II, III, IV, and VI dissection. All major outcomes, such as cosmetic effect, operative time and complications, etc., were analyzed. In addition, another 20 patients who underwent traditional open surgery (open group) were enrolled in the study to conduct a contrasting analysis between patients treated with the endoscopic technique (endoscopic group) and open group patients, in terms of demographic data and main operative outcomes, to evaluate the feasibility of this technique. RESULTS All 18 endoscopic surgery cases were successfully performed, and no patient was converted to the open procedure intra-operatively. There were no significant differences between the two groups regarding age (P = 0.209), Body Mass Index (P = 0.479), sex (P = 0.218), drainage time (P = 0.153), operation time (P = 0.065), intra-operative blood loss (P = 0.139), post-operative pain (P = 0.114), and number of dissected lateral lymph nodes (II: P = 0.201; III + IV: P = 0.107). The mean total and lateral lymph nodes dissection (LLND) time in the endoscopic group were longer than those of the open group (P = 0.002; 235 ± 35 vs. 182 ± 20 min, P = 0.000; 125 ± 21 vs. 80 ± 14 min, P = 0.000). The primary lesion diameter of the endoscopic group was smaller than that of the open group (1.7 ± 0.8 vs. 2.9 ± 1.3 cm, P = 0.002). The scores for cosmetic satisfaction in the endoscopic group were higher than those in the open group (8.3 ± 0.7 vs. 4.4 ± 0.9, P = 0.000). Among the complications, there was no significant difference between the two approaches in transient vocal cord paresis (1/18 vs. 0/20, P = 0.474), transient hypoparathyroidism (4/18 vs. 4/20, P = 1.000), post-operative lymphatic leakage (1/18 vs. 3/20, P = 0.606), and intra-operative large blood vessel injury (2/18 vs. 0/20, P = 0.218). There was no incidence of uncontrolled bleeding, mental nerve injury, permanent hypoparathyroidism, permanent recurrent laryngeal nerve (RLN) injury, skin bruise on the neck, asphyxia/dyspnea or other complications like tracheal injury, esophageal injury, etc., nor was there any death or recurrence in either of the two groups during the short follow-up period. CONCLUSION It is feasible to perform LLND (levels II, III, IV, and VI) with endoscopic thyroidectomy via a chest-breast approach. In particular, this technique avoids a large scar on the patient's neck and has well operative outcomes compared with open surgery. Accordingly, this technique may offer one more option for selective patients.
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Affiliation(s)
- Youming Guo
- Department of Thyroid Surgery, First People's Hospital of Zunyi, Zunyi, 563000, China
| | - Rui Qu
- Department of Thyroid Surgery, First People's Hospital of Zunyi, Zunyi, 563000, China.
| | - Jinlong Huo
- Department of Thyroid Surgery, First People's Hospital of Zunyi, Zunyi, 563000, China
| | - Cunchuan Wang
- Department of General Surgery, First Affiliated Hospital of Jinan University, Guangzhou, 510630, China
| | - Xiaochi Hu
- Department of Thyroid Surgery, First People's Hospital of Zunyi, Zunyi, 563000, China
| | - Chen Chen
- Department of Thyroid Surgery, First People's Hospital of Zunyi, Zunyi, 563000, China
| | - Daosheng Liu
- Department of Thyroid Surgery, First People's Hospital of Zunyi, Zunyi, 563000, China
| | - Weiwei Chen
- Department of Endoscopy Center, First People's Hospital of Zunyi, Zunyi, 563000, China
| | - Jing Xiong
- Department of Thyroid Surgery, First People's Hospital of Zunyi, Zunyi, 563000, China
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Another Strategy for the Treatment of Thyroglossal Duct Cyst: Totally Endoscopic Surgery by Breast Approach. Surg Laparosc Endosc Percutan Tech 2018. [PMID: 29521676 DOI: 10.1097/sle.0000000000000514] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Open surgery is the most common treatment of thyroglossal duct cyst (TGDC), but it leaves obvious neck scarring. This study aimed to explore the feasibility and strategy of total endoscopic procedure by breast approach to avoid such scarring on the neck. MATERIALS AND METHODS This study reviewed 13 patients who underwent endoscopic resection of TGDC and 15 patients who underwent open resection of TGDC. We compared and analyzed factors including operative time, estimated blood loss, postoperative hospitalization, complications, and cosmetic effect. RESULTS The surgery by the endoscopic approach was successfully completed in 13 cases and no one was converted to an open procedure. Another 15 cases were successfully performed by an open procedure. There were no significant differences between the 2 procedures in the mean cyst size, drainage time, intraoperative blood loss, and postoperative hospital stay. The cosmetic effect was better and the operative time was longer in the endoscopic approach. Two cases had swallowing discomfort after surgery in the endoscopic approach, whereas one case developed this complication in the open approach. On patient treated with each approach developed infection. One patient developed skin bruise and one patient developed subcutaneous hydros in the endoscopic approach, whereas no complications developed in the open approach. There were no incidences of uncontrolled bleeding, tracheal injury, dysphagia, salivary fistula, or asphyxia/dyspnea in both approaches, nor were there any deaths or recurrences of TGDC during the follow-up period. CONCLUSION With strict indications, the total endoscopic breast procedure is feasible and effective for selected patients. This procedure can be another choice for patients who wish to avoid neck scarring when undergoing treatment for TGDC.
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Abstract
BACKGROUND Transoral thyroidectomy is a kind of "natural orifice transluminal endoscopic surgery (NOTES)" which is now being performed in increasing frequency. However, the safety and feasibility have not been concluded yet. MATERIALS AND METHODS A systemic literature search was performed in Pubmed, Cochrane, and Embase databases to identify all studies written in English and published up to April 2017. The keywords used were "transoral endoscopic," "transoral robotic," "oral vestibular endoscopic," and "oral vestibular robotic" combined with "thyroidectomy" or "thyroid surgery." RESULTS Ten articles containing 211 cases matched the review criteria. The weighted average operative time was 119.9 minutes with an average intraoperative blood loss of 35.5 mL while the weighted average length of hospital stay was 4.0 days. The overall conversion rate to open surgery was 1.9%. An overall incidence rate of temporary hypoparathyroidism was 7.1%, temporary recurrent laryngeal nerve injury was 4.3%, whereas of mental nerve palsy was 4.3%. CONCLUSIONS According to those reviewed literatures, we can conclude that transoral thyroidectomy is safe and feasible in well-selected patients and offers good perioperative and postoperative outcomes.
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Affiliation(s)
| | - Jianing Liu
- Thyroid Surgery, The Second Hospital of Shandong University, Jinan, Shandong, China
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Treatment of differentiated thyroid cancer: can endoscopic thyroidectomy via a chest-breast approach achieve similar therapeutic effects as open surgery? Surg Endosc 2018; 32:4749-4756. [PMID: 29761277 DOI: 10.1007/s00464-018-6221-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 05/09/2018] [Indexed: 01/08/2023]
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Qu R, Guo Y, Hu X, Luo L, Liu D. Endoscopic Thyroid Surgeries via Areola Approach: Experience and Outcomes of 500 Cases in a Single Institute. Indian J Surg 2018. [DOI: 10.1007/s12262-018-1758-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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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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Anuwong A, Sasanakietkul T, Jitpratoom P, Ketwong K, Kim HY, Dionigi G, Richmon JD. Transoral endoscopic thyroidectomy vestibular approach (TOETVA): indications, techniques and results. Surg Endosc 2017; 32:456-465. [PMID: 28717869 DOI: 10.1007/s00464-017-5705-8] [Citation(s) in RCA: 175] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Accepted: 07/03/2017] [Indexed: 10/19/2022]
Abstract
INTRODUCTION The Transoral Neck Surgery (TONS) Study Group was established at the 1st International Thyroid NOTES Conference in February 2016 with the intention of standardizing and refining thyroid NOTES techniques, including both transoral endoscopic and robotic thyroidectomy approaches. Herein, the authors report the modification of indications, preparation, and step-by-step explanations for operative techniques, as well as results and postoperative care for transoral endoscopic thyroidectomy vestibular approach (TOETVA). METHODS Between February 2015 and December 2015, a total of 200 patients comprising 8 males (4%) and 192 females (96%) underwent TOETVA using 3 laparoscopic ports inserted at the oral vestibule. Of these patients, 111 presented with single thyroid nodules (55.5%), while 66 patients had multinodular goiters (33%), 12 had Graves' disease (6%) and 11 had papillary microcarcinoma (5.5%). The CO2 insufflation pressure was maintained at 6 mmHg. Each surgery was performed using laparoscopic instruments and ultrasonic devices. RESULTS TOETVA was performed on 200 consecutive patients. No conversion to conventional open surgery was necessary. Average tumor size was 4.1 ± 1.78 cm (1-10 cm). Median operative time was 97 ± 40.5 min (45-300 min). Median blood loss was 30 ± 46.25 mL (6-300 mL). Mean visual analog scale measurements were 2.41 ± 2.04 (2-7), 1.17 ± 1.4 (0-5), and 0.47 ± 0.83 (0-3) on the first, second, and third days, respectively. Temporary hoarseness and hypoparathyroidism occurred in 8 patients (4%) and 35 patients (17.5%), respectively. No permanent hoarseness or hypoparathyroidism occurred. Mental nerve injury occurred in 3 patients (1.5%). One patient (0.5%) developed a post-operative hematoma that required open surgery. No infection was identified. CONCLUSION TOETVA was shown to be safe and feasible with a reasonable surgical duration and minimal pain scores. This approach shows promise for those patients who are motivated to avoid a neck scar.
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Affiliation(s)
- Angkoon Anuwong
- Minimally-Invasive and Endocrine Surgery Division, Department of Surgery, Police General Hospital, 492/1 Rama I Road, Pathumwan, Bangkok, 10330, Thailand.
| | - Thanyawat Sasanakietkul
- Minimally-Invasive and Endocrine Surgery Division, Department of Surgery, Police General Hospital, 492/1 Rama I Road, Pathumwan, Bangkok, 10330, Thailand
| | - Pornpeera Jitpratoom
- Minimally-Invasive and Endocrine Surgery Division, Department of Surgery, Police General Hospital, 492/1 Rama I Road, Pathumwan, Bangkok, 10330, Thailand
| | - Khwannara Ketwong
- Minimally-Invasive and Endocrine Surgery Division, Department of Surgery, Police General Hospital, 492/1 Rama I Road, Pathumwan, Bangkok, 10330, Thailand
| | - Hoon Yub Kim
- Department of Surgery, KUMC Thyroid Center, Korea University Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Gianlorenzo Dionigi
- Division of Endocrine Surgery, Department of Human Pathology in Adulthood and Childhood "G. Barresi", Department of Surgical Oncology, University Hospital - Policlinico "G.Martino", University of Messina, Via Consolare Valeria, 98125, Messina, Italy
| | - Jeremy D Richmon
- Department of Otolaryngology Head Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, USA
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Anuwong A, Kim HY, Dionigi G. Transoral endoscopic thyroidectomy using vestibular approach: updates and evidences. Gland Surg 2017; 6:277-284. [PMID: 28713700 DOI: 10.21037/gs.2017.03.16] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Recently, natural orifice transluminal endoscopic surgery (NOTES) has been applied in thyroid surgery with transoral access. The benefit of transoral endoscopic thyroidectomy is the potential for scar-free surgery. However, there are many concerns over some aspects, such as infection, recurrent laryngeal nerve injury, and oncological outcome. In this paper, we have reviewed the development history and the current clinical evidence of this innovative surgery. We conclude that the transoral endoscopic thyroidectomy vestibular approach (TOETVA) is feasible and can be considered no longer an experimental operation.
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Affiliation(s)
- Angkoon Anuwong
- Department of Surgery, Minimally Invasive and Endocrine Surgery Division, Police General Hospital, Bangkok, Thailand
| | - Hoon Yub Kim
- Department of Surgery, KUMC Thyroid Center, Korea University College of Medicine, Seoul, Korea
| | - Gianlorenzo Dionigi
- Department of Surgical Sciences and Human Morphology, 1st Division of Surgery, Research Center for Endocrine Surgery, University of Insubria (Como-Varese), Varese, Italy
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