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Schopf S, Umschlag C, Mechera R, Karakas E. [Indications and technique for transoral thyroid gland and parathyroid gland surgery]. CHIRURGIE (HEIDELBERG, GERMANY) 2024; 95:801-809. [PMID: 39196342 DOI: 10.1007/s00104-024-02118-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/23/2024] [Indexed: 08/29/2024]
Abstract
The conventional Kocher collar incision is the standard access to the thyroid and parathyroid glands. Although the incision length has been significantly shortened in recent years with this approach, there is increasing interest among patients in a surgical technique without visible scars in the décolleté. Transoral endoscopic thyroid gland surgery via the vestibular approach (TOETVA) is a modern technique that can be learned relatively quickly and leaves no visible scars because it is carried out exclusively through a natural orifice (natural orifice transluminal endoscopic surgery, NOTES). For retrieval of larger specimens, the transoral approach can be combined with a retroauricular access and thus covers a larger range of indications. The indications must be strictly followed, analogous to conventional surgery. Once the transoral access has been established, the operation is carried out as in open surgery but strictly from cranial to caudal. The classical complications are comparable to the results of conventional surgery. Specific complications include perioral, mandibular or cervical dysesthesia and hypesthesia.
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Affiliation(s)
- S Schopf
- InnKlinikum Altötting und Mühldorf, Krankenhausstr. 1, 84453, Mühldorf, Deutschland.
| | - C Umschlag
- InnKlinikum Altötting und Mühldorf, Krankenhausstr. 1, 84453, Mühldorf, Deutschland
| | - R Mechera
- Spital Männedorf, Männedorf, Schweiz
| | - E Karakas
- Landeskrankenhaus, Universitätsklinik für Chirurgie, Salzburg, Österreich
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Oh MY, Park D, Chai YJ, Kim K, Kim HY. Transoral robotic thyroidectomy: Lessons learned from consecutive series of 1,000 patients. Surgery 2024:S0039-6060(24)00583-X. [PMID: 39294008 DOI: 10.1016/j.surg.2024.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Revised: 06/25/2024] [Accepted: 08/10/2024] [Indexed: 09/20/2024]
Abstract
BACKGROUND Transoral robotic thyroidectomy has gained popularity as a promising approach for thyroid surgery owing to its improved cosmetic outcomes. The objective of this retrospective study was to describe the surgical and safety outcomes of 1,000 consecutive transoral robotic thyroidectomy cases. METHODS 1,000 consecutive patients who underwent transoral robotic thyroidectomy for thyroid disease were reviewed at a large metropolitan tertiary hospital (Seoul, Korea) between September 2012 and March 2022. RESULTS The study comprised 1,000 patients (815 women), with 891 cancer cases. Lobectomy was the most common procedure (89.4%), followed by total thyroidectomy (9.8%) and isthmusectomy (0.8%), and their respective mean total operative times were 173.8 ± 36.2, 236.8 ± 50.5, and 107.5 ± 19.8 minutes. An obvious learning curve was noted. The respective postoperative pain scores on postoperative days 0, 1, and 2 were 4.6 ± 1.3, 3.1 ± 0.8, and 2.5 ± 0.8. The mean postoperative hospital stay duration was 2.6 ± 0.9 days. Complications occurred in 3.6% of cases, including oral wound infection, skin flap burn, bleeding, chyle leakage, transient and permanent mental nerve injury, and transient and permanent recurrent laryngeal nerve injury. Transient hypoparathyroidism occurred in 4.1% of total thyroidectomy cases. Thirty-seven patients (4.2%) underwent additional radioactive iodine therapy. The median follow-up period was 39 months, and there were no cases of recurrence. CONCLUSIONS Under the expertise of an experienced surgeon, transoral robotic thyroidectomy results in favorable cosmetic outcomes, tolerable postoperative pain, and acceptable complication rates in carefully selected patients.
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Affiliation(s)
- Moon Young Oh
- Department of Surgery, Seoul National University College of Medicine, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Dawon Park
- Department of Surgery, KUMC Thyroid Center, Korea University College of Medicine, Korea University Hospital, Seoul, Korea
| | - Young Jun Chai
- Department of Surgery, Seoul National University College of Medicine, Seoul National University Boramae Medical Center, Seoul, Korea; Transdisciplinary Department of Medicine & Advanced Technology, Seoul National University Hospital, Seoul, Korea
| | - Kwangsoon Kim
- Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hoon Yub Kim
- Department of Surgery, KUMC Thyroid Center, Korea University College of Medicine, Korea University Hospital, Seoul, Korea.
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Qiu R, Fu J. Prophylactic central lymph node dissection in cN0 papillary thyroid cancer: a comparative study of via breast and transoral approach versus via breast approach alone. Front Endocrinol (Lausanne) 2024; 15:1356739. [PMID: 38774230 PMCID: PMC11106435 DOI: 10.3389/fendo.2024.1356739] [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: 12/16/2023] [Accepted: 04/09/2024] [Indexed: 05/24/2024] Open
Abstract
Background Papillary thyroid cancer (PTC) progresses slowly and has a good prognosis, while the prognosis is worse if combined with central neck lymph node metastasis at an early stage. The different endoscope approaches may affect the thoroughness of lymph node dissection. This study aimed to compare the clinical efficacy and safety of prophylactic central lymph node dissection(CLND) for cN0 PTC performed via breast and transoral approach versus via breast approach alone. Materials and methods A retrospective analysis of the surgical data of 136 patients with stage cN0 PTC was performed from August 2020 to December 2022. Among them, 64 underwent the breast and transoral approach (combined approach group), and 72 underwent the breast approach alone (breast approach group). The relevant indexes of surgery, the number of lymph nodes dissected, the occurrence of postoperative complications, and the cosmetic satisfaction of incision were statistically compared between the two groups. Results The operation time of the combined approach group was 156.4 ± 29.8 min, significantly longer than that of the breast approach group, 119.6 ± 55.9 min, and the difference was statistically significant (P<0.05). The two groups of patients were compared in terms of intraoperative bleeding, postoperative drainage, hospitalization time, incision cosmetic satisfaction, and the occurrence of postoperative complications, and the differences were not statistically significant (P>0.05). The total number of lymph nodes retrieved in the central area (10.6 ± 7.1) and the number of positive lymph nodes (4.6 ± 4.9) in the combined approach group were significantly more than those in the breast approach group (7.4 ± 4.8, 1.6 ± 2.7), and the difference was statistically significant (P<0.05). The difference between the two groups in terms of the number of negative lymph nodes was not statistically significant (P>0.05). Conclusions The study demonstrated that choosing the breast combined transoral approach for prophylactic CLND of cN0 PTC could more thoroughly clear the central area lymph nodes, especially the positive lymph nodes, which could help in the evaluation of the disease and the guidance of the treatment, while not increasing the postoperative complications. It provides a reference for clinicians to choose the appropriate surgical approach and also provides new ideas and methods for prophylactic CLND in patients with cN0 PTC.
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Affiliation(s)
- Rongliang Qiu
- The School of Clinical Medicine, Fujian Medical University, Fuzhou, China
- Department of General Surgery, Zhongshan Hospital, Xiamen University, Xiamen, China
| | - Jinbo Fu
- The School of Clinical Medicine, Fujian Medical University, Fuzhou, China
- Department of General Surgery, Zhongshan Hospital, Xiamen University, Xiamen, China
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Huo J, Ou D, Guo Y, Chen C, Qu R, Zhao L. Safety and Efficacy of Transoral Endoscopic Thyroidectomy Vestibular Approach Versus Conventional Open Thyroidectomy: A Systematic Review and Meta-analysis. Surg Laparosc Endosc Percutan Tech 2023; 33:547-555. [PMID: 37523575 DOI: 10.1097/sle.0000000000001197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 06/02/2023] [Indexed: 08/02/2023]
Abstract
OBJECTIVE To evaluate the safety and efficacy of the transoral endoscopic thyroidectomy vestibular approach (TOETVA) versus conventional open thyroidectomy (COT) for some thyroid diseases. MATERIALS AND METHODS Databases PubMed, Embase, and Web of Science were searched. Full-text English papers that described TOETVA and COT for people with thyroid diseases were included. Randomized, nonrandomized, controlled, and uncontrolled trials were all included. Extracted data included population characteristics and intraoperative and postoperative complications. RESULTS A total of 2 randomized controlled trials and 10 retrospective studies, including 3048 patients, were included in the meta-analysis. Meta-analysis results suggested that the intraoperative conditions and postoperative complication rates did not differ significantly between the two groups. However, in the TOETVA group, there is a slightly longer operative time [weighted mean difference (WMD): 73.64; 95% CI: 49.34 to 97.94; P < 0.0001], drainage (WMD: 91.0; 95% CI: 35.52 to 146.48; P = 0.001), and hospital stay (WMD: 0.28; 95% CI: 0.18 to 0.38; P < 0.0001). CONCLUSION For most of the benign thyroid nodules and selected patients with papillary thyroid cancer, TOETVA seems to be as feasible and safe as COT.
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Affiliation(s)
- Jinlong Huo
- Departments of Breast and Thyroid Surgery
- Department of General Surgery, Digestive Disease Hospital, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
| | - Dong Ou
- Oncology, The Third Affiliated Hospital of Zunyi Medical University (The First People's Hospital of Zunyi)
| | | | - Chen Chen
- Departments of Breast and Thyroid Surgery
| | - Rui Qu
- Departments of Breast and Thyroid Surgery
| | - Lijin Zhao
- Department of General Surgery, Digestive Disease Hospital, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
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Oh MY, Chai YJ, Yu HW, Kim SJ, Choi JY, Lee KE. Transoral endoscopic thyroidectomy vestibular approach as a safe and feasible alternative to open thyroidectomy: a systematic review and meta-analysis. Int J Surg 2023; 109:2467-2477. [PMID: 37161554 PMCID: PMC10442077 DOI: 10.1097/js9.0000000000000444] [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: 03/13/2023] [Accepted: 05/01/2023] [Indexed: 05/11/2023]
Abstract
BACKGROUND Transoral endoscopic thyroidectomy vestibular approach (TOETVA) is a scarless alternative to open thyroidectomy (OT). This systematic review and meta-analysis aimed to synthesize evidence comparing the intraoperative and postoperative outcomes of TOETVA and OT. METHODS A systematic literature search of PubMed, Web of Science, the Cochrane Library, and Google Scholar was performed to identify studies comparing the outcomes of TOETVA and OT published before February 2023. The outcomes of interest were operative time, intraoperative blood loss, hospital stay, postoperative pain, number of central lymph nodes retrieved, number of metastatic central lymph nodes, and incidences of transient and permanent recurrent laryngeal nerve injury, transient and permanent hypocalcemia, hematoma, and infection. RESULTS Thirteen studies published between 2016 and 2022, involving a total of 2889 patients (TOETVA, n =1085; OT, n =1804) were included in this systematic review and meta-analysis. Meta-analysis showed that the TOETVA group had a significantly longer overall operative time (weighted mean difference [WMD] 55.19; 95% CI, 39.15, 71.23; P <0.001), longer hospital stay (WMD, 0.27; 95% CI, 0.14, 0.39; P <0.001), and lower pain scores on postoperative day 1 (WMD, -1.41; 95% CI, -2.79, -0.03; P =0.04) than the OT group. Other intraoperative and postoperative outcomes were not significantly different between the groups. CONCLUSION TOETVA has a similar safety profile to OT with less postoperative pain, making it an appropriate and more cosmetically appealing alternative to OT for select patients.
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Affiliation(s)
- Moon Young Oh
- Department of Surgery, Seoul National University College of Medicine, Seoul Metropolitan Government - Seoul National University Boramae Medical Center
| | - Young Jun Chai
- Department of Surgery, Seoul National University College of Medicine, Seoul Metropolitan Government - Seoul National University Boramae Medical Center
- Transdisciplinary Department of Medicine and Advanced Technology, Seoul National University Hospital
| | - Hyeong Won Yu
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam-si, Korea
| | - Su-Jin Kim
- Department of Surgery, Seoul National University College of Medicine, Seoul
| | - June Young Choi
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam-si, Korea
| | - Kyu Eun Lee
- Department of Surgery, Seoul National University College of Medicine, Seoul
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Wang Y, Wu G, Yan W, Lin F, Lin S, Luo Y, Zheng Y. Transoral endoscopic thyroid surgery via vestibular approach with silastic chin augmentation genioplasty. Exp Ther Med 2023; 26:357. [PMID: 37324516 PMCID: PMC10265711 DOI: 10.3892/etm.2023.12056] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 04/03/2023] [Indexed: 06/17/2023] Open
Abstract
From July 2020 to March 2022, 3 patients with papillary thyroid cancer (PTC) and microgenia underwent transoral endoscopic thyroid surgery via a vestibular approach or a endoscopic lateral neck dissection via the breast and transoral approaches with chin silastic augmentation genioplasty performed concurrently. Image documentation, patient satisfaction, complications and other factors such as demographics and clinicopathologic details were recorded. None of the patients developed major complications and there were no complications such as infection or displacement of the implant. All patients were satisfied with the cosmetic outcomes. Despite the study being limited to these 3 selected patients with PTC and microgenia, the follow-up to our initial description of the new technique established its safety and efficacy.
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Affiliation(s)
- Yuanyuan Wang
- Department of Thyroid Surgery, Zhengzhou University First Affiliated Hospital of Zhengzhou, Zhengzhou, Henan 450000, P.R. China
| | - Guoyang Wu
- Department of General Surgery, Zhongshan Hospital, Xiamen University, Xiamen, Fujian 361004, P.R. China
| | - Wei Yan
- Department of General Surgery, Zhongshan Hospital, Xiamen University, Xiamen, Fujian 361004, P.R. China
| | - Fusheng Lin
- Department of General Surgery, Zhongshan Hospital, Xiamen University, Xiamen, Fujian 361004, P.R. China
| | - Suqiong Lin
- Department of General Surgery, Zhongshan Hospital, Xiamen University, Xiamen, Fujian 361004, P.R. China
| | - Yezhe Luo
- Department of General Surgery, Zhongshan Hospital, Xiamen University, Xiamen, Fujian 361004, P.R. China
| | - Yarong Zheng
- Department of Plastic Surgery, Zhongshan Hospital, Xiamen University, Xiamen, Fujian 361004, P.R. China
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Ludwig B, Ludwig M, Dziekiewicz A, Mikuła A, Cisek J, Biernat S, Kaliszewski K. Modern Surgical Techniques of Thyroidectomy and Advances in the Prevention and Treatment of Perioperative Complications. Cancers (Basel) 2023; 15:cancers15112931. [PMID: 37296896 DOI: 10.3390/cancers15112931] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 05/16/2023] [Accepted: 05/23/2023] [Indexed: 06/12/2023] Open
Abstract
Thyroid cancer is the most common cancer of the endocrine system, and, in recent years, there has been a phenomenon of overdiagnosis followed by subsequent overtreatment. This results in an increasing number of thyroidectomy complications being faced in clinical practice. In this paper, we present the current state of knowledge and the latest findings in the fields of modern surgical techniques, thermal ablation, the identification and assessment of parathyroid function, recurrent laryngeal nerve monitoring and treatment and perioperative bleeding. We reviewed 485 papers, from which we selected 125 papers that are the most relevant. The main merit of this article is its comprehensive view of the subject under discussion-both general, concerning the selection of the appropriate method of surgery, and particular, concerning the selection of the appropriate method of prevention or treatment of selected perioperative complications.
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Affiliation(s)
- Bartłomiej Ludwig
- Department of General, Minimally Invasive and Endocrine Surgery, Wroclaw Medical University, Borowska Street 213, 50-556 Wroclaw, Poland
| | - Maksymilian Ludwig
- Department of General, Minimally Invasive and Endocrine Surgery, Wroclaw Medical University, Borowska Street 213, 50-556 Wroclaw, Poland
| | - Anna Dziekiewicz
- Department of General, Minimally Invasive and Endocrine Surgery, Wroclaw Medical University, Borowska Street 213, 50-556 Wroclaw, Poland
| | - Agnieszka Mikuła
- Department of General, Minimally Invasive and Endocrine Surgery, Wroclaw Medical University, Borowska Street 213, 50-556 Wroclaw, Poland
| | - Jakub Cisek
- Department of General, Minimally Invasive and Endocrine Surgery, Wroclaw Medical University, Borowska Street 213, 50-556 Wroclaw, Poland
| | - Szymon Biernat
- Department of General, Minimally Invasive and Endocrine Surgery, Wroclaw Medical University, Borowska Street 213, 50-556 Wroclaw, Poland
| | - Krzysztof Kaliszewski
- Department of General, Minimally Invasive and Endocrine Surgery, Wroclaw Medical University, Borowska Street 213, 50-556 Wroclaw, Poland
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Tenório LR, Bertelli AA, Nakai MY, Menezes MB, Russell JO, Gonçalves AJ. Transoral thyroid and parathyroid surgery in Brazil: where are we? Rev Col Bras Cir 2023; 50:e20233457. [PMID: 37222344 PMCID: PMC10508676 DOI: 10.1590/0100-6991e-20233457-en] [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: 08/23/2022] [Accepted: 09/20/2022] [Indexed: 05/25/2023] Open
Abstract
INTRODUCTION thyroid surgery through the transoral vestibular approach is a reality in many countries. While several competing remote access techniques have been developed in the last 20 years, many were not reproducible. Transoral Endoscopic Neck Surgery (TNS) has been shown to be reproducible in different centers around the world, and approximately five years after its description it has been adopted relatively quickly for various reasons. To date, there are at least 7 Brazilian studies published, including a series of more than 400 cases. The aim of this work is to study the progression of Transoral Neck Surgery in Brazil and describe the profile of surgeons involved in this new approach. METHODS this is a retrospective study with descriptive statistics. A REDCap based survey about transoral endoscopic thyroidectomy and parathyroidectomy vestibular approach (TOETVA/TOEPVA) was done with 66 Brazilian surgeons regarding surgeon profile, numbers of cases performed by geographic region, what kind of training was necessary prior to the first case and behavior of the surgeon proposing these new approaches. RESULTS response rate of this survey was 53%. To date, 1275 TOETVA/TOEPVA cases had been performed in Brazil, 1229 thyroidectomies (96.4%), 42 parathyroidectomies (3.3%) and 4 combined procedures (0.3%). Most of the cases were done in the southeast region (821, 64.4%), 538 (42.2%) cases in the State of São Paulo and 283 (22.2%) cases in the State of Rio de Janeiro. CONCLUSIONS TOETVA is becoming popular in Brazil. Younger surgeons, especially those between 30 and 50 years old were more likely to adopt this approach.
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Affiliation(s)
- Lucas Ribeiro Tenório
- - Faculdade de Ciências Médicas da Santa Casa de São Paulo, Disciplina de Cirurgia de Cabeça e Pescoço, Departamento de Cirurgia - São Paulo - SP - Brasil
| | - Antonio Augusto Bertelli
- - Faculdade de Ciências Médicas da Santa Casa de São Paulo, Disciplina de Cirurgia de Cabeça e Pescoço, Departamento de Cirurgia - São Paulo - SP - Brasil
| | - Marianne Yumi Nakai
- - Faculdade de Ciências Médicas da Santa Casa de São Paulo, Disciplina de Cirurgia de Cabeça e Pescoço, Departamento de Cirurgia - São Paulo - SP - Brasil
| | - Marcelo Benedito Menezes
- - Faculdade de Ciências Médicas da Santa Casa de São Paulo, Disciplina de Cirurgia de Cabeça e Pescoço, Departamento de Cirurgia - São Paulo - SP - Brasil
| | - Jonathon Owen Russell
- - Universidade Johns Hopkins, Divisão de Cirurgia Endócrina em Cabeça e Pescoço - Baltimore - MD - Estados Unidos
| | - Antonio José Gonçalves
- - Faculdade de Ciências Médicas da Santa Casa de São Paulo, Disciplina de Cirurgia de Cabeça e Pescoço, Departamento de Cirurgia - São Paulo - SP - Brasil
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Chereau N, Paladino NC, Nomine Criqui C, Tresallet C, Deroide G, Caiazzo R. Transoral endoscopic thyroidectomy vestibular approach (TOETVA). Recommendations of the AFCE (Francophone Association of Endocrine Surgery) with the SFE (French Society of Endocrinology) and the SFMN (French Society of Nuclear Medicine). J Visc Surg 2023:S1878-7886(23)00080-2. [PMID: 37198067 DOI: 10.1016/j.jviscsurg.2023.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
Transoral endoscopic thyroidectomy vestibular approach (TOETVA) can be proposed for selected patients with a thyroid volume<45mL and/or a nodule<4cm (for Bethesda category II, III or IV lesions), or<2cm (for Bethesda category V or VI lesions), with no suspicion of lateral nodal involvement or mediastinal extension who wish to avoid a cervical scar. Such patients should have satisfactory dental status, have been educated on the specific risks of the transoral route and the need for perioperative oral care, and also fully informed regarding the lack of proof of TOETVA effectiveness in terms of quality of life and patient satisfaction. The patient should be made aware of the possibility of postoperative pain in the neck cervical and chin, which may persist for several days to a few weeks after the intervention. Transoral endoscopic thyroidectomy should be performed in centers with expertise in thyroid surgery.
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Affiliation(s)
- Nathalie Chereau
- Department of General, Visceral and Endocrine Surgery, GH Pitié-Salpêtrière, AP-HP, Sorbonne University, 47-83, boulevard de l'Hôpital, 75013 Paris, France.
| | - Nunzia Cinzia Paladino
- Department of General, Endocrine and Metabolic Surgery, CHU La Conception, AP-HM, Aix Marseille University, Marseille, France
| | - Claire Nomine Criqui
- Department of Visceral, Metabolic and Oncological Surgery, University of Lorraine, CHRU Nancy, Brabois Hospital, Vandœuvre-lès-Nancy, France
| | - Christophe Tresallet
- Department of Digestive, Bariatric and Endocrine Surgery, HU Paris Seine-Saint-Denis, AP-HP, Avicenne Hospital, Bobigny, France
| | - Gregoire Deroide
- Visceral Surgery Department, Hôpital Franco-Britannique-Fondation Cognacq-Jay, Levallois-Perret, France
| | - Robert Caiazzo
- General and Endocrine Surgery Department, University Hospital Center of Lille, Lille, France
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Transoral Thyroidectomy: Initial Results of the European TOETVA Study Group. World J Surg 2023; 47:1201-1208. [PMID: 36799993 PMCID: PMC10070222 DOI: 10.1007/s00268-023-06932-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2023] [Indexed: 02/18/2023]
Abstract
BACKGROUND The aim of this study was to evaluate a new surgical technique by the European Transoral Endoscopic Thyroidectomy Vestibular Approach (TOETVA) Study Group. METHODS This study included 391 patients (47 [(12%]) male and 344 [(88%)] female) who had undergone endoscopic thyroid or parathyroid surgery via the vestibular approach between February 2016 and May 2022 at nine centers. The data were analyzed with regard to complications, surgery time and specimen retrieval. RESULTS Overall, 376 (96.2%) TOETVA and 15 (3.8%) transoral endoscopic parathyroidectomy vestibular approach interventions were performed with an average surgery time of 145 (± 61.2) minutes and 509 nerves at risk. The specimens were retrieved via a transoral vestibular and retroauricular approach in 66 (16.9%) patients and via a transaxillary approach in 8 (2%). Benign histology including Grave's disease was identified in 272 (69.6%) patients, 1 (0.3%) presented noninvasive follicular thyroid neoplasms with papillary-like nuclear features, and 103 (26.3%) showed differentiated thyroid carcinoma. Solitary parathyroid adenoma were removed in 15 (3.8%) patients. Conversion to open surgery was necessary in 13 (3.3%) and revision had to be performed in 2 (0.5%) patients. Transient recurrent laryngeal nerve palsy (RLNP) was present in 18 (4.6%) and permanent RLNP in 2 (0.5%) patients. Fifteen (3.8%) patients experienced transient hypoparathyroidism after thyroidectomy. No case of permanent hypoparathyroidism was observed. Postoperative surgical site infection occurred in 1 (0.3%) patient. Despite a higher rate of sensory and motor disorders and skin discoloration at discharge, permanent disorders were present in only 3 (0.8%) and 16 (4.1%) patients, respectively. CONCLUSION Our results show that transoral endoscopic surgery, performed by experienced endocrine surgeons, is a safe alternative to conventional thyroid surgery.
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Yan X, Zhu C, Wu W, Geng X, Ding Y, Li Y. Transoral endoscopic thyroidectomy vestibular approach for papillary thyroid microcarcinoma: an analysis of clinical outcomes. Am J Transl Res 2022; 14:7907-7915. [PMID: 36505275 PMCID: PMC9730113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 10/11/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To analyze the influence of transoral endoscopic thyroidectomy vestibular approach (TOETVA) on the clinical outcomes of patients with papillary thyroid microcarcinoma (PTMC). METHODS The clinical data of PTMC patients (n=90) who visited the Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University from July 2019 to July 2021 were retrospectively analyzed. Patients who underwent endoscopic thyroidectomy via the transthoracic-areola approach were included in the control group (CG; n=42) and those with TOETVA were assigned to the observation group (OG; n=48). The operative time (OT), length of hospital stay (LOS), postoperative drainage volume, and complications were recorded. Besides, C-reactive protein (CRP), white blood cell count (WBC), erythrocyte sedimentation rate (ESR), as well as scores of the Visual Analogue Scale (VAS), Vancouver Scar Scale (VSS), postoperative patient satisfaction, and the Short-Form 36 Item Health Survey (SF-36) were compared between the two groups. RESULTS The data showed that the OT and LOS of the OG were not statistically different from those of the CG, and the postoperative drainage volume was less than that of the CG (P<0.05). The two cohorts of patients showed a similar incidence of complications such as postoperative hematoma, transient hoarseness, infection, temporary recurrent laryngeal nerve injury and transient hypothyroidism (all P>0.05). CRP, WBC and ESR increased in both groups after treatment but showing no evident difference between groups. The OG had statistically lower VAS and VSS scores at two days after surgery, a statistical higher satisfaction rate than the CG, and a statistically higher score of SF-36 at three months after surgery than in the CG (all P<0.05). CONCLUSIONS While ensuring the therapeutic effect, TOETVA can significantly reduce the pain degree of patients and scarring, as well as provide better cosmetic effect, higher patient satisfaction, and better quality of life, which is worthy of clinical promotion.
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Affiliation(s)
- Xiaoyi Yan
- Department of Thyroid Surgery, The Affiliated Changzhou No. 2 People’s Hospital of Nanjing Medical UniversityChangzhou, Jiangsu, China
| | - Chunfu Zhu
- Department of General Surgery, The Affiliated Changzhou No. 2 People’s Hospital of Nanjing Medical UniversityChangzhou, Jiangsu, China
| | - Wenze Wu
- Department of Thyroid Surgery, The Affiliated Changzhou No. 2 People’s Hospital of Nanjing Medical UniversityChangzhou, Jiangsu, China
| | - Xiang Geng
- Department of Thyroid Surgery, The Affiliated Changzhou No. 2 People’s Hospital of Nanjing Medical UniversityChangzhou, Jiangsu, China
| | - Yu Ding
- Department of Thyroid Surgery, The Affiliated Changzhou No. 2 People’s Hospital of Nanjing Medical UniversityChangzhou, Jiangsu, China
| | - Yuan Li
- Department of Thyroid Surgery, The Affiliated Changzhou No. 2 People’s Hospital of Nanjing Medical UniversityChangzhou, Jiangsu, China
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Zhang Y, Fu SC, Wu Y, Zhou CS, Ma XY. Research on pharyngeal bacterial flora in transoral atlantoaxial operation and the postoperative follow-up study. BMC Musculoskelet Disord 2022; 23:922. [PMID: 36261821 PMCID: PMC9580130 DOI: 10.1186/s12891-022-05851-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 09/13/2022] [Indexed: 11/18/2022] Open
Abstract
Objectives To study the changes of bacterial flora after a series of preoperative oral disinfection and the postoperative recovery of nerve function of patients with craniovertebral junction disorders who were treated with transoral approach operations. Methods This research analyzed 20 cases collected from October 2009 to May 2010. All these patients were with CVJ disorders, including 8 males and 12 females, aged 2 to 66 (38.1 on average), and they were all treated with transoral approach operations. The mucosa samples of the posterior pharyngeal wall were sent for bacteria culture. These samples were collected by sterile cotton swabs at four crucial points, including 3 days before operation/before gargling, 3 days after continuous gargling/after anesthesia intubation on the day of operation, after intraoperative cleaning and washing of the mouth, and after intraoperative iodophor immersion. The microflora was stained by means of smear and further counted after an investigation by microscope. The neural function of patients was evaluated by the ASIA classification and the JOA scores. All patients but two with posterior stabilization performed respectively underwent transoral atlantoaxial reduction plate (TARP) fixation consecutively in the same sitting. A regular reexamination of cervical vertebra with lateral and open mouth X-ray, CT and MRI was conducted after operation to evaluate the reduction of atlantoaxial dislocation, internal fixation position, bone graft fusion, inflammatory lesions and tumor recurrence. Results This bacteriological research showed that the mucosa of the posterior pharyngeal wall of all the patients was in a sterile state after a series of oral preoperative preparations and intraoperative iodophor disinfection, which was considered as type I incision. The bacterial culture results of the mucosa samples of the posterior pharyngeal wall collected at different time points showed significant differences (χ2 = 42.762, P = 0.000). All the patients had improvement in ASIA, and their neural functions were improved to different levels after operation. There was a significant difference in JOA scores before and after operation (t = 8.677, P = 0.000). Postoperative imaging examination showed that the atlantoaxial screw position was good and firm, and the CVJ disorders were treated appropriately. Conclusion It is safe and effective to cut the posterior pharyngeal muscle layer and implant internal fixation by means of transoral approach.
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Affiliation(s)
- Yu Zhang
- Department of Orthopaedics, General Hospital of Southern Theatre Command of PLA, Guangzhou, 510010, Guangdong, People's Republic of China.
| | - Suo-Chao Fu
- Department of Orthopaedics, General Hospital of Southern Theatre Command of PLA, Guangzhou, 510010, Guangdong, People's Republic of China
| | - You Wu
- Department of Orthopaedics, General Hospital of Southern Theatre Command of PLA, Guangzhou, 510010, Guangdong, People's Republic of China
| | - Chu-Song Zhou
- Department of Orthopaedics, Zhu-Jiang Hospital of Southern Medical University (First Military Medical University), Guangzhou, 510282, Guangdong, People's Republic of China.
| | - Xiang-Yang Ma
- Department of Orthopaedics, General Hospital of Southern Theatre Command of PLA, Guangzhou, 510010, Guangdong, People's Republic of China.
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Lee JS, Kim HJ, Lee JS, Yun HJ, Lee S, Cheong JH, Kim SY, Kim SM, Chang H, Lee YS, Park CS, Chang HS. Prophylactic antibiotics may not be necessary for transoral endoscopic thyroidectomy. Front Surg 2022; 9:940391. [PMID: 35983550 PMCID: PMC9379135 DOI: 10.3389/fsurg.2022.940391] [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: 05/10/2022] [Accepted: 07/08/2022] [Indexed: 11/23/2022] Open
Abstract
Background With the recent advances in thyroid cancer surgery techniques and the increasing number of patients concerned about cosmetics, the use of transoral endoscopic thyroidectomy is increasing globally. The aim of this study was to determine whether transoral endoscopic thyroidectomy is truly a clean-contaminated surgery. Methods From September 2016 to April 2018, 20 patients with thyroid cancer underwent transoral endoscopic thyroidectomy performed by a single surgeon at Gangnam Severance Hospital. Before and after surgery, the oral cavity was swabbed to obtain culture samples, and antibiotics were administered before and after surgery each once. Results Of the total 20 patients, no bacteria were identified before or after surgery in eight (40%) patients. Bacteria were identified both before and after surgery in seven patients (35%). In four patients (20%), bacteria were not identified before surgery, but bacteria were identified after surgery. Bacteria were identified before surgery but not after surgery in one patient (5%). No surgical site infection was observed. All the bacteria identified were normal flora of the oral cavity and skin. Conclusions There was no difference between the preoperative culture and postoperative culture of the oral cavity in patients undergoing TOET, and there were no postoperative surgical site infection with prophylactic pre & post-operative antibiotics use. Considering the patient's position and surgical extent in TOET, it appears to be difficult for non-indigenous bacteria to invade the surgical site in oral cavity.
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Affiliation(s)
- Jun Sung Lee
- Department of Surgery, Thyroid Cancer Center, Gangnam Severance Hospital, Institute of Refractory Thyroid Cancer, Yonsei University College of Medicine, Seoul, South Korea
| | - Hee Jun Kim
- Department of Surgery, CHA Ilsan Medical Center, Cha University School of Medicine, Goyang-si, South Korea
| | - Jin Seok Lee
- Department of Surgery, Thyroid Cancer Center, Gangnam Severance Hospital, Institute of Refractory Thyroid Cancer, Yonsei University College of Medicine, Seoul, South Korea
| | - Hyeok Jun Yun
- Department of Surgery, Thyroid Cancer Center, Gangnam Severance Hospital, Institute of Refractory Thyroid Cancer, Yonsei University College of Medicine, Seoul, South Korea
| | - Suji Lee
- Department of Surgery, Graduate school of medical science, BK21 Project, Yonsei University College of Medicine, Seoul, Korea
| | - Jae-Ho Cheong
- Department of Surgery, Graduate school of medical science, BK21 Project, Yonsei University College of Medicine, Seoul, Korea
| | - Soo Young Kim
- Department of Surgery, Ajou University School of Medicine, Suwon, Korea
| | - Seok-Mo Kim
- Department of Surgery, Thyroid Cancer Center, Gangnam Severance Hospital, Institute of Refractory Thyroid Cancer, Yonsei University College of Medicine, Seoul, South Korea
- Correspondence: Seok-mo Kim
| | - Hojin Chang
- Department of Surgery, Thyroid Cancer Center, Gangnam Severance Hospital, Institute of Refractory Thyroid Cancer, Yonsei University College of Medicine, Seoul, South Korea
| | - Yong Sang Lee
- Department of Surgery, Thyroid Cancer Center, Gangnam Severance Hospital, Institute of Refractory Thyroid Cancer, Yonsei University College of Medicine, Seoul, South Korea
| | - Cheong Soo Park
- Department of Surgery, CHA Ilsan Medical Center, Cha University School of Medicine, Goyang-si, South Korea
| | - Hang-Seok Chang
- Department of Surgery, Thyroid Cancer Center, Gangnam Severance Hospital, Institute of Refractory Thyroid Cancer, Yonsei University College of Medicine, Seoul, South Korea
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de Cillia M, Obrist C, Mittermair C, Karakas E, Weiss H. Flexible single port access in transoral endoscopic thyroidectomy vestibular approach. Gland Surg 2022; 11:778-787. [PMID: 35694100 PMCID: PMC9177271 DOI: 10.21037/gs-21-818] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 04/02/2022] [Indexed: 10/14/2023]
Abstract
BACKGROUND Transoral endoscopic thyroidectomy vestibular approach (TOETVA) is regarded the only no-scar technique which combines minimized surgical trauma with all advantages of endoscopy such as enhanced view, fluorescent parathyroid imaging (FPI) and optimum cosmesis. Addressing TOETVA specific local risk profiles like mental nerve injury, the potential of skin lesions or difficult specimen retrieval we modified the three trocar based TOETVA towards a soft single port platform. METHODS Single port-TOETVA (SP-TOETVA) was established and retrospectively analysed in five patients using a soft handmade single port housing multiple trocar valves. Standard laparoscopic instruments, one articulating instrument and a vessel-sealing device were utilized. CO2 insufflation was maintained at 6-8 mmHg. RESULTS In all patients SP-TOETVA was completed successfully. Hemigland and total thyroid volumes ranged from 5-40 and 55 mL, respectively. Neither additional trocars nor conversion to open was required. Operation time yielded 102-214 min. Neuromonitoring and FPI were applied. The soft wound protection foil served for convenient specimen harvest. No intra- or postoperative complication occurred. In particular, no functional impairment on mental nerve was seen. CONCLUSIONS SP-TOETVA with the soft and flexible handmade single port system is feasible and ensures wound protection. It allows for easy instrument application and benefits of minimally invasive surgery without the specific risk of lateral vestibular incisions.
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Affiliation(s)
- Michael de Cillia
- Department of Surgery, Saint John of God (SJOG) Hospital, Salzburg, Austria
| | - Christian Obrist
- Department of Surgery, Saint John of God (SJOG) Hospital, Salzburg, Austria
| | | | - Elias Karakas
- Department of General-, Visceral-, Endocrine Surgery, Hospital Maria Hilf, Alexianer GmbH, Krefeld, Germany
| | - Helmut Weiss
- Department of Surgery, Saint John of God (SJOG) Hospital, Salzburg, Austria
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