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Agne GR, Kohler HF, Lira RB, Belli M, Bento GN, Viana A, Kowalski LP. Aesthetic Perceptions Regarding a Thyroidectomy Scar and Transvestibular Approach in Brazil. Laryngoscope 2024; 134:3862-3867. [PMID: 38411345 DOI: 10.1002/lary.31372] [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: 11/06/2023] [Revised: 02/05/2024] [Accepted: 02/15/2024] [Indexed: 02/28/2024]
Abstract
OBJECTIVE We investigated motivation levels across the general Brazilian population and subgroups and their willingness to spend for surgery without a cervical scar. METHODS This random-sample survey was performed by a specialized third-party research institute. In this study, we created a hypothetical thyroidectomy scenario, and the transcervical and transoral endoscopic thyroidectomy vestibular approach (TOETVA) were used. The survey included sociocultural data and questions regarding participants' surgical preferences. RESULTS Data were obtained from 1250 participants; 42.4% were of the opinion that a cervical scar affects social or professional life. Young and childless women were most likely to be affected (p <0.001). All respondents accepted the transoral approach to avoid cervical scarring. However, 30.7% and 31.9% of respondents maintained their preference for TOETVA despite understanding the risks of a hypothetical increase in complications and unfavorable oncological outcomes and 98.6% were of the opinion that this approach was likely associated with greater postoperative pain. Only 16.2% were unwilling to spend for TOETVA. The variable that most affected patients' willingness to spend was a salary greater than 10 Brazilian minimum wages (odds ratio 9.797, 95% confidence interval, p <0.005). Upper class respondents were 10 times more likely to spend for TOETVA than lower class patients. CONCLUSION This study highlights patients' interest in TOETVA. Cervical scar perception is affected by concerned about appearance, particularly in certain societal subgroups. Our study population showed significant motivation to undergo TOETVA, which was emphasized by their acceptance of the complication rate, poor postoperative outcomes, greater postoperative pain, and willingness to spend on surgery with an invisible scar. LEVEL OF EVIDENCE 4 Laryngoscope, 134:3862-3867, 2024.
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Affiliation(s)
| | - Hugo Fontan Kohler
- Department of Head and Neck Surgery and Otorhinolaryngology, A.C. Camargo Cancer Center, São Paulo, Brazil
| | - Renan Bezerra Lira
- Department of Head and Neck Surgery and Otorhinolaryngology, A.C. Camargo Cancer Center, São Paulo, Brazil
| | - Marcelo Belli
- Department of Head and Neck Surgery, PESCOP Group, Balneário Camboriú, Brazil
| | - Gustavo Nunes Bento
- Department of Head and Neck Surgery, PESCOP Group, Balneário Camboriú, Brazil
| | - Acklei Viana
- Department of Head and Neck Surgery, NICAP Group, Florianópolis, Brazil
| | - Luiz Paulo Kowalski
- Department of Head and Neck Surgery and Otorhinolaryngology, A.C. Camargo Cancer Center, São Paulo, Brazil
- Department of Head and Neck Surgery, Universidade de São Paulo, São Paulo, Brazil
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Park J, Kim K. Current and Future of Robotic Surgery in Thyroid Cancer Treatment. Cancers (Basel) 2024; 16:2470. [PMID: 39001532 PMCID: PMC11240454 DOI: 10.3390/cancers16132470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Revised: 07/02/2024] [Accepted: 07/03/2024] [Indexed: 07/16/2024] Open
Abstract
Thyroid cancer is among the most common endocrine malignancies, necessitating effective surgical interventions. Traditional open cervicotomy has long been the standard approach for thyroidectomy. However, the advent of robotic surgery has introduced new possibilities for minimally invasive procedures with benefits in terms of cosmetic outcomes, enhanced precision, comparable complication rates, and reduced recovery time. This study mainly reviewed the most widely used and well-known robotic thyroidectomy approaches: the transaxillary approach, the bilateral axillo-breast approach, and the transoral approach. This review examines the current status and future potential of robotic surgery in thyroid cancer treatment, comparing its efficacy, safety, and outcomes with those of conventional open cervicotomy. Challenges such as a longer operative time and higher costs exist. Future directions include technological advancements, tele-surgery, single-port surgery, and the integration of artificial intelligence. Robotic surgery holds promise in optimizing patient outcomes in thyroid cancer treatment.
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Affiliation(s)
- Joonseon Park
- Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Kwangsoon Kim
- Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
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Nagururu NV, Seo S, Ding AS, Grogan R, Wolfe SA, Harbison RA, Tufano RP, Russell JO. Long-term Quality of Life After Thyroidectomy: Transoral Endoscopic Thyroidectomy Vestibular Approach Versus Transcervical Approach. Otolaryngol Head Neck Surg 2024; 171:45-53. [PMID: 38488229 DOI: 10.1002/ohn.712] [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: 10/12/2023] [Revised: 01/31/2024] [Accepted: 02/05/2024] [Indexed: 06/28/2024]
Abstract
OBJECTIVE To compare long-term health-related quality of life (HRQOL) after Transoral Endoscopic Thyroidectomy Vestibular Approach (TOETVA) and transcervical approach (TCA) thyroidectomy. STUDY DESIGN Prospective cohort study. SETTING Tertiary referral center. METHODS A web-based survey was distributed to patients at our institution who met the criteria for TOETVA and underwent thyroidectomy by TOETVA or TCA between August 2017 and October 2021. All survey participants were at least 6 months postsurgery. Minors, non-English speakers, and patients who received concomitant neck dissection or reoperative thyroidectomy were excluded from the study. The survey assessed quality of life through 4 standardized instruments: the Dermatology Life Quality Index (DLQI), the Eating Assessment Tool (EAT-10), the Voice Handicap Index (VHI-10), and the Short Form Health Survey (SF-36). RESULTS A total of 108 TOETVA and 129 TCA patients were included in the study. The median age of respondents was 44 (36, 54; 25th, 75th percentile) years and median time from surgery to survey was 35 (22, 45; 25th, 75th percentile) months. TOETVA group DLQI (0.63 vs 0.99; P = .17), VHI-10 (1.94 vs 1.67; P = .35), EAT-10 (2.14 vs 2.32; P = .29), SF-36 physical component (52.25 vs 51.00; P = .25), and SF-36 mental component (47.74 vs 47.29; P = .87) scores were all similar to those of the TCA group. Scrutinizing specific DLQI questions, individuals in the TOETVA group were less self-conscious of their skin as compared to the TCA group (Q2; 0.08 vs 0.26, P = .03). CONCLUSION Long-term HRQOL after TOETVA is similar to TCA, with significantly lower skin-related self-consciousness.
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Affiliation(s)
- Nimesh V Nagururu
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Stefanie Seo
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Andy S Ding
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Raymon Grogan
- Department of Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - Samantha A Wolfe
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Richard Alex Harbison
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Ralph P Tufano
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Division of Head and Neck Endocrine Surgery, Sarasota Memorial Health Care System, Sarasota, Florida, USA
| | - Jonathon O Russell
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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La Via L, Zanghì A, Cavallaro A, Di Vita M, Maniaci A, Cocuzza S, Cappellani A, Di Majo S. Vestibular approach for thyroid surgery: a comprehensive review. Front Surg 2024; 11:1423222. [PMID: 38948483 PMCID: PMC11211391 DOI: 10.3389/fsurg.2024.1423222] [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: 04/25/2024] [Accepted: 05/29/2024] [Indexed: 07/02/2024] Open
Abstract
The transoral endoscopic thyroidectomy vestibular approach (TOETVA) is an innovative technique in thyroid surgery. This review compiles current research on TOETVA, covering its development, anatomical challenges, techniques, selection of suitable patients, results, complications, and future advancements. We performed a comprehensive literature review on PubMed, EMBASE, and Cochrane databases for articles published up to 15th March 2024. The search strategy included a combination of terms focused on "vestibular approach" and "thyroidectomy". The review underscores the necessity for preoperative planning and careful patient selection to reduce risks and enhance outcomes. It discusses the unique anatomical challenges of TOETVA, such as avoiding mental nerve damage and the complexities involved in creating a subplatysmal space. Outcomes of TOETVA, including surgical duration, complication rates, and recovery times, are compared favorably to traditional methods. The approach is particularly noted for high patient satisfaction and superior cosmetic results. Complications specific to TOETVA, like infection, bleeding, and potential harm to the recurrent laryngeal nerve, are recognized. Future research directions are discussed as well. In summary, TOETVA is a promising alternative for thyroidectomy with excellent cosmetic outcomes and patient satisfaction. Success relies on selective patient criteria, surgical expertise, and continuous research to refine the approach.
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Affiliation(s)
- Luigi La Via
- Department of Anesthesia and Intensive Care, University Hospital Policlinico “G.Rodolico-San Marco”, Catania, Italy
| | - Antonio Zanghì
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia”, University of Catania, Catania, Italy
- Centro di Ricerca in Chirurgia Delle Sindromi Malformative Complesse Della Transizione e dell’Età Adulta, University of Catania, Catania, Italy
| | - Andrea Cavallaro
- Department of General Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy
| | - Maria Di Vita
- Department of General Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy
| | - Antonino Maniaci
- Faculty of Medicine and Surgery, University of Enna “Kore”, Enna, Italy
| | - Salvatore Cocuzza
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia”, University of Catania, Catania, Italy
| | - Alessandro Cappellani
- Department of General Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy
| | - Simone Di Majo
- Residency Program in General Surgery, University of Catania, Catania, Italy
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Kinet S, van Weezelenburg MAS, Pijnenburg A, Stoot JHMB, van Bastelaar J. Feasibility and complications after transoral endoscopic thyroidectomy via vestibular approach (TOETVA) - a single-center first experience case series. Langenbecks Arch Surg 2024; 409:158. [PMID: 38748236 DOI: 10.1007/s00423-024-03347-3] [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: 11/29/2023] [Accepted: 05/06/2024] [Indexed: 05/18/2024]
Abstract
BACKGROUND This paper reports on the first experience after implementation of a transoral endoscopic thyroidectomy via vestibular approach (TOETVA) as an alternative to (partial) thyroidectomy or isthmusectomy in a single center. Feasibility, implementation and specific complications are addressed. METHODS All patients who underwent a TOETVA procedure in our center between November 2019 and March 2023 were included. The surgical technique was performed as described by Anuwong et al. All procedures were performed by two dedicated head- and neck surgeons. RESULTS A total of 20 patients were included. All patients underwent TOETVA surgery as planned and no conversions were needed. Observed complications were post-operative wound infections (POWI) (2/20; 10%), clinically significant seroma (1/20, 5%) and unilateral hemiparesis of the larynx (3/20; 15%). Permanent mental nerve damage was seen in 3/20 patients (15%), and 4 other patients (20%) experienced transient neuropraxia. CONCLUSIONS TOETVA is a feasible alternative to (partial) thyroidectomy or isthmusectomy in selected patients. Special care should be taken when placing the trocars in the oral vestibulum to prevent mental nerve damage. Experience and training are essential for implementing the TOETVA procedure. TRIAL REGISTRATION This study was registered to ClinicalTrials.gov. TRIAL REGISTRATION NUMBER NCT05396703.
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Affiliation(s)
- Sam Kinet
- Faculty of Medicine, KU Leuven, Herestraat 49, Leuven, 3000, Belgium.
| | | | - A Pijnenburg
- Department of Surgery, Zuyderland Medical Centre, Dr. H. van der Hoffplein 1, Sittard-Geleen, 6162 BG, The Netherlands
| | - J H M B Stoot
- Department of Surgery, Zuyderland Medical Centre, Dr. H. van der Hoffplein 1, Sittard-Geleen, 6162 BG, The Netherlands
| | - J van Bastelaar
- Department of Surgery, Zuyderland Medical Centre, Dr. H. van der Hoffplein 1, Sittard-Geleen, 6162 BG, The Netherlands
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Ngo QX, Ngo DQ, Le DT, Nguyen DD, Tran TD, Le QV. Transoral endoscopic thyroidectomy vestibular approach versus conventional open thyroidectomy for the treatment of benign thyroid tumours: A prospective cohort study. J Minim Access Surg 2024:01413045-990000000-00028. [PMID: 38214326 DOI: 10.4103/jmas.jmas_197_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 09/18/2023] [Indexed: 01/13/2024] Open
Abstract
INTRODUCTION Thyroid tumours are a common condition and open surgery is a conventional method for treating benign thyroid tumours when surgery is indicated. In this study, we evaluate the outcomes of benign thyroid tumour treatment using transoral endoscopic thyroidectomy via vestibular approach (TOETVA) and compare the results with those of conventional open thyroidectomy (COT). PATIENTS AND METHODS We conducted a prospective cohort study between 100 patients who underwent TOETVA and 100 who underwent COT surgery for benign diseases from June 2018 to December 2021 in our hospital. Outcomes between the two groups, including post-operative complications, operative time and length of stay, were compared. RESULTS The surgical time in the TOETVA group was significantly longer than in the COT group. The operative time of lobectomy in the TOETVA and COT groups was 77.5 ± 13.3 and 51.5 ± 4.2 min, respectively, with a P < 0.001. The operative time of total thyroidectomy in the TOETVA and COT groups was 108.1 ± 7.0 and 65.0 ± 4.1 min, respectively, with a P < 0.001. There was no difference in post-operative length of stay between the two groups. In TOETVA group, there were no patients who converted to open surgery. Amongst all 200 patients in the study, there were no cases of post-operative bleeding. The transient hypoparathyroidism rate after surgery in the TOETVA and COT groups was 3% and 2%, respectively, with no statistically significant difference (P = 0.651). Similarly, the transient recurrent laryngeal nerve injury rate showed no difference between the two groups, with rates of 5% and 4% in the TOETVA and COT groups, respectively (P = 0.733). There were no cases of post-operative infection in either group in our study. At 3 months postoperatively, the cosmetic satisfaction were significantly higher in the endoscopic groups than in the conventional group (P < 0.001). CONCLUSIONS TOETVA is a safe and effective method, with a low complication rate and optimal aesthetic results compared to traditional surgery to treat benign thyroid tumours.
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Affiliation(s)
- Quy Xuan Ngo
- Department of Head and Neck Surgery, Vietnam National Cancer Hospital, Thanh Tri District, Hanoi, Vietnam
| | - Duy Quoc Ngo
- Department of Head and Neck Surgery, Vietnam National Cancer Hospital, Thanh Tri District, Hanoi, Vietnam
- Department of Oncology, Hanoi Medical University, Dong Da, Hanoi, Vietnam
| | - Duong The Le
- Department of Head and Neck Surgery, Vietnam National Cancer Hospital, Thanh Tri District, Hanoi, Vietnam
| | - Duc Dinh Nguyen
- Department of Head and Neck Surgery, Vietnam National Cancer Hospital, Thanh Tri District, Hanoi, Vietnam
| | - Toan Duc Tran
- Department of Head and Neck Surgery, Vietnam National Cancer Hospital, Thanh Tri District, Hanoi, Vietnam
| | - Quang Van Le
- Department of Head and Neck Surgery, Vietnam National Cancer Hospital, Thanh Tri District, Hanoi, Vietnam
- Department of Oncology, Hanoi Medical University, Dong Da, Hanoi, Vietnam
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Ritter A, Levyn H, Shah J. Recent advances in head and neck surgical oncology. J Surg Oncol 2024; 129:32-39. [PMID: 37990842 PMCID: PMC10842243 DOI: 10.1002/jso.27529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 10/31/2023] [Indexed: 11/23/2023]
Abstract
In recent years, the field of head and neck oncology has witnessed a remarkable transformation with unprecedented advances that have revolutionized the management of complex tumors in this region. As an intricate subspecialty within oncology, head and neck surgical procedures demand detailed knowledge of the complex anatomy meticulous precision in surgical technique, and expertise to preserve vital functions while ensuring optimal oncological outcomes. With the relentless pursuit of improved patient outcomes, the integration of innovative technologies has significantly enhanced the surgical armamentarium. Robotics, endoscopic platforms, and image-guided navigation have revolutionized the surgical approach, enabling precise tumor resection and sparing healthy tissues. Furthermore, the application of advanced imaging modalities and molecular biomarker profiling has opened new avenues for personalized treatment strategies. From targeted therapies and immunotherapies to adaptive radiation techniques, clinicians are now equipped with an array of tailored options, ushering in a new era of personalized care for patients with head and neck malignancies. This article delves into the unfolding narratives of clinical triumphs, exploring the transformative potential of emerging therapies and the collaborative efforts propelling head and neck surgical oncology toward a future of hope and healing.
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Karimov Z, Kim SM, Turk Y, Dionigi G, Moscoso ES, Ozdemir M, Frattini F, Ozgul S, Makay O. Complication and conversion outcomes in transoral endoscopic thyroidectomy vestibular approach (TOETVA): a retrospective multicenter propensity score-matched cohort study. Updates Surg 2024; 76:227-238. [PMID: 38095833 DOI: 10.1007/s13304-023-01721-2] [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: 10/05/2023] [Accepted: 11/29/2023] [Indexed: 01/24/2024]
Abstract
Transoral endoscopic thyroidectomy with vestibular approach (TOETVA) is a scarless thyroid surgery used as an alternative to open conventional surgery. Our aim was to investigate possible risk factors for complications and conversion during TOETVA. The study was conducted internationally by centres from Turkiye, the Republic of Korea, Italy, and Peru. A total of 406 patients who underwent TOETVA and were ≥ 18 years of age were included in the study. Demographic, pre-, intra-, and postoperative data were collected and compared between the groups with/without complication/conversion to identify possible predictors of complication/conversion. Subsequently, patients with complication/conversion were matched by the hospital, age, sex, and American Society of Anesthesiologists classification score using a propensity score (PSM) of 1:3 to eliminate confounding differences. Results were reported for the un-matched and matched groups. Complications occurred in 11 (2.7%) patients. High body mass index (26.4 ± 3.4 vs. 23.3 ± 3.7, p = 0.007), larger tumor size (1.7 ± 1.3 cm. vs. 1.1 ± 1.0 cm, p = 0.012), larger thyroid volume (20.0 ± 9.2 vs. 12.8 ± 8.5, p = 0.007) and long operation time (127.8 ± 45.0 min. vs. 97.7 ± 38.5 min., p = 0.008) were significantly associated with complications in un-matched analyses. Older age (42.7 ± 8.0 vs. 34.9 ± 9.2, p = 0.023), high BMI (26.7 ± 3.2 vs. 23.3 ± 3.7, p = 0.012), and longer operation time (160.1 ± 54.1 min. vs. 97.4 ± 37.8, p = 0.001) were significantly related to conversion in un-matched analyses. However, significance was lost after PSM for both complication and conversion. The data from this study conducted on TOETVA cases do not suggest a risk factor for complications and conversion with PSM.
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Affiliation(s)
- Ziya Karimov
- Medicine Program, Ege University Faculty of Medicine, Izmir, Turkey
| | - 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
| | - Yigit Turk
- Division of Endocrine Surgery, Department of General Surgery, Ege University Hospital, Bornova, 35100, Izmir, Turkey
| | - Gianlorenzo Dionigi
- Division of Surgery, Istituto Auxologico Italiano IRCCS (Istituto di Ricovero e Cura a Carattere Scientifco), Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | | | - Murat Ozdemir
- Division of Endocrine Surgery, Department of General Surgery, Ege University Hospital, Bornova, 35100, Izmir, Turkey
| | - Francesco Frattini
- Division of Surgery, Istituto Auxologico Italiano IRCCS (Istituto di Ricovero e Cura a Carattere Scientifco), Milan, Italy
| | - Semiha Ozgul
- Department of Biostatistics and Medical Informatics, Ege University Faculty of Medicine, Izmir, Turkey
| | - Ozer Makay
- Division of Endocrine Surgery, Department of General Surgery, Ege University Hospital, Bornova, 35100, Izmir, Turkey.
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Jin X, Huang Z, Guo P, Yuan R. TOETVA: a single surgeon's learning curve and a case report of CASTLE thyroid tumor. Langenbecks Arch Surg 2023; 408:398. [PMID: 37831199 DOI: 10.1007/s00423-023-03140-8] [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: 07/06/2023] [Accepted: 10/04/2023] [Indexed: 10/14/2023]
Abstract
BACKGROUND Owing to the lack of visible scars, the transoral endoscopic thyroidectomy vestibular approach (TOETVA) offers superior aesthetic outcomes compared to conventional thyroidectomy. Carcinoma showing thymus-like differentiation (CASTLE) represents a rare thyroid gland neoplasm. This study aimed to explore the TOETVA learning curve and present a case report of CASTLE. METHODS A study with precise 1:1 matching was conducted to assess the procedure safety and cancer control outcomes of TOETVA in comparison to conventional surgery between May 2020 and May 2023. Cumulative sum analysis was employed to optimally fit the learning curve. Subsequently, a case report of CASTLE treated with TOETVA surgery was presented. RESULTS The mean operative time was longer in the TOETVA group than in the open group. The TOETVA group had a higher incidence of skin numbness and excellent cosmetic outcomes compared to the open group. The learning curves for work area preparation, unilateral thyroid lobectomy, and the entire surgical process were 59, 28, and 50 cases, respectively. There were no differences between the learning and proficient groups, except for operative time, intraoperative blood loss, and drainage volume on the first postoperative day. CONCLUSIONS A comprehensive analysis of the TOETVA learning curve utilizing cumulative and analytical methods demonstrated the feasibility of TOETVA with regards to surgical integrity, safety, and oncological safety. This study's findings suggest that a surgeon's cumulative number of TOETVA cases exceeding 50 can reach the mastery stage. Moreover, diagnosing CASTLE is challenging and necessitates immunohistochemical detection of relatively specific markers associated with thymic epithelial tumors.
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Affiliation(s)
- Xiaohu Jin
- Department of Thyroid and Breast Surgery, Nantong City No 1 People's Hospital and Second Affiliated Hospital of Nantong University, Chongchuan District, No. 6, North Child Lane, Nantong, Jiangsu, China
| | - Zhiqi Huang
- Department of Thyroid and Breast Surgery, Nantong City No 1 People's Hospital and Second Affiliated Hospital of Nantong University, Chongchuan District, No. 6, North Child Lane, Nantong, Jiangsu, China
| | - Peng Guo
- Department of Gastrointestinal Surgery, Nantong City No 1 People's Hospital and Second Affiliated Hospital of Nantong University, Nantong, China
| | - Ronghua Yuan
- Department of Thyroid and Breast Surgery, Nantong City No 1 People's Hospital and Second Affiliated Hospital of Nantong University, Chongchuan District, No. 6, North Child Lane, Nantong, Jiangsu, 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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Lu Q, Zhu X, Wang P, Xue S, Chen G. Comparisons of different approaches and incisions of thyroid surgery and selection strategy. Front Endocrinol (Lausanne) 2023; 14:1166820. [PMID: 37529600 PMCID: PMC10390217 DOI: 10.3389/fendo.2023.1166820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 04/13/2023] [Indexed: 08/03/2023] Open
Abstract
To date, the traditional open thyroid surgery via a low collar incision remains the standard approach for patients undergoing thyroidectomy. However, this conventional approach will inevitably leave patients a neck scar and even cause a variety of complications such as paresthesia, hypesthesia, and other uncomfortable sensations. With the progress in surgical techniques, especially in endoscopic surgery, and the increasing desire for cosmetic and functional outcomes, various new approaches for thyroidectomy have been developed to avoid or decrease side effects. Some of these alternative approaches have obvious advantages compared with traditional surgery and have already been widely used in the treatment of thyroid disease, but each has its limitations. This review aims to evaluate and compare the different approaches to thyroidectomy to help surgeons make the proper treatment strategy for different individuals.
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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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Cohen O, Mäkitie AA, Khafif A, Shaha AR, Randolph G, Coca-Pelaz A, Ferlito A. Remote-Access Thyroidectomy in the Pediatric Population: a Systematic Review. Adv Ther 2023; 40:1560-1570. [PMID: 36746825 DOI: 10.1007/s12325-023-02429-w] [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: 11/03/2022] [Accepted: 01/06/2023] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Remote-access thyroidectomy has been reported in the pediatric population in a limited fashion. METHODS This was a systematic review in PubMed and Scopus for pediatric remote-access thyroidectomy. RESULTS Seventy-eight articles were identified and screened, of which 13 met the inclusion criteria, including 231 patients; 70% of publications reported six or fewer patients. The mean age was 15.3 years (range 5-19). Sixty percent of surgeries were total thyroidectomy. Transaxillary robotic approach was most commonly performed (48.9%). Sixty-seven percent of the cases were operated on for a malignancy. Tumor size ranged between 0.4 and 1.8 cm. Recurrent laryngeal nerve injury rate was 1.9%. Transient and permanent hypocalcemia rates were 23.9% and 2.2%, respectively. CONCLUSION Pediatric remote-access thyroidectomy is not widely employed currently. Comparative studies with better quality are needed to establish its safety. Among selected pediatric patients, it can provide an alternative to open approaches, especially when neck scar is of major concern.
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Affiliation(s)
- Oded Cohen
- Department of Otorhinolaryngology - Head and Neck Surgery, Soroka Medical Center, Affiliated with Ben-Gurion University of the Negev, Be'er Sheva, Israel.
| | - Antti A Mäkitie
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Avi Khafif
- A.R.M. Center of Otolaryngology Head and Neck Surgery, Assuta Medical Center, Affiliated with Ben-Gurion University of the Negev, Tel Aviv, Israel
| | - Ashok R Shaha
- Head and Neck Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Gregory Randolph
- Division of Otolaryngology - Endocrine Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard University, Boston, MA, USA
| | - Andrés Coca-Pelaz
- Department of Otolaryngology, Hospital Universitario Central de Asturias, University of Oviedo, ISPA, IUOPA, CIBERONC, Oviedo, Spain
| | - Alfio Ferlito
- Coordinator of the International Head and Neck Scientific Group, Padua, Italy
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Wu V, Samargandy S, Philteos J, Pasternak JD, de Almeida JR, Monteiro E. Evaluation of Preference and Utility Measures for Transoral Thyroidectomy. Ann Otol Rhinol Laryngol 2023; 132:381-386. [PMID: 35503808 PMCID: PMC9989232 DOI: 10.1177/00034894221094950] [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: 11/16/2022]
Abstract
BACKGROUND Traditional, trans-cervical thyroidectomy results in the presence of a neck scar, which has been shown to correlate with lower quality of life and lower patient satisfaction. Transoral thyroid surgery (TOTS) has been utilized as an alternative approach to avoid a cutaneous incision and scar by accessing the neck and thyroid through the oral cavity. This study was designed to evaluate patient preference through health-state utility scores for TOTS as compared to conventional trans-cervical thyroidectomy. METHODS In this cross-sectional study, patient preferences were elicited for TOTS and trans-cervical thyroidectomy with the use of an online survey. Respondents were asked to consider 4 hypothetical health scenarios involving thyroid surgery with varying approaches. Health-state utility scores were elicited using visual analog scale and standard gamble exercises. RESULTS Overall, 516 respondents completed the survey, of whom 261 (50.6%) were included for analysis, with a mean age of 41.5 years (SD 14.9 years), including 171 (65.5%) females. Health utility scores were similar for TOTS and conventional transcervical techniques. Statistically significant differences in the standard gamble utility score were noted for gender and ethnicity across all scenarios. Comparisons of visual analog score utilities were not statistically significant based on respondent demographics. CONCLUSION Preferences for TOTS and trans-cervical thyroidectomy did not significantly differ in the current study. Females and white ethnicity indicated stronger preference for a TOTs approach compared to males and other ethnicities, respectively. Some literature suggests certain types of patients who might prefer minimally invasive thyroidectomy more so than other patients-in keeping with the current findings of this study.
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Affiliation(s)
- Vincent Wu
- Department of Otolaryngology-Head & Neck Surgery, Sinai Health, University of Toronto, Toronto, ON, Canada
| | - Shireen Samargandy
- Department of Otolaryngology-Head & Neck Surgery, Sinai Health, University of Toronto, Toronto, ON, Canada
| | - Justine Philteos
- Department of Otolaryngology-Head & Neck Surgery, Sinai Health, University of Toronto, Toronto, ON, Canada
| | - Jesse D Pasternak
- Department of Surgery, University Health Network, University of Toronto, Toronto, ON, Canada
| | - John R de Almeida
- Department of Otolaryngology-Head & Neck Surgery, Sinai Health, University of Toronto, Toronto, ON, Canada.,Institute for Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Eric Monteiro
- Department of Otolaryngology-Head & Neck Surgery, Sinai Health, University of Toronto, Toronto, ON, Canada
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Rebelo B, Nogueira R, Horta M. The Role of High-Resolution Ultrasound in the Assessment of Surgical Candidates for Transoral Endoscopic Thyroidectomy Via Vestibular Approach (TOETVA). ACTA MEDICA PORT 2023; 36:212-217. [PMID: 36898208 DOI: 10.20344/amp.19038] [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: 09/03/2022] [Accepted: 01/09/2023] [Indexed: 03/06/2023]
Abstract
The approach of surgical techniques has evolved significantly over the last decade, with natural orifice surgeries replacing traditional open approaches. In 2016, Angkoon Anuwong, in Thailand, demonstrated it was possible to perform thyroidectomies in a series of patients by a transoral endoscopic ap-proach - transoral endoscopy thyroidectomy vestibular approach (TOETVA) - with similar complication rates when compared to conventional surgeries. This transoral surgery has become a safe alternative with better cosmetic results, compared to conventional open-route procedures, like Kocher cervi-cotomy. Indeed, it is an option to surgically treat neoplastic and functional thyroid diseases. The technique is performed through a median incision in the oral vestibule, plus two bilateral incisions, followed by the insertion of three trocars, one centrally for a camera, and two laterally for working instruments. Although revolutionary, TOETVA has its technical limitations. Therefore, it is important to precisely define the preoperative eligibility criteria for this type of surgical approach. High-resolution ultrasound is the first imaging modality for the assessment of thyroid nodules, lymph node metastases and surgical field. The aim of this article is to outline the sonographic technique and the role of high-resolution ultrasound in the presurgical evaluation of TOETVA.
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Affiliation(s)
- Beatriz Rebelo
- Department of Radiology. Instituto Português de Oncologia de Lisboa Francisco Gentil. Lisbon. Portugal
| | - Ricardo Nogueira
- Department of Head and Neck Surgery. Instituto Português de Oncologia de Lisboa Francisco Gentil. Lisbon. Portugal
| | - Mariana Horta
- Department of Radiology. Instituto Português de Oncologia de Lisboa Francisco Gentil. Lisbon; Institute of Anatomy. Faculty of Medicine. University of Lisbon. Lisbon. Portugal
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Lee DW, Kim JK, Shin SH, Tae K. Transoral thyroidectomy implemented by a novice surgeon: Efforts for safe implementation. Laryngoscope Investig Otolaryngol 2023; 8:287-295. [PMID: 36846424 PMCID: PMC9948568 DOI: 10.1002/lio2.974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 10/29/2022] [Indexed: 12/03/2022] Open
Abstract
Background This study aimed to evaluate the feasibility, safety, and early surgical outcomes of transoral robotic and endoscopic thyroidectomy conducted by a novice surgeon. Methods We analyzed 27 patients who underwent transoral thyroidectomy between December 2018 and November 2021. All the surgeries were performed by a novice surgeon without prior endoscopic or robotic surgery experience; the surgeon had experienced 12 cases of transcervical thyroidectomy before adopting transoral thyroidectomy. Results Of the 27 cases, 1 was converted to the transcervical approach due to poor bleeding control. Four cases had transient recurrent laryngeal nerve palsy, and three had transient hypoparathyroidism. Most of the patients were very satisfied with the postoperative cosmetic outcome. Conclusions Transoral robotic and endoscopic thyroidectomies are feasible for the novice surgeon, with reasonable results in the early adoption stage if preparations are according to the suggested framework. Level of Evidence Level 4.
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Affiliation(s)
- Dong Won Lee
- Department of Otorhinolaryngology‐Head and Neck Surgery, School of MedicineDaegu Catholic UniversityDaeguRepublic of Korea
| | - Jeong Kyu Kim
- Department of Otorhinolaryngology‐Head and Neck Surgery, School of MedicineDaegu Catholic UniversityDaeguRepublic of Korea
| | - Seung Heon Shin
- Department of Otorhinolaryngology‐Head and Neck Surgery, School of MedicineDaegu Catholic UniversityDaeguRepublic of Korea
| | - Kyung Tae
- Department of Otolaryngology‐Head and Neck Surgery, College of MedicineHanyang UniversitySeoulRepublic of Korea
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Lee MJ, Oh MY, Lee JM, Sun J, Chai YJ. Comparative surgical outcomes of transoral endoscopic and robotic thyroidectomy for thyroid carcinoma: a propensity score-matched analysis. Surg Endosc 2023; 37:1132-1139. [PMID: 36131160 DOI: 10.1007/s00464-022-09636-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Accepted: 09/13/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Surgical outcomes of patients with thyroid carcinoma who underwent transoral endoscopic thyroidectomy vestibular approach (TOETVA) versus transoral robotic thyroidectomy (TORT) were compared. METHODS Patients who underwent TOETVA or TORT between July 2016 and February 2022 were retrospectively analyzed. TOETVA and TORT groups were propensity score-matched (1:1) based on age, sex, body mass index, surgical extent, tumor size, and presence of thyroiditis. RESULTS A total of 185 patients underwent transoral thyroidectomy (142 TOETVA and 43 TORT). Final diagnoses consisted of 135 papillary and seven follicular thyroid carcinomas in the TOETVA group and 43 papillary thyroid carcinomas in the TORT group (p = 0.138). Mean operative time was shorter for the TOETVA group than the TORT group (106.3 vs. 158.9 min, p < 0.001), whereas mean hospital stay was longer for the TOETVA group than the TORT group (2.2 vs. 1.9 days, p = 0.031). After 1:1 propensity score matching, each group included 43 patients. Mean operative time was shorter in the TOETVA group than the TORT group (106.2 vs. 158.9 min, p < 0.001), whereas mean hospital stay was longer in the TOETVA group (2.3 vs. 1.9 days, p = 0.031). There was no significant difference in vocal cord palsy incidences between the groups (one transient, one permanent in the TOETVA group vs. none in the TORT group, p = 0.359). The learning curve was 71 cases for TOETVA and 25 cases for TORT. CONCLUSION TOETVA had shorter mean operative time, and TORT had shorter learning curve and shorter mean hospital stay. Surgeons should be familiar with the advantages and disadvantages of each procedure.
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Affiliation(s)
- Min Jung Lee
- Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Moon Young Oh
- Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jung-Man Lee
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea
| | - Jiyu Sun
- Medical Research Collaborating Center, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea
| | - Young Jun Chai
- Department of Surgery, Seoul National University College of Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea.
- Transdisciplinary Department of Medicine & Advanced Technology, Seoul National University Hospital, Seoul, Korea.
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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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Wang J, Lin Q, Wu X, Lin Y, Liu E. Total areola approach for endoscopic thyroidectomy: Six years of experience with the same surgeon. J Minim Access Surg 2023; 19:42-50. [PMID: 36722529 PMCID: PMC10034795 DOI: 10.4103/jmas.jmas_359_21] [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: 11/24/2021] [Revised: 06/05/2022] [Accepted: 06/23/2022] [Indexed: 02/03/2023] Open
Abstract
Background Scarless endoscopic thyroidectomy (ET) is increasingly accepted by the growing amount of surgeons. The target of this study is to assess the efficacy and summarise the experiences of total areola approach for ET (TAAET). Subjects and Methods TAAET was performed on 529 patients between January 2016 and October 2021. All operated patients were divided into two groups according to the chronological order. Demographic data, perioperative data and post-operative complications were collected to assess the effectiveness of TAAET. Results Five hundred and twenty-eight patients were successfully treated with TAAET, while 1 case was converted to open surgery due to bleeding. The surgical approach consists of lobectomy or total thyroidectomy with or without central lymph node dissection. The post-operative pathology of 433 (81.9%) patients was diagnosed with T1 ~2N0M0. The average number of unilateral lymph node dissection was 7.72 ± 2.44 while the bilateral lymph node was 10.70 ± 3.72. In terms of complications, 38 cases had transient hoarseness, 28 cases had tetany and numbness, 3 cases had post-operative bleeding, 1 case had infection and 33 cases had subcutaneous fluid. There were statistically significant differences between the two groups with respect to transient hoarseness (P < 0.001), tetany and numbness (P = 0.005), intraoperative blood loss (P = 0.003) and operation time for malignant tumour (P < 0.001) because of the accumulation of surgical experience and the maturation of technology. Conclusions TAAET which conforms to the anatomical pathway of open thyroidectomy is a safe, effective and feasible technique and is highly suitable for novices.
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Affiliation(s)
- Junxiao Wang
- Department of Thyroid and Breast Surgery, The Second Hospital of Sanming; Department of General Surgery, The Fifth Clinical Medical College of Fujian University of Traditional Chinese Medicine, Sanming City, Fujian Province, China
| | - Qisheng Lin
- Department of Thyroid and Breast Surgery, The Second Hospital of Sanming; Department of General Surgery, The Fifth Clinical Medical College of Fujian University of Traditional Chinese Medicine, Sanming City, Fujian Province, China
| | - Xiaolan Wu
- Department of CT/MR, The Second Hospital of Sanming; Department of Imaging, The Fifth Clinical Medical College of Fujian University of Traditional Chinese Medicine, Sanming City, Fujian Province, China
| | - Yixing Lin
- Department of Thyroid and Breast Surgery, The Second Hospital of Sanming; Department of General Surgery, The Fifth Clinical Medical College of Fujian University of Traditional Chinese Medicine, Sanming City, Fujian Province, China
| | - Ezhang Liu
- Department of Thyroid and Breast Surgery, The Second Hospital of Sanming; Department of General Surgery, The Fifth Clinical Medical College of Fujian University of Traditional Chinese Medicine, Sanming City, Fujian Province, China
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Learning curve of transoral robotic thyroidectomy. Surg Endosc 2023; 37:535-543. [PMID: 36002679 DOI: 10.1007/s00464-022-09549-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 08/07/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND Transoral thyroidectomy has superior cosmesis and better postoperative voice outcomes than conventional thyroidectomy. However, it usually requires a steep learning curve and longer operative time. The transoral robotic thyroidectomy (TORT) learning curve has not been well investigated. This study aimed to evaluate the TORT learning curve and factors affecting operative time. METHODS We retrospectively studied 173 consecutive patients who underwent TORT with or without central neck dissection from July 2017 to August 2021. We assessed the TORT learning curve using operative time, complication rate, and surgical success (procedure conversion) rate. The operative time and surgical success rate learning curves were calculated using the cumulative summation (CUSUM) method. Additionally, we analyzed factors affecting operative time in TORT. RESULTS Total thyroidectomy operative time was significantly longer than those of lobectomy and isthmusectomy (p < 0.001). In correlation analysis, a significantly positive correlation was observed between body mass index (BMI) and operative time (R2 = 0.04, p = 0.025). The TORT learning curve was 52 cases in the CUSUM operative time analysis. In the CUSUM surgical success rate chart, the turning point was the 55th case. Complication and procedure conversion rates were significantly decreased after the learning curve. CONCLUSIONS The CUSUM learning curve of TORT was about 52-55 cases, and the operative time, total complication rate, and procedure conversion decreased significantly after the learning curve. The operative time was associated with the extent of thyroidectomy and BMI.
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Gasless endoscopic transaxillary thyroid surgery: CUSUM analysis of a single surgeon's experience from 105 preliminary procedures. Surg Endosc 2022; 36:8270-8279. [PMID: 35680669 DOI: 10.1007/s00464-022-09273-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 04/09/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND We aimed to evaluate the feasibility and oncologic safety of gasless endoscopic transaxillary thyroidectomy (TAT) in patients with thyroid diseases. Improvements in surgical techniques were also reported, and the learning curves of gasless endoscopic TAT were further studied. METHODS An exact 1:1 matching analysis was performed to compare the technical safety and oncologic outcomes between TAT and conventional open surgery. A questionnaire was designed to evaluate the quality of life of enrolled patients. A cumulative summation analysis was designed for the quantitative estimation of the learning curves. RESULTS A total of 105 consecutive patients who successfully received endoscopic TAT were retrospectively enrolled in the current study. A standard three-step working space making procedure, an approach that does not free the superficial part of the sternal head of the sternocleidomastoid muscle (SCM, NFSSH) and a "point to line to surface" en bloc procedure utilized in lobectomy with ipsilateral central neck dissection (CND), were introduced in our surgical procedures. The mean operation time in the TAT group was significantly longer than that in the conventional open group (86.9 ± 31.3 vs 44.2 ± 8.3, p < 0.001). Significant differences in the complication rate were not found between the two groups. Discomfort in the anterior neck area and SCM was relieved over time in most cases (verbal response scores (VRSs) were gradually decreased over time). The learning curves for working space making, ipsilateral thyroidectomy and the total endoscopic TAT approach were 45 cases, 25 cases and 42 cases, respectively. The operation time in the proficient group was significantly shorter than that in the learning group (67.0 ± 8.4 vs 112.3 ± 35.7, p < 0.001). VRSs in the SCM were significantly lower in the proficient group (for 1 week: 1.25 ± 0.65 vs 2.40 ± 0.63, p < 0.001; for 1 month: 0.81 ± 0.69 vs 1.81 ± 0.40, p < 0.001). CONCLUSIONS Gasless endoscopic TAT was safe in a cohort of patients with thyroid diseases, with satisfactory surgical outcomes and cosmetic appearance. The learning curve for endoscopic TAT was approximately 42 cases. The proficiency of the endoscopic TAT approach depended primarily on the proficiency of working space making.
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Yang X, Zhao JG, Liu M, Wang S, Wang L. Management of Patients with Cervicofacial Edema and Paresthesia during Perioperative Period of Transoral Endoscopic Thyroidectomy. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:4775264. [PMID: 36213587 PMCID: PMC9534668 DOI: 10.1155/2022/4775264] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 08/11/2022] [Accepted: 08/23/2022] [Indexed: 11/18/2022]
Abstract
Objective To analyze the clinical intervention effect of transoral endoscopic thyroidectomy on the neck and face during perioperative period. Method From January 2019 to January 2020, 60 patients included in this study were randomly divided into observation group and control group according to the ratio of 1 : 1, with 30 cases in each group. Both groups underwent rapid surgical intervention during the perioperative period. The patients in the observation group received neck and face management. The degree of jaw swelling, the degree of facial microexpression completion, and the changes in jaw and neck sensation were compared between the two groups. Results There was no significant difference in neck and face swelling, pain, facial microexpression, and feeling between the two groups before operation. Patients with facial I/II swelling degree in the observation group were significantly more than in the control group, and the patients with III swelling degree were less than in the control group. There was significant difference for facial swelling between the two groups in the three intervention periods after the operation, and the difference was statistically significant (P < 0.05). The scores of facial microexpression in the observation group were higher than those in the control group during the three postoperative intervention periods, with statistical significance (P < 0.05). There was no significant difference in the pain score of the first day after surgery between the two groups (P = 0.298). In the other two postoperative intervention periods, the pain score of the observation group was lower than that of the control group, with a statistically significant difference, and the difference was statistically significant (P < 0.05). The threshold of chin and neck sensory pressure in the two groups was statistically significant (P < 0.05) except that the "cheek in area 4" (P = 0.290). Conclusion The results showed that these interventions, such as the elevation of bed after operation, 24-hour intermittent cryotherapy, ice cubes in mouth, and the "meter" functional training, have good clinical effects on the symptoms of facial swelling and abnormal sensation of neck and face. It can accelerate the speed of edema dissipation, improve the patients' postoperative comfort, and improve the satisfaction and quality of life of patients with the effect of surgery and beauty.
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Affiliation(s)
- Xia Yang
- Department of Thyroid and Breast Surgery, Wuhan Number 1 Hospital, Tongji Medical College, Huazhong University of Science and Technology, China
| | - Jian Guo Zhao
- Department of Thyroid and Breast Surgery, Wuhan Number 1 Hospital, Tongji Medical College, Huazhong University of Science and Technology, China
| | - Mengting Liu
- Department of Thyroid and Breast Surgery, Wuhan Number 1 Hospital, Tongji Medical College, Huazhong University of Science and Technology, China
| | - Shan Wang
- Department of Thyroid and Breast Surgery, Wuhan Number 1 Hospital, Tongji Medical College, Huazhong University of Science and Technology, China
| | - Li Wang
- Department of Nursing, Wuhan Number 1 Hospital, Tongji Medical College, Huazhong University of Science and Technology, China
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Dabsha A, Khairallah S, Elkharbotly IAMH, Hossam E, Hanafy A, Kamel M, Amin A, Mohamed A, Rahouma M. Learning curve and volume outcome relationship of endoscopic trans-oral versus trans-axillary thyroidectomy; A systematic review and meta-analysis. Int J Surg 2022; 104:106739. [PMID: 35764254 DOI: 10.1016/j.ijsu.2022.106739] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 06/08/2022] [Accepted: 06/16/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND In the modern era, minimally invasive surgery is rapidly evolving and even replacing conventional open techniques in many surgical fields. Thyroidectomy was not an exception, with the introduction of multiple endoscopic thyroidectomy techniques. Trans-oral endoscopic trans-vestibular thyroidectomy (TOT) is a novel technique with promising outcomes. We conducted this meta-analysis to compare surgical outcomes and learning curves for TOT and other endoscopic thyroidectomy techniques. METHODS A systematic review in PubMed, MEDLINE, and EMBASE databases was conducted searching for publications on TOT versus trans-axillary thyroidectomy (TAT). The primary endpoint was operative (OR) time. Secondary endpoints were number of harvested lymph nodes (LNs), estimated blood loss (EBL), recurrent laryngeal nerve (RLN) injury, hoarseness, seroma, infection, chyle leak, hypocalcemia, hospital length of stay (LOS), and Cost. We also investigated the learning curve for each technique. Leave-out-out analysis, meta-regression, and subgroup analysis were used. Random effect inverse variance method was utilized. RESULTS Among 3820 retrieved studies, 15 studies (10 unmatched and 5 matched), with 2173 (TOT: 1024(47.12%) and TAT:1149(52.87%)) patients, met the inclusion criteria. The operative time and harvested L. Ns number were higher in TOT versus TAT (standard mean difference (SMD) = 0.72 [95%CI 0.07; 1.37], P = 0.029 and SMD = 0.32 [95%CI 0.02; 0.62], P = 0.036 respectively) while less EBL in TOT versus TAT (SMD = -0.26 [-0.43; -0.09], P = 0.0018). All other outcomes showed no significant difference between both groups. Weighted mean values for TOT and TAT were 158.03 vs 144.97 min for OR time, 6.33 vs 5.16 for harvested LNs, and $5,919.05 vs $6,253.79 for the cost. Statistical significance in learning curve development was noticed ranging between 6 and 15 annual cases. CONCLUSION Trans-oral thyroidectomy is a safe and reliable technique with outcomes comparable to other endoscopic techniques. It provides better access to the central compartment with a more feasible LN dissection. Improvement in surgical outcomes is expected with growing learning curve and technique mastery.
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Affiliation(s)
- Anas Dabsha
- Surgical Oncology Department, National Cancer Institute, Cairo University, Cairo, 11796, Egypt; Weill Cornell Medicine, New York, NY, USA
| | - Sherif Khairallah
- Surgical Oncology Department, National Cancer Institute, Cairo University, Cairo, 11796, Egypt; Weill Cornell Medicine, New York, NY, USA
| | - Ismail A M H Elkharbotly
- Surgical Oncology Department, National Cancer Institute, Cairo University, Cairo, 11796, Egypt; General Surgery Department, Newham University Hospital, London, UK
| | - Eslam Hossam
- Surgical Oncology Department, National Cancer Institute, Cairo University, Cairo, 11796, Egypt
| | - Ayman Hanafy
- Surgical Oncology Department, National Cancer Institute, Cairo University, Cairo, 11796, Egypt
| | - Mohamed Kamel
- Surgical Oncology Department, National Cancer Institute, Cairo University, Cairo, 11796, Egypt; Weill Cornell Medicine, New York, NY, USA
| | - Ayman Amin
- Surgical Oncology Department, National Cancer Institute, Cairo University, Cairo, 11796, Egypt
| | - Abdelrahman Mohamed
- Surgical Oncology Department, National Cancer Institute, Cairo University, Cairo, 11796, Egypt
| | - Mohamed Rahouma
- Surgical Oncology Department, National Cancer Institute, Cairo University, Cairo, 11796, Egypt; Weill Cornell Medicine, New York, NY, USA.
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Li HS, Lin Q, Xie WJ. Thyroidectomy using a single-port cervico-mental angle approach. J Minim Access Surg 2022; 18:585-590. [PMID: 36204938 PMCID: PMC9632720 DOI: 10.4103/jmas.jmas_276_21] [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: 11/04/2022] Open
Abstract
Background Over the last two decades, several endoscopic thyroidectomy methods have been developed. However, there are some limitations in these procedures. To date, the optimal surgical approach for thyroid cancer has not yet been developed. This study reported the surgical operation steps, clinical outcomes, and experience of 30 patients who underwent trans-cervico-mental angle single-port endoscopic thyroidectomy (TCMASPET) at our centre. Patients and Methods A total of 30 patients were enrolled in the present study. Patients underwent unilateral or bilateral thyroidectomy through a cervico-mental angle incision of 2.48 ± 0.31 cm, after which the lymphoid adipose tissues in the central region were dissected. Results All surgeries were successfully completed. Two patients underwent bilateral thyroid carcinoma resection with bilateral central region lymph node dissection, 23 patients received unilateral thyroid cancer resection with unilateral central region lymph node dissection, four patients underwent unilateral thyroid resection, and one patient received bilateral thyroid resection with unilateral central region lymph node dissection. No permanent post-operative complications were observed. Conclusions TCMASPET was a safe and feasible approach that was relatively easy to perform. This approach may expand the indications for endoscopic thyroidectomy while maintaining excellent cosmetic outcomes.
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Affiliation(s)
- Hua-Shui Li
- Department of General Surgery, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Qiang Lin
- Department of General Surgery, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Wen-Jun Xie
- Department of General Surgery, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
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Working Space Creation in Transoral Thyroidectomy: Pearls and Pitfalls. Cancers (Basel) 2022; 14:cancers14041031. [PMID: 35205779 PMCID: PMC8869989 DOI: 10.3390/cancers14041031] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 02/15/2022] [Accepted: 02/16/2022] [Indexed: 12/04/2022] Open
Abstract
Simple Summary Transoral thyroidectomy accesses the thyroid gland through three incisions in the oral vestibule. The cosmetic outcome was excellent since no scar was observed on the body surface. However, it is challenging to create a working space using this new approach. Unconventional but severe complications can also occur. Our review summarizes the tips regarding working space creation in transoral thyroidectomy and tricks for preventing complications. Abstract Transoral thyroidectomy is a novel technique that uses three small incisions hidden in the oral vestibule to remove the thyroid gland. It provides excellent cosmetic results and outcomes comparable to the open approach. One of the main obstacles for this technique is the creation of a working space from the lip and chin to the neck. The anatomy of the perioral region and the top-down surgical view are both unfamiliar to general surgeons. As a result, inadequate manipulation might easily occur and would lead to several unconventional complications, such as mental nerve injury, carbon dioxide embolism, and skin perforation, which are rarely observed in open surgery. Herein, we summarize the basic concepts, techniques, and rationales behind working space creation in transoral thyroidectomy to assist surgeons in obtaining an adequate surgical field while eliminating preventable complications.
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Yap RV, Villamor Jr M. Scarless total thyroidectomy via transoral endoscopic vestibular approach: initial case series in a developing Asian country. J Surg Case Rep 2022; 2022:rjab623. [PMID: 35070269 PMCID: PMC8769911 DOI: 10.1093/jscr/rjab623] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 12/20/2021] [Indexed: 12/29/2022] Open
Abstract
Conventional open thyroidectomy may leave a visible scar postoperatively and can lead to impaired quality of life. Since 2016, the transoral endoscopic thyroidectomy via vestibular approach (TOETVA) has gained popularity due to being a true 'scarless' procedure. However, minimally invasive thyroidectomy has not been widely adopted in the Philippines yet. From August 2019 to December 2019, nine patients (mean thyroid nodule size of 3.1 cm) underwent TOETVA with one open conversion due to adherent papillary cancer. Majority had a blood loss of <100 ml, whereas mean operative time was 149.8 ± 20.5 minutes. Five patients developed hypocalcemia (three transient), whereas two patients reported transient lower lip numbness. TOETVA is a safe and feasible novel procedure for both benign and malignant thyroid diseases. Care must be taken in selecting patients who opt for TOETVA, and that surgeons should reassess their limitations before implementing this technique in their surgical practice.
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Affiliation(s)
- Ralph Victor Yap
- Correspondence address. Department of Surgery, Cebu Doctors’ University Hospital, Osmeña Blvd, Cebu City, Cebu 6000, Philippines. Tel: (63) 0917-130-1923; Fax: (032) 255-5555; E-mail:
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Akritidou E, Douridas G, Spartalis E, Tsourouflis G, Dimitroulis D, Nikiteas NI. Complications of Trans-oral Endoscopic Thyroidectomy Vestibular Approach: A Systematic Review. In Vivo 2022; 36:1-12. [PMID: 34972695 DOI: 10.21873/invivo.12671] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Revised: 10/02/2021] [Accepted: 10/06/2021] [Indexed: 01/04/2023]
Abstract
This review focuses on complications linked to trans-oral endoscopic thyroidectomy via vestibular approach (TOETVA) and aimed to elucidate the procedure's initial safety profile. According to the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA), Pubmed, Embase, and the Cochrane databases were screened till May 2021. Twenty-eight articles, nine cohorts and nineteen case series, met the inclusion criteria. Procedure-related complications were analyzed, the most important being hypoparathyroidism: transient (range=0.94-22.2%), permanent (range=1.33-2.22%), and recurrent laryngeal nerve injury: transient (range=1.9-8.8%) and permanent (range=0.59-1.42%). Surgical trauma related complications, the most prevalent being seroma, emphysema, and hematoma accounted for 2.91%. Null mortality was reported. Although current evolving experience indicates that TOETVA is safe and linked to acceptable complication rates, the method needs to be compared with the gold standard of traditional thyroidectomy in the context of sufficiently numbered cohorts and ultimately randomized controlled trials.
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Affiliation(s)
- Ellada Akritidou
- Department of Surgery, Thriassio General Hospital, Athens, Greece; .,Hellenic Minimally Invasive and Robotic Surgery (MIRS) Study Group, Athens, Greece
| | | | - Eleftherios Spartalis
- Hellenic Minimally Invasive and Robotic Surgery (MIRS) Study Group, Athens, Greece.,2 Department of Propaedeutic Surgery, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Gerasimos Tsourouflis
- Hellenic Minimally Invasive and Robotic Surgery (MIRS) Study Group, Athens, Greece.,2 Department of Propaedeutic Surgery, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Dimitroulis
- Hellenic Minimally Invasive and Robotic Surgery (MIRS) Study Group, Athens, Greece.,2 Department of Propaedeutic Surgery, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos I Nikiteas
- Hellenic Minimally Invasive and Robotic Surgery (MIRS) Study Group, Athens, Greece.,2 Department of Propaedeutic Surgery, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Lee SH, Moorthy R, Nagala S. OUP accepted manuscript. Br J Surg 2022; 109:497-502. [PMID: 35576381 DOI: 10.1093/bjs/znac072] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 01/12/2022] [Accepted: 02/21/2022] [Indexed: 11/12/2022]
Abstract
BACKGROUND The IDEAL Framework is a scheme for safe implementation and assessment of surgical innovation. The transoral endoscopic thyroidectomy vestibular approach (TOETVA) is a new innovation in thyroid surgery that eliminates the need for a cervical incision. Despite considerable interest and adoption worldwide, significant scepticism remains regarding the outcomes and cost-effectiveness for healthcare systems. The aim of this narrative review was to appraise the available literature and examine whether TOETVA has progressed in line with the IDEAL Framework. METHODS A literature review of PubMed with a focus on historical and landmark studies was undertaken to classify the evidence according to the different stages of the IDEAL Framework. RESULTS Several different transoral approaches were developed by a small of number of surgeon-innovators on animals and cadavers, and subsequently in first-in-human studies. The trivestibular approach emerged as the safest technique, with further refinements of this technique culminating in TOETVA. The basic steps and indications for this technique have been standardized and it is now being replicated by early adopters in many centres worldwide. The development of TOETVA has closely aligned with the IDEAL Framework, and is currently at stage 2B (Exploration). CONCLUSION There is need for multi-institutional collaborations and international registry studies to plan high-quality randomized trials comparing TOETVA with other remote-access approaches and collect long-term follow-up data. In countries where TOETVA has yet to be adopted, the IDEAL Framework will be a useful roadmap for government regulators and professional societies to evaluate, regulate, and provide best practice recommendations for the adoption of this technique.
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Affiliation(s)
- Shen-Han Lee
- Department of Otorhinolaryngology, Hospital Sultanah Bahiyah, Kedah, Malaysia
| | - Ram Moorthy
- Department of Otolaryngology-Head and Neck Surgery, Royal Berkshire Hospital, Reading, UK
- Department of Otolaryngology-Head and Neck Surgery, Wexham Park Hospital, Frimley Health NHS Foundation Trust, Slough, UK
| | - Sidhartha Nagala
- Department of Otolaryngology-Head and Neck Surgery, Royal Berkshire Hospital, Reading, UK
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Fernandez-Ranvier G, Lieberman B, Guevara D, Voogd A, Matsuda ME, Eck K, Inabnet WB, Damiano GA. Transoral Endoscopic Thyroidectomy Vestibular Approach (TOETVA) learning curve: a regression analysis of complication rates and severity. Surg Endosc 2021; 36:4839-4844. [PMID: 34748089 DOI: 10.1007/s00464-021-08832-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Accepted: 10/19/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND Transoral Endoscopic Thyroidectomy Vestibular Approach (TOETVA) is a natural orifice transluminal endoscopic surgery that offers a truly scarless approach to thyroidectomy. Introduced in 2008, there is a growing body of literature establishing it as a safe endoscopic approach for thyroid procedures. While it is not yet widely practiced, it is quickly growing in popularity. As more surgeons begin to add this technique to their repertoire the question of the learning curve has to be examined. METHODS Case series from the initial TOETVA operations of four surgeons at three different hospitals were examined. Binomial and ordinal logistic regression were used to characterize the changes in complication rate and severity as they related to case number in the series. Statistics were performed in Minitab and SAS. RESULTS Each surgeon performed between 23 and 40 TOETVA operations for a total of 130 cases. Binary logistic regression shows a negative relationship between case number and complication rate (P < 0.001, Odds Ratio: 0.91). Ordinal logistic regression shows a negative relationship between case number and complication severity (P < 0.001, Odds Ratio: 1.07). The maximum slope of improvement of complication rate occurred at case number 12. CONCLUSION The most significant decrease in complications for TOETVA occurs at case 12. As case number progresses, there is a significant decrease in both the risk of a complication occurring and of the severity of that complication. These results support the previously published data on TOETVA learning curve based on operative time.
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Affiliation(s)
- Gustavo Fernandez-Ranvier
- Division of Metabolic, Endocrine and Minimally Invasive Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, 5 East 98th Street, New York, NY, 10029, USA.
| | - Benjamin Lieberman
- Department of Surgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, New York, NY, USA
| | - Daniela Guevara
- Department of Surgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, New York, NY, USA
| | - Ana Voogd
- Department of Head and Neck Surgery, Hospital Universitario Austral, Pilar, Argentina
| | - Maria Eugenia Matsuda
- Department of Head and Neck Surgery, Hospital Universitario Austral, Pilar, Argentina
| | - Kaitlyn Eck
- State University of New York College at Geneseo, Geneseo, NY, USA
| | - William B Inabnet
- Department of Surgery, University of Kentucky College of Medicine, Lexington, KY, USA
| | - Gabriel Antonio Damiano
- Division of Head and Neck Surgery, Department of Surgery, Hospital Ignacio Pirovano, Buenos Aires, Argentina
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Patient Eligibility for Transoral Endoscopic Thyroidectomy Vestibular Approach in an Endemic Region. MEDICAL BULLETIN OF SISLI ETFAL HOSPITAL 2021; 55:304-309. [PMID: 34712070 PMCID: PMC8526231 DOI: 10.14744/semb.2021.87160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 07/28/2021] [Indexed: 11/20/2022]
Abstract
Objective Transoral endoscopic thyroidectomy vestibular approach (TOETVA) is a scarless method that enables thyroidectomyusing natural orifice of the body. The opinion which is even common among TOETVA performing surgeons is that this surgery involves a small percentage of thyroidectomy applied patients. In this study, based on the currently accepted exclusion criteria, we aimed to determine what percentage of patients, who underwent thyroidectomy in an endemic area are actually suitable for TOETVA. Methods Between January 2017 and December 2019, 1197 consecutive patients who underwent surgery for thyroid pathology in our clinic were analyzed retrospectively. Pre-operative evaluations were made according to the current exclusion criteria and as a result, patients with no previous neck surgery, no history of radiotherapy, no retrosternal thyroid extension, and none lymph node dissection operation been made and whose thyroid gland diameter is <10 cm and gland volume is not more than 45 ml, malignant nodule diameter is <2 cm, and benign nodule diameter is <4 cm are involved to this study by being considered appropriate for TOETVA procedure. Results According to the criteria, 513 patients (42.8%) were found suitable for TOETVA. A total of 421 (82%) of these patients were female and 92 (18%) were male. The mean age was 46.2±13.2. A total of 192 (37%) of these patients were operated due to the benign reasons, and 321 (63%) of these patients operated due to the malignancy or suspicion of malignancy. Average nodule size was 1.9 cm, and the average thyroid volume was 23.8 ml among benign patients. Whereas among malignant patients, the average nodule size was 1.7 cm and the average thyroid volume was 21.8 ml. A total of 462 (90.1%) of the patients were applied to the total thyroidectomy and 51 (9.9%) of the patients were applied to the hemithyroidectomy. In the same period, 29 patients operated through TOETVA and 4 patients operated through bilateral axillary breast approach thyroidectomy. When the final pathology, results of the patients were examined, papillary thyroid carcinoma was seen in 301 (58.7%) patients, benign pathologies were seen in 192 (37.4%) patients, and 20 (3.9%) patients were diagnosed with other pathologies (follicular thyroid carcinoma, poorly differentiated carcinoma and Hürthle cell neoplasia, etc.). Conclusion Although "patient willingness" factor could not be included in the study, TOETVA eligible patient repository is wider contrary to popular belief. In our humble opinion, TOETVA method is going to pursue its spread and become a part of the routine surgical training session due to its effectiveness in terms of credibility in today's world where cosmetic concerns gradually gain prominence.
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Bertelli AA, Lira RB, Gonçalves AJ, Kowalski LP. Transoral endoscopic thyroidectomy vestibular approach (TOETVA) and complications. Rev Col Bras Cir 2021; 48:e20213084. [PMID: 34468504 PMCID: PMC10683466 DOI: 10.1590/0100-6991e-20213084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 06/07/2021] [Indexed: 11/21/2022] Open
Affiliation(s)
- Antonio Augusto Bertelli
- - Faculdade de Ciências Médicas da Santa Casa de São Paulo, Departamento de Cirurgia - São Paulo - SP - Brasil
| | - Renan Bezerra Lira
- - AC Camargo Cancer Center, Departamento de Cirurgia de Cabeça e Pescoço - São Paulo - SP - Brasil
- - Hospital Israelita Albert Einstein, Departamento de Cirurgia - São Paulo - SP - Brasil
| | - Antonio José Gonçalves
- - Faculdade de Ciências Médicas da Santa Casa de São Paulo, Departamento de Cirurgia - São Paulo - SP - Brasil
| | - Luiz Paulo Kowalski
- - AC Camargo Cancer Center, Departamento de Cirurgia de Cabeça e Pescoço - São Paulo - SP - Brasil
- - Faculdade de Medicina da Universidade de São Paulo, Departamento de Cirurgia - São Paulo - SP - Brasil
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Alnehlaoui F, Guraya SY. Transoral and submental thyroidectomy using intraoperative nerve stimulation and indocyanin green fluorescence imaging. BMJ Case Rep 2021; 14:e243306. [PMID: 34426423 PMCID: PMC8383884 DOI: 10.1136/bcr-2021-243306] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2021] [Indexed: 11/04/2022] Open
Abstract
There is a recent proliferation of clinical studies about the minimally invasive scarless thyroid surgery. The transoral endoscopic thyroidectomy vestibular approach (TOETVA) carries a great potential for being scarless surgery via a short dissection flap. However, TOETVA has limitations in extracting larger thyroid tumours via the transoral vestibular incision and due to its potential damage to the branches of the mental nerve. The rapidly evolving surgical innovations have now introduced transoral and submental thyroidectomy (TOaST) approach that allows extraction of large thyroid tumours with less flap dissection and minimal postoperative pain. We present a 39-year-old man with a large multinodular goitre. The patient was euthyroid with moderate to severe compression symptoms of difficulty in breathing and swallowing. We performed a TOaST procedure using intraoperative neuromonitoring and indocyanin green fluorescence imaging with an uneventful recovery. This is a first case report from the middle east region that will pave the way to large clinical trials to determine the efficacy and safety of TOaST.
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Affiliation(s)
| | - Salman Yousuf Guraya
- Clinical Sciences Department, College of Medicine, University of Sharjah, Sharjah, UAE
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Shaha AR. Transoral thyroidectomy-learning curve. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2021; 65:255-256. [PMID: 34191417 DOI: 10.20945/2359-3997000000382] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Ashok R Shaha
- Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center New York, New York,
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Tincani A, Lehn C, Cernea C, Queiroz E, Dias F, Walder F, Hojaij F, Monteiro F, Kligerman J, Podesta J, Brandão L, de Mello LEB, Medina L, Abrahao M, Tavares M, Barbosa M, Cervantes O, Demétrio P, Curioso R, Lima R, Arap S, Vasconcellos S. Transoral thyroidectomy: A reflexive opinion on the technique. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2021; 65:396-399. [PMID: 34191418 PMCID: PMC10065330 DOI: 10.20945/2359-3997000000383] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Alfio Tincani
- Universidade Estadual de Campinas, Campinas, SP, Brasil
| | - Carlos Lehn
- Hospital do Servidor Público Estadual de São Paulo, São Paulo, SP, Brasil
| | - Cláudio Cernea
- Departamento de Cirurgia da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil
| | | | - Fernando Dias
- Instituto Nacional de Câncer, Rio de Janeiro, RJ, Brasil
| | - Fernando Walder
- Universidade Federal de São Paulo, Escola Paulista de Medicina, São Paulo, SP, Brasil
| | - Flávio Hojaij
- Departamento de Cirurgia, Laboratório de Investigação Médica (LIM-02), Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil,
| | | | | | - José Podesta
- Instituto Nacional de Câncer, Rio de Janeiro, RJ, Brasil
| | - Lenine Brandão
- Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil
| | - Luiz Eduardo Barbalho de Mello
- Universidade Federal do Rio Grande do Norte, Centro de Ciências da Saúde, Programa de Pós-graduação em Ciências da Saúde, Natal, RN, Brasil
| | - Luiz Medina
- Departamento de Cirurgia da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil
| | - Márcio Abrahao
- Universidade Federal de São Paulo, Escola Paulista de Medicina, São Paulo, SP, Brasil
| | - Marcos Tavares
- Departamento de Cirurgia da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil
| | - Mauro Barbosa
- Instituto Nacional de Câncer, Rio de Janeiro, RJ, Brasil
| | - Onivaldo Cervantes
- Universidade Federal de São Paulo, Escola Paulista de Medicina, São Paulo, SP, Brasil
| | - Paula Demétrio
- Universidade Federal de São Paulo, Escola Paulista de Medicina, São Paulo, SP, Brasil
| | | | - Roberto Lima
- Instituto Nacional de Câncer, Rio de Janeiro, RJ, Brasil
| | - Sérgio Arap
- Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil
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Lira RB, De Cicco R, Rangel LG, Bertelli AA, Duque Silva G, de Medeiros Vanderlei JP, Kowalski LP. Transoral endoscopic thyroidectomy vestibular approach: Experience from a multicenter national group with 412 patients. Head Neck 2021; 43:3468-3475. [PMID: 34382715 DOI: 10.1002/hed.26846] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 07/05/2021] [Accepted: 08/05/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Well-established conventional thyroidectomy has satisfactory outcomes; however, robotic and endoscopic thyroid surgery can avoid visible anterior neck scars. Transoral endoscopic thyroidectomy vestibular approach (TOETVA) is the most recent of these techniques. METHODS This was a retrospective review of 412 patients who underwent TOETVA from 2017 to 2020 in 13 Brazilian centers. RESULTS The study included 359 (87.1%) females and 53 (12.9%) males, with a mean age of 40 years. There were 231 (56.1%) total thyroidectomies. The conversion rate was 0.7%. The transient vocal cord palsy rate was 7.6% (30 patients). Temporary and persistent hypocalcemia rates were 4.0% and 0.8%, respectively. There were two cases of infection (0.5%). DISCUSSION This is a large multi-institute TOETVA study, with one of the largest cohorts published to date that; despite its retrospective nature and selection bias, reached outcomes comparable to previously reported series, this study reinforced safeness, feasibility, and nationwide reproducibility for this technique.
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Affiliation(s)
- Renan Bezerra Lira
- Department of Head and Neck Surgery and Otorhinolaryngology, A.C. Camargo Cancer Center, São Paulo, Brazil.,Post-Graduate in Robotic Head and Neck Surgery, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Rafael De Cicco
- Instituto de Câncer Dr. Arnaldo Vieira de Carvalho, São Paulo, Brazil
| | - Leonardo Guimarães Rangel
- Head and Neck Surgery Division, Universidade Estadual do Rio de Janeiro (UERJ), Rio de Janeiro, Brazil
| | - Antônio Augusto Bertelli
- Head and Neck Surgery Division, Department of Surgery, Santa Casa Medical School, São Paulo, Brazil
| | - Guilherme Duque Silva
- Head and Neck Surgery Division, Universidade Estadual do Rio de Janeiro (UERJ), Rio de Janeiro, Brazil
| | | | - Luiz Paulo Kowalski
- Department of Head and Neck Surgery and Otorhinolaryngology, A.C. Camargo Cancer Center, São Paulo, Brazil.,Head and Neck Surgery Department and LIM 28, University of São Paulo Medical School, São Paulo, Brazil
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Camenzuli C, Schembri Wismayer P, Calleja-Agius J. The Effect of Carbon Dioxide Insufflation During Transoral Endoscopic Thyroidectomy via a Vestibular Approach on Internal Jugular Vein Pressure Changes: Is There a Safer Alternative? Surg Innov 2021; 29:301-302. [PMID: 34320888 DOI: 10.1177/15533506211035252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Christian Camenzuli
- Department of Anatomy, Faculty of Medicine and Surgery, 37563University of Malta, Msida, Malta
| | | | - Jean Calleja-Agius
- Department of Anatomy, Faculty of Medicine and Surgery, 37563University of Malta, Msida, Malta
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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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Bertelli AAT, Rangel LG, Lira RB, Tesseroli MAS, Santos IC, Silva GD, Gomes MA, Tenório LR, Kowalski LP, Gonçalves AJ, Russel JO, Tufano RP. Trans Oral Endoscopic Thyroidectomy Vestibular Approach (TOETVA) in Brazil: Safety and complications during learning curve. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2021; 65:259-264. [PMID: 34191415 PMCID: PMC10065341 DOI: 10.20945/2359-3997000000380] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Objective The aim of this study was to address the first cases of TOETVA done in Brazil, by TOETVA-Bra study group, regarding safety and complications. Methods Series of the first 93 TOETVAs cases in Brazil. All authors except LPK, AJG JOR and RPT received TOETVA training including cadaveric hands-on in Thailand or United States (Johns Hopkins Medicine) during 2017. After they came back to Brazil and started doing their first TOETVA cases in the cities of Rio de Janeiro, Sao Paulo and Chapecó they agreed to collaborate and gather data using an online spreadsheet. All patients were submitted to the technique described by Anuwong. Results A total of 93 patients underwent TOETVA. Most patients (58.1%) were submitted to total thyroidectomy and 59.1% had benign disease. Two patients (2.2%) needed conversion to open surgery. Five patients (9.3%) developed transient hypoparathyroidism and there were 3 (2.0%) temporary recurrent laryngeal nerve palsy. There was one (0.7%) permanent unilateral palsy. Twenty patients had some sort of complication, 16.1% were minor and 5.4% were major. A total of 73 patients (78.5%) had an uneventful recovery. Conclusion The technique is reproducible with a low complication rate. While further studies are needed to confirm equivalency, early efforts suggest that TOETVA is not inferior to traditional open thyroidectomy in appropriately selected patients.
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Affiliation(s)
- Antonio Augusto Tupinambá Bertelli
- Disciplina de Cirurgia de Cabeça e Pescoço, Departamento de Cirurgia, Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, SP, Brasil
| | | | | | | | | | - Guilherme Duque Silva
- Serviço de Cirurgia de Cabeça e Pescoço, Hospital Central da Polícia Militar do Rio de Janeiro, Universidade do Estado do Rio de Janeiro, RJ, Brasil
| | | | - Lucas Ribeiro Tenório
- Disciplina de Cirurgia de Cabeça e Pescoço, Departamento de Cirurgia, Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, SP, Brasil,
| | | | - Antonio José Gonçalves
- Disciplina de Cirurgia de Cabeça e Pescoço, Departamento de Cirurgia, Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, SP, Brasil
| | - Jonathon Owen Russel
- Head and Neck Endocrine Surgery, Otolaryngology-Head and Neck Surgery, Johns Hopkins Medicine, Baltimore, USA
| | - Ralph Patrick Tufano
- Head and Neck Endocrine Surgery, Otolaryngology-Head and Neck Surgery, Johns Hopkins Medicine, Baltimore, USA
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Liang TJ, Wang NY, Tsai CY, Liu SI, Chen IS. Outcome Comparison between Endoscopic Transoral and Bilateral Axillo-Breast Approach Thyroidectomy Performed by a Single Surgeon. World J Surg 2021; 45:1779-1784. [PMID: 33641001 DOI: 10.1007/s00268-021-06014-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND The transoral approach and the bilateral axillo-breast approach (BABA) are remote access approaches for endoscopic thyroidectomy. Both follow a symmetric design and use CO2 insufflation to maintain the working space. The outcome differences between the techniques are rarely compared in the literature. METHODS All patients who underwent endoscopic transoral (n = 72) and BABA (n = 63) thyroidectomy between October 2018 and August 2020 by a single surgeon were retrospectively reviewed. The following peri-operative data were collected and compared: operative time, blood loss, postoperative drainage amount, hospital stay, pain score, number of retrieved lymph nodes, and complications. RESULTS Patients in the transoral group were younger (44.7 vs. 49.3 years, p = 0.022) and had smaller tumors (2.4 vs. 2.8 cm, p = 0.020) than those in the BABA group. The operative times were significantly longer in the transoral group than in the BABA group (lobectomy, 194.1 vs. 177.0 min, p = 0.026; total thyroidectomy, 246.0 vs. 214.3 min, p = 0.042). Nevertheless, the time difference became insignificant after completing the initial 20 cases of transoral thyroidectomy. The drainage fluid collected after the surgery was serosanguinous, and a lower drainage volume was observed in the transoral group than that in the BABA group (64.9 vs. 78.5 ml, p = 0.017). However, there was no significant difference regarding the blood loss, hospital stay, postoperative pain score, and lymph nodes retrieved. The rate of postoperative complications, such as hypoparathyroidism and vocal cord palsy was comparable between the two groups. CONCLUSIONS Transoral approach and BABA are comparable with regard to surgical outcomes. Selected patients may choose either technique based on their preferences.
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Affiliation(s)
- Tsung-Jung Liang
- Division of General Surgery, Department of Surgery, Kaohsiung Veterans General Hospital, No. 386, Dazhong 1st Rd, Zuoying, Kaohsiung, 81362, Taiwan
- School of Medicine, National Yang-Ming University, No.155, Sec.2, Linong Street, Taipei, 11221, Taiwan
| | - Nai-Yu Wang
- Division of General Surgery, Department of Surgery, Kaohsiung Veterans General Hospital, No. 386, Dazhong 1st Rd, Zuoying, Kaohsiung, 81362, Taiwan
| | - Chung-Yu Tsai
- Division of General Surgery, Department of Surgery, Kaohsiung Veterans General Hospital, No. 386, Dazhong 1st Rd, Zuoying, Kaohsiung, 81362, Taiwan
| | - Shiuh-Inn Liu
- Division of General Surgery, Department of Surgery, Kaohsiung Veterans General Hospital, No. 386, Dazhong 1st Rd, Zuoying, Kaohsiung, 81362, Taiwan
- School of Medicine, National Yang-Ming University, No.155, Sec.2, Linong Street, Taipei, 11221, Taiwan
| | - I-Shu Chen
- Division of General Surgery, Department of Surgery, Kaohsiung Veterans General Hospital, No. 386, Dazhong 1st Rd, Zuoying, Kaohsiung, 81362, Taiwan.
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Transoral Endoscopic Thyroidectomy Vestibular Approach (TOETVA): Surgical Outcomes and Learning Curve. J Clin Med 2021; 10:jcm10040863. [PMID: 33669741 PMCID: PMC7922263 DOI: 10.3390/jcm10040863] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 02/14/2021] [Accepted: 02/15/2021] [Indexed: 12/15/2022] Open
Abstract
The transoral endoscopic thyroidectomy vestibular approach (TOETVA) has excellent cosmetic effects and its popularity is increasing worldwide. We present our experience with TOETVA and its short-term outcomes. This study included 110 consecutive patients who underwent TOETVA at a single institution between July 2016 and June 2020. We analyzed clinicopathologic data, short-term postoperative outcomes, and learning curve using cumulative summation (CUSUM) analysis. Of the 110 patients who underwent TOETVA, 101 had malignant disease and 100 (90.9%) underwent lobectomy. The mean age was 39.7 ± 9.7 years, and the mean tumor size was 1.0 ± 0.7 cm (range, 0.3–3.6 cm). Operation time was 168.0 ± 63.4 min for total thyroidectomy, 111.0 ± 27.7 min for lobectomy, and 73.7 ± 18.1 min for isthmusectomy. Five patients (4.5%) experienced transient vocal cord palsy (VCP) and one (0.9%) had permanent VCP. The swallowing impairment index-6 score was 2.18 ± 3.21 at postoperative three months, and 0.97 ± 1.72 at postoperative six months. The learning curve for lobectomy was 58 cases in CUSUM analysis. TOETVA is a safe and feasible approach with an acceptable operation time and a low complication rate. This approach is a surgical option for patients who desire excellent cosmesis.
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Liang TJ, Tsai CY, Liu SI, Chen IS. Multidimensional Analyses of the Learning Curve of Endoscopic Thyroidectomy. World J Surg 2021; 45:1446-1456. [PMID: 33512565 DOI: 10.1007/s00268-021-05953-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Endoscopic thyroidectomy has comparable surgical outcomes and superior cosmetic satisfaction to open thyroidectomy. However, steep learning curve is a concern. This study evaluated the learning curve of endoscopic thyroidectomy using various parameters and statistical methods. METHODS A total of 90 consecutive patients who underwent endoscopic thyroidectomy using bilateral axillo-breast approach (BABA) between March 2016 and April 2020 were enrolled. Operative time, postoperative drainage amount, and blood loss were assessed by cumulative sum (CUSUM) analysis and moving average to evaluate the learning curve. RESULTS Using the CUSUM analysis, the peak point of both operative time and drainage amount occurred at the 30th case. No clear single peak was identified in the CUSUM plot for blood loss. The moving average also showed significant reduction in operative time and drainage amount after, approximately, the first 30 cases. The blood loss decreased after the 25th case. We therefore divided the patients into 2 phases: phase 1 (1-30 cases) and phase 2 (31-90 cases). The operative time, drainage amount, and blood loss decreased significantly in the phase 2 compared with phase 1. Lower pain score in first postoperative day and shorter hospital stay were also observed in the phase 2. Although the reduction in transient hypoparathyroidism did not reach statistical significance, no permanent hypoparathyroidism was noted in the phase 2. CONCLUSIONS The learning curve for endoscopic thyroidectomy is approximately 30 cases. Aside from the operative time, drainage amount may also serve as a surrogate for the learning curve evaluation.
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Affiliation(s)
- Tsung-Jung Liang
- Division of General Surgery, Department of Surgery, Zuoying District, Kaohsiung Veterans General Hospital, No. 386, Dazhong 1st Rd, Kaohsiung, 81362, Taiwan.,School of Medicine, National Yang-Ming University, No.155, Sec.2, Linong Street, Taipei, 11221, Taiwan
| | - Chung-Yu Tsai
- Division of General Surgery, Department of Surgery, Zuoying District, Kaohsiung Veterans General Hospital, No. 386, Dazhong 1st Rd, Kaohsiung, 81362, Taiwan
| | - Shiuh-Inn Liu
- Division of General Surgery, Department of Surgery, Zuoying District, Kaohsiung Veterans General Hospital, No. 386, Dazhong 1st Rd, Kaohsiung, 81362, Taiwan.,School of Medicine, National Yang-Ming University, No.155, Sec.2, Linong Street, Taipei, 11221, Taiwan
| | - I-Shu Chen
- Division of General Surgery, Department of Surgery, Zuoying District, Kaohsiung Veterans General Hospital, No. 386, Dazhong 1st Rd, Kaohsiung, 81362, Taiwan.
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Rossi L, Materazzi G, Bakkar S, Miccoli P. Recent Trends in Surgical Approach to Thyroid Cancer. Front Endocrinol (Lausanne) 2021; 12:699805. [PMID: 34149628 PMCID: PMC8206549 DOI: 10.3389/fendo.2021.699805] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Accepted: 05/19/2021] [Indexed: 12/12/2022] Open
Abstract
Over the past decade, the incidence of thyroid cancer has rapidly increased worldwide, and thyroid surgery has become one of the most common performed surgical procedure. Even though conventional open thyroidectomy remains the gold standard, this approach leaves a neck scar which could be worrying mainly for young women. The recent progress in surgical technology, as well as patient cosmetic requests, have led to the development of alternative access to the thyroid lodge. Thus, alternative techniques have been established in order to potentially provide a more appealing cosmetic result, both with a minimally-invasive cervical or remote-access approach. However, the introduction of these new techniques was initially approached with caution due to technical challenges, the introduction of new complications and, above all, skepticism about the oncologic effectiveness. Among several alternative approaches proposed, the minimally invasive video-assisted thyroidectomy and the robot-assisted transaxillary thyroidectomy became popular and obtained the favor of the scientific community. Moreover, the recent introduction of the trans-oral endoscopic thyroidectomy with vestibular approach, although the safety and the efficacy are still under discussion, deserves particular attention since it represents the only technique truly scarless and provides the best cometic result. The purpose of this article is to provide an overview of the current main alternative approaches for the treatment of thyroid cancer with particular focus on the oncological effectiveness of the procedures.
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Affiliation(s)
- Leonardo Rossi
- Department of Surgical, Medical, Molecular Pathology and Critical Area, University of Pisa, Pisa, Italy
| | - Gabriele Materazzi
- Department of Surgical, Medical, Molecular Pathology and Critical Area, University of Pisa, Pisa, Italy
| | - Sohail Bakkar
- Department of Surgery, Faculty of Medicine, Hashemite University, Zarqa, Jordan
| | - Paolo Miccoli
- Department of Surgical, Medical, Molecular Pathology and Critical Area, University of Pisa, Pisa, Italy
- *Correspondence: Paolo Miccoli,
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Tae K. Complications of Transoral Thyroidectomy: Overview and Update. Clin Exp Otorhinolaryngol 2020; 14:169-178. [PMID: 33211953 PMCID: PMC8111399 DOI: 10.21053/ceo.2020.02110] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 11/15/2020] [Indexed: 11/22/2022] Open
Abstract
Transoral thyroidectomy via the vestibular approach has become popular worldwide, with advantages including less surgical morbidity, excellent postoperative cosmesis, and superior functional voice outcomes. Several studies have reported that the surgical outcomes of the transoral approach were comparable to those of the conventional transcervical approach in selected patients. However, unusual complications, such as CO2 embolism, mental nerve injury, surgical space infection, skin perforation, burns, and trauma have been noted in transoral thyroidectomy. This paper aims to review and provide updated information on these complications and their management. Routine intraoperative neural monitoring is required to avoid laryngeal nerve palsy in the transoral approach. To prevent CO2 embolism, surgeons need to be careful not to injure the anterior jugular vein, and the CO2 insufflation pressure should be set as low as 4-6 mmHg. To avoid mental nerve injury, vestibular incisions should be placed in the safety zone, and dissection of the vestibular area and chin should be minimized. In conclusion, recognizing the possibility of complications and understanding their prevention and management are important for patient safety and the success of the transoral approach.
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Affiliation(s)
- Kyung Tae
- Department of Otolaryngology-Head and Neck Surgery, Hanyang University College of Medicine, Seoul, Korea
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