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Kim H, Woo SH. Endoscopically-Assisted Scar-Free Midline Neck Mass Excision. Clin Exp Otorhinolaryngol 2021; 14:251-258. [PMID: 34407369 PMCID: PMC8373841 DOI: 10.21053/ceo.2020.02446] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 06/25/2021] [Indexed: 11/22/2022] Open
Abstract
Traditional open surgery is indicated for the treatment of selected tumor subsites in the head and neck. However, it can cause major cosmetic problems and functional pathologies. The endoscopically-assisted transoral approach is increasingly preferred in some surgical fields due to its superior cosmetic and functional outcomes. Nonetheless, endoscopically-assisted transoral approach is not yet standard in the head and neck due to their anatomical complexity. The transoral surgical approach has been used for head and neck masses since the 1960s, and its application continues to evolve with changing disease conditions and recent innovations in surgical instruments. The potential for wide application of transoral surgery continues to be investigated, with a focus on minimizing occurrence of the complications. This review presents details of the surgical procedure and postoperative clinical outcomes, as well as endoscopically-assisted scar-free techniques for the resection of midline neck masses.
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Affiliation(s)
- Hyoyeon Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Dankook University College of Medicine, Cheonan, Korea
| | - Seung Hoon Woo
- Department of Otorhinolaryngology-Head and Neck Surgery, Dankook University College of Medicine, Cheonan, Korea
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Chand G, Gupta N, Johri G, Moidu S, Mishra A, Mishra SK. Natural Orifice Endoscopic Thyroidectomy via Transoral Vestibular Approach (TOVA): Single Surgeon Experience from North India. Indian J Otolaryngol Head Neck Surg 2020; 73:160-166. [PMID: 34150590 DOI: 10.1007/s12070-020-01935-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 06/23/2020] [Indexed: 01/04/2023] Open
Abstract
The transoral vestibular approach (TOVA) is the shortest route for endoscopic thyroidectomy (ET) to approach the thyroid and is a totally scar free procedure, hence it has a clear cosmetic advantage not only over conventional open thyroid surgery but also over other remote access approaches for ET like axilla, breast and chest wall approaches. The aim of this study was to evaluate the feasibility, safety and our initial outcomes of TOVA and highlight the advantages of 3D endoscopic equipment in remote access thyroid surgery. We reviewed our prospectively maintained database who underwent ET. 42 patients who fulfilled the stringent inclusion criteria were offered TOVA. We have used novel Trans-vestibular approach with 3D technology for endoscopic thyroid surgery in all cases. Clinico-demographic profile, investigations, operative details, histopathology and postoperative complications and follow-up data were analyzed by using statistical analysis with SPSS19.00 version. Out of 203 ET operated during study period, 42 (20.69%) patients were operated through TOVA. Hemithyroidectomy were performed in all the patients. There were 3 men and 39 women (M:F = 1:13). Mean tumor size was 3.54 ± 1.17 cm. All patients were euthyroid. All patient had cytological diagnosis of Bethesda category II-IV and all underwent hemithyroidectomy. Mean operation time was 107.71 ± 17.60 min and post-operative length of hospital stay was 2.90 ± 1.28 days. Besides magnification, 3D endoscopy provided excellent depth perception which helped in precise dissection in the restricted space and aided in identification and preservation of the two most vital structures i.e. recurrent laryngeal nerve and parathyroid glands. As most of our patients present with larger goitres, not many patients desirous of ET can be offered TOVA. This novel TOVA has fairly stringent inclusion criteria, however it is the only approach which offers completely scarless endoscopic thyroidectomy and should be offered to eligible patients desirous of ET.
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Affiliation(s)
- Gyan Chand
- Department of Endocrine Surgery, SGPGIMS, 226014 Lucknow, India
| | - Nitish Gupta
- Department of Endocrine Surgery, SGPGIMS, 226014 Lucknow, India
| | - Goonj Johri
- Department of Endocrine Surgery, SGPGIMS, 226014 Lucknow, India
| | - Shalikh Moidu
- Department of Endocrine Surgery, SGPGIMS, 226014 Lucknow, India
| | - Anjali Mishra
- Department of Endocrine Surgery, SGPGIMS, 226014 Lucknow, India
| | - Saroj K Mishra
- Department of Endocrine Surgery, SGPGIMS, 226014 Lucknow, India
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Abstract
PURPOSE OF REVIEW To provide an overview of the feasibility and safety of current minimally invasive remote-access approaches for thyroid surgery, in view of the amounting new challenges and paradigm shifts in the management of thyroid pathologies. RECENT FINDINGS Over the past two decades, several remote-access approaches for thyroid surgery have been developed to improve cosmesis; however, none has been widely adopted extensively in the Western world. The recently emerged transoral endoscopic thyroidectomy via vestibular approach (TOETVA) is the only true minimally invasive approach, completely avoiding skin incisions. It has a relatively short learning curve, midline surgical view, accessible surgical equipment, and relatively broad inclusion criteria with promising surgical outcomes as reported to date. TOETVA has proven to be safe and feasible for carefully selected patients. Further experience and long-term follow-up are needed to define the added value of TOETVA except for improved cosmetic outcome.
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Hong YT, Ahn J, Kim JH, Yi JW, Hong KH. Bi‐institutional experience of transoral endoscopic thyroidectomy: Challenges and outcomes. Head Neck 2020; 42:2115-2122. [DOI: 10.1002/hed.26153] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 02/23/2020] [Accepted: 03/10/2020] [Indexed: 12/20/2022] Open
Affiliation(s)
- Yong Tae Hong
- Department of Otolaryngology‐HNSResearch Institute for Clinical Medicine of Chonbuk National University—Biomedical Research Institute of Chonbuk National University Hospital Chonbuk South Korea
| | - Jong‐hyuk Ahn
- Department of SurgeryInha University College of Medicine & Inha University Hospital Incheon South Korea
| | - Jae Hwan Kim
- Department of SurgeryInha University College of Medicine & Inha University Hospital Incheon South Korea
| | - Jin Wook Yi
- Department of SurgeryInha University College of Medicine & Inha University Hospital Incheon South Korea
| | - Ki Hwan Hong
- Department of Otolaryngology‐HNSResearch Institute for Clinical Medicine of Chonbuk National University—Biomedical Research Institute of Chonbuk National University Hospital Chonbuk South Korea
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Endoscope-assisted hairline approach for resecting maxillofacial masses. Int J Oral Maxillofac Surg 2020; 49:310-316. [DOI: 10.1016/j.ijom.2019.06.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 04/28/2019] [Accepted: 06/18/2019] [Indexed: 11/20/2022]
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Bamroong P, Kasemsiri P, Thongrong C, Mahawerawat K, Tongwiset S, Rachain A, Khaengraeng S. Modified equipment for facilitating the transoral vestibular approach to endoscopic thyroidectomy. J Minim Access Surg 2019; 16:399-403. [PMID: 31571672 PMCID: PMC7597879 DOI: 10.4103/jmas.jmas_157_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Objectives: The objectives of the study were to investigate the improvement in operation time for thyroid surgery gained using a modified endobag and suture and to accelerate the learning process for novice endoscopic surgeons. Materials and Methods: A retrospective study was conducted between 2 June 2015 and 1 November 2018. Medical records of patients who underwent transoral endoscopic thyroidectomy vestibular approach (TOETVA) were retrieved and analysed. Comparisons of operative time with or without the use of modified equipment were calculated by the unequal variance t-test in lobectomy and isthmectomy groups. Results: Medical records of 102 patients (mean age: 39.1 years) were analysed. The size of thyroid nodule averaged 4.0 cm (range: 1.0–13.0 cm). TOETVA was applied for right lobectomy (57.8%), left lobectomy (34.3%), isthmectomy (3.9%) and total thyroidectomy (3.9%). Early in our experience, TOETVA required 168 min, whereas following the introduction of the modified endobag and extracorporeal suture, operative time was reduced to 30 min (P > 0.05). Conclusions: The use of modified equipment permitted shorter operation times. The time difference was not statistically significant but does represent a significant time-saving. The use of the modified equipment will simplify and speed up the learning process for novice endoscopic surgeons.
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Affiliation(s)
- Piyapong Bamroong
- Department of Otorhinolaryngology, Mukdahan Hospital, Mukdahan, Thailand
| | - Pornthep Kasemsiri
- Department of Otorhinolaryngology, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University; Khon Kaen Head and Neck Oncology Research; Srinagarind Minimally Invasive Surgery Center of Excellence, Khon Kaen, Thailand
| | - Cattleya Thongrong
- Khon Kaen Head and Neck Oncology Research; Department of Anesthesiology, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | | | - Siriwan Tongwiset
- Department of Otorhinolaryngology, Mukdahan Hospital, Mukdahan, Thailand
| | - Angkana Rachain
- Department of Otorhinolaryngology, Mukdahan Hospital, Mukdahan, Thailand
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Anatomical study of gasless transoral thyroidectomy and clinical application. Surg Endosc 2019; 34:3414-3423. [PMID: 31531736 DOI: 10.1007/s00464-019-07117-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 09/04/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND Transoral thyroidectomy is becoming a preferred technique because it has the advantage of not leaving a scar after surgery. However, it is not yet standard because of the anatomic nerve complexity of this oral cavity and difficulty of approach. The aim of this study was to determine the safety zone of a gasless transoral thyroidectomy approach using an anatomical study and to evaluate the efficacy of this approach on clinical application. METHODS Phase 1, twenty unilateral specimens from fresh cadavers underwent staining by the modified Sihler's method to identify nerves around the oral vestibules. Then, the safety zone of the transoral thyroidectomy approach was proposed. Phase 2, a comparative analysis of the clinical outcomes of gasless transoral thyroidectomy through the safety zone versus transcutaneous thyroidectomy approach. RESULTS In phase 1, numerous inferior labial branches diverged from the mental nerve and were distributed across the lower lip. In most cases, the most lateral branch reached almost to the corner of the mouth, whereas a nerve-free area was present at the medial region of the lower lip. The suggested safety zone was presented as a trapezoid shape. In phase 2, there were no significant differences in age, mass size, or complications between the two groups. However, the operation time in the transoral thyroidectomy group was longer than in the transcutaneous group (p = 0.001). CONCLUSIONS Based on the anatomical study, we suggested a safety zone for the gasless transoral thyroidectomy. On application of this safety zone, gasless transoral thyroidectomy is a safe and feasible procedure.
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Nerve Monitoring for Transoral Thyroid Surgery: Why, How, and What to Expect. CURRENT OTORHINOLARYNGOLOGY REPORTS 2019. [DOI: 10.1007/s40136-019-00251-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Zhang D, Park D, Sun H, Anuwong A, Tufano R, Kim HY, Dionigi G. Indications, benefits and risks of transoral thyroidectomy. Best Pract Res Clin Endocrinol Metab 2019; 33:101280. [PMID: 31204296 DOI: 10.1016/j.beem.2019.05.004] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The advancement of minimally invasive surgery in the field of endocrine surgery over the last 2 decades has fostered the attempt of natural orifice transluminal endoscopic surgery (NOTES) for thyroidectomy and parathyroidectomy via oral incisions. This technically demanding surgery is currently being evaluated in a number of specialised centres. The procedure has gained popularity worldwide and is performed in more than 50 centres. By retrieving information from published or presented articles and direct personal communications, this study reports several issues to enable and optimise correct patient and surgeon candidacy, present the advantages and prevent novel complications under the standards of open thyroid surgery. Not all patients are eligible for the transoral approach. Transoral endoscopic and robotic procedures were described and critically analysed in this study.
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Affiliation(s)
- Daqi Zhang
- Division of Thyroid Surgery, China-Japan Union Hospital Of Jilin University, Jilin Provincial Key Laboratory Of Surgical Translational Medicine, Jilin Provincial Precision Medicine Laboratory of Molecular Biology and Translational Medicine on Differentiated Thyroid Carcinoma, 126 Xiantai Blvd, Changchun City, Jilin Province, PR China
| | - Dawon Park
- Department of Surgery, Division of Breast and Endocrine Surgery, Minimally Invasive Surgery and Robotic Surgery Center, KUMC Thyroid Center Korea University, Anam Hospital, Seoul, Republic of Korea.
| | - Hui Sun
- Division of Thyroid Surgery, China-Japan Union Hospital Of Jilin University, Jilin Provincial Key Laboratory Of Surgical Translational Medicine, Jilin Provincial Precision Medicine Laboratory of Molecular Biology and Translational Medicine on Differentiated Thyroid Carcinoma, 126 Xiantai Blvd, Changchun City, Jilin Province, PR China
| | - Angkoon Anuwong
- Minimally Invasive and Endocrine Surgery Division, Department of Surgery, Police General Hospital, Bangkok, Thailand
| | - Ralph Tufano
- Division of Head and Neck Endocrine Surgery, Department of Otolaryngology - Head & Neck Surgery, Johns Hopkins University School of Medicine
| | - Hoon Yub Kim
- Department of Surgery, Division of Breast and Endocrine Surgery, Minimally Invasive Surgery and Robotic Surgery Center, KUMC Thyroid Center Korea University, Anam Hospital, Seoul, Republic of Korea
| | - Gianlorenzo Dionigi
- Division for Endocrine and Mininvasive Surgery, Department of Human Pathology in Adulthood and Childhood ''G. Barresi'', University Hospital G. Martino, University of Messina, Via C. Valeria 1, 98125, Messina, Italy
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Jamikorn T, Anuwong A. Transoral Endoscopic Thyroidectomy (TOETVA). CURRENT OTORHINOLARYNGOLOGY REPORTS 2019. [DOI: 10.1007/s40136-019-00250-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Kim JP, Lee DK, Moon JH, Ryu JS, Woo SH. Endoscope‐assisted transoral accessory parotid mass excision: Multicenter prospective observational study. Laryngoscope 2019; 130:1218-1226. [DOI: 10.1002/lary.28190] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 05/20/2019] [Accepted: 07/02/2019] [Indexed: 02/03/2023]
Affiliation(s)
- Jin Pyeong Kim
- Department of OtolaryngologyGyeongsang National University Hospital Changwon Republic of Korea
- Institute of Health Sciences, Gyeongsang National University Jinju Republic of Korea
| | - Dong Kun Lee
- Department of Otolaryngology–Head and Neck SurgeryDong‐A University College of Medicine Busan Republic of Korea
| | - Jeong Hwan Moon
- Department of OtorhinolaryngologyNational Cancer Center Ilsan Republic of Korea
| | - Jun Sun Ryu
- Head and Neck Oncology ClinicNational Cancer Center Ilsan
| | - Seung Hoon Woo
- Department of Otolaryngology–Head and Neck surgeryDankook University College of Medicine Cheonan Republic of Korea
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Kovatch KJ, Baerg T, Ha JF, Brown DJ. Endoscopic-Assisted Removal of a Massive Pediatric Floor of Mouth Dermoid. EAR, NOSE & THROAT JOURNAL 2019; 98:554-556. [PMID: 31722570 DOI: 10.1177/0145561318824222] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Kevin J Kovatch
- Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, Ann Arbor, MI, USA
| | - Timothy Baerg
- University of Michigan School of Medicine, Ann Arbor, MI, USA
| | - Jennifer F Ha
- Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, Ann Arbor, MI, USA
| | - David J Brown
- Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, Ann Arbor, MI, USA
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Lessons Learned From a Faulty Transoral Endoscopic Thyroidectomy Vestibular Approach. Surg Laparosc Endosc Percutan Tech 2019; 28:e94-e99. [PMID: 29975356 DOI: 10.1097/sle.0000000000000555] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Transoral endoscopic thyroidectomy via vestibular approach (TOETVA) is currently considered the most promisingly scarless approach to the thyroid and has gained more acceptance. MATERIALS AND METHODS We described a case of faulty TOETVA. RESULTS The faulty TOETVA resulted in pneumomediastinum, diffuse subcutaneous emphysema, prolonged surgery, and anesthesia. CONCLUSIONS The important technical considerations during TOETVA, including the use of external retraction, the identification of the subplatysmal plane of dissection, CO2 insufflation settings, the learning curve, and patient selection, were described and discussed.
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Tae K, Lee DW, Song CM, Ji YB, Park JH, Kim DS, Tufano RP. Early experience of transoral thyroidectomy: Comparison of robotic and endoscopic procedures. Head Neck 2018; 41:730-738. [DOI: 10.1002/hed.25426] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 08/03/2018] [Accepted: 09/21/2018] [Indexed: 01/20/2023] Open
Affiliation(s)
- Kyung Tae
- Department of Otolaryngology-Head and Neck Surgery; College of Medicine, Hanyang University; Seoul South Korea
| | - Dong Won Lee
- Department of Otolaryngology-Head and Neck Surgery; College of Medicine, Hanyang University; Seoul South Korea
| | - Chang Myeon Song
- Department of Otolaryngology-Head and Neck Surgery; College of Medicine, Hanyang University; Seoul South Korea
| | - Yong Bae Ji
- Department of Otolaryngology-Head and Neck Surgery; College of Medicine, Hanyang University; Seoul South Korea
| | - Jung Hwan Park
- Department of Internal Medicine; College of Medicine, Hanyang University; Seoul South Korea
| | - Dong Sun Kim
- Department of Internal Medicine; College of Medicine, Hanyang University; Seoul South Korea
| | - Ralph P. Tufano
- Department of Otolaryngology-Head and Neck Surgery; Johns Hopkins University School of Medicine; Baltimore Maryland
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Kim JP, Lee DK, Moon JH, Park JJ, Woo SH. Transoral Dermoid Cyst Excision: A Multicenter Prospective Observational Study. Otolaryngol Head Neck Surg 2018; 159:981-986. [PMID: 30149779 DOI: 10.1177/0194599818791772] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Transoral surgery is becoming a preferred technique because it does not leave any scar after surgery. However, transoral surgery for a dermoid cyst of the oral cavity is not standardized yet, due to the anatomic complexity of this region. The aim of this study was to evaluate the safety and efficacy of a transoral dermoid cyst excision. STUDY DESIGN Multicenter prospective observational study. SETTING University hospital. SUBJECTS AND METHODS This study was designed as a 4-year prospective multicenter evaluation of dermoid cyst excisions within the floor of mouth. Clinical outcomes and complications related to procedures were evaluated among patients. The primary outcome was the efficacy of the procedure, and the secondary outcome was cosmetic satisfaction of each procedure. RESULTS Twenty-one patients underwent transoral dermoid cyst excisions, and 22 underwent transcervical excisions. In the transoral surgery group, the mean size of the dermoid cyst was 5.35 cm (95% CI, 4.79-5.91), and in the transcervical surgery group, it was 6.19 cm (95% CI, 5.67-6.71). There was no significant differences with respect to overall demographic characteristics between the groups. However, the duration of the operation was shorter with the transoral group than with the transcervical group ( P = .001), and cosmetic satisfaction was much better in the transoral group ( P < .001). CONCLUSION Transoral dermoid cyst excision is a potentially safe and effective method that can lead to easy and quick removal of an oral cavity dermoid cyst, with excellent cosmetic outcomes.
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Affiliation(s)
- Jin Pyeong Kim
- 1 Department of Otolaryngology, Gyeongsang National University, Changwon, South Korea
- 2 Institute of Health Sciences, Gyeongsang National University, Jinju, South Korea
| | - Dong Kun Lee
- 3 Department of Otolaryngology-Head and Neck Surgery, Dong-A University College of Medicine, Busan, South Korea
| | - Jeong Hwan Moon
- 4 Department of Otorhinolaryngology, Dankook University College of Medicine, Cheonan, South Korea
| | - Jung Je Park
- 2 Institute of Health Sciences, Gyeongsang National University, Jinju, South Korea
- 5 Department of Otorhinolaryngology-Head and Neck Surgery, Gyeongsang National University, Jinju, South Korea
| | - Seung Hoon Woo
- 2 Institute of Health Sciences, Gyeongsang National University, Jinju, South Korea
- 5 Department of Otorhinolaryngology-Head and Neck Surgery, Gyeongsang National University, Jinju, South Korea
- 6 Beckman Laser Institute, University of California, Irvine, California, USA
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Lee JS, Kim JP, Ryu JS, Woo SH. Effect of wound massage on neck discomfort and voice changes after thyroidectomy. Surgery 2018; 164:965-971. [PMID: 30054014 DOI: 10.1016/j.surg.2018.05.029] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Revised: 05/20/2018] [Accepted: 05/23/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND Neck discomfort and voice change are common complications after thyroidectomy. These symptoms might be due to damaged laryngeal nerves, intrinsic structures, or extralaryngeal muscles. They can also occur without injury to any structure as with wound adhesion after thyroidectomy. The objective of this study was to determine causes of neck discomfort and voice change after thyroidectomy and to evaluate the effect of wound massage on symptom relief. METHODS Forty-five female patients who underwent total thyroidectomy were included (21 in the experimental group and 24 in the control group). Wound massage was used as an intervention to release surgical adhesion. After wound massage education, participants in the experimental group received wound massage from 4 to 12 weeks after thyroidectomy. Analysis was performed for both groups. RESULTS No laryngeal pathology was found after thyroidectomy. The experimental group had significantly better recovery from surgical adhesion and subjective visual analog scale, voice impairment score, and swallowing impairment score (all P < .01) compared with the control group. Voice analysis results associated with laryngeal movement (speaking fundamental frequency, voice range profile maximum, voice range profile range) also indicated significant recovery (P < .01) in the experimental group. These results indicate that local adhesion after thyroidectomy might affect general movement of the larynx and that wound massage could help patients recover normal general movement of the larynx. CONCLUSION Neck discomfort and voice change after thyroidectomy are related to local wound adhesion, possibly associated with impairment of laryngeal vertical movement. Release of wound adhesion could help patients recover from neck discomfort and voice changes after thyroidectomy.
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Affiliation(s)
- Jae Seok Lee
- Department of Otolaryngology, Gyeongsang National University Hospital, Jinju, Korea
| | - Jin Pyeong Kim
- Department of Otolaryngology, Gyeongsang National University Hospital, Jinju, Korea; Institute of Health Sciences, Gyeongsang National University, Jinju, Korea
| | - Jun Sun Ryu
- Head and Neck Oncology Clinic, National Cancer Center, Ilsan, South Korea
| | - Seung Hoon Woo
- Department of Otolaryngology, Gyeongsang National University Hospital, Jinju, Korea; Institute of Health Sciences, Gyeongsang National University, Jinju, Korea; Beckman Laser Institute, University of California, Irvine, CA.
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Abstract
BACKGROUND No-scar transoral thyroglossal duct cyst (TGDC) excision is a newly developed treatment for TGDC, but limited information is available regarding the clinical outcomes in children. The aim of this study was to evaluate the safety, efficacy, and effects of transoral TGDC excision in children. METHODS Forty-four children <10 years of age received operative treatment for TGDC from January 2013 to December 2014, and follow-up was performed over 24 months. Clinicopathologic, surgical, and follow-up data were collected and analyzed. The primary outcome variable was feasibility of the procedure, and the secondary outcome was patient's cosmetic satisfaction after each operation. RESULTS Twenty-one patients underwent transoral TGDC excision, and 21 patients underwent conventional excision. No significant differences were observed between the two groups in terms of the overall patient and operation factors. However, the rate of identifying the thyroglossal duct during transoral excision was superior to that during conventional excision (p < 0.05), and cosmetic satisfaction was much better in the transoral TGDC excision group (p < 0.001). CONCLUSION No-scar transoral TGDC excision in children is a potentially safe and effective methodology that can achieve easy removal of the thyroglossal duct and excellent cosmetic outcomes.
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Affiliation(s)
- Jin Pyeong Kim
- Department of Otolaryngology—Head and Neck Surgery, Gyeongsang National University, Jinju, Korea
| | - Jung Je Park
- Department of Otolaryngology—Head and Neck Surgery, Gyeongsang National University, Jinju, Korea
| | - Seung Hoon Woo
- Department of Otolaryngology—Head and Neck Surgery, Gyeongsang National University, Jinju, Korea
- Institute of Health Sciences, Gyeongsang National University, Jinju, Korea
- Beckman Laser Institute, University of California, Irvine, California
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Kim K, Gu MO, Jung JH, Hahm JR, Kim SK, Kim JH, Woo SH. Efficacy of a Home-Based Exercise Program After Thyroidectomy for Thyroid Cancer Patients. Thyroid 2018; 28:236-245. [PMID: 29258382 DOI: 10.1089/thy.2017.0277] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND The objective of this study was to determine the effect of a home-based exercise program on fatigue, anxiety, quality of life (QoL), and immune function of thyroid cancer patients taking thyroid hormone replacement after thyroidectomy. METHOD This quasi-experimental study with a non-equivalent control group included 43 outpatients taking thyroid hormone replacement after thyroidectomy (22 in the experimental group and 21 in the control group). After education about the home-based exercise program, subjects in the experimental group underwent 12 weeks of aerobic, resistance, and flexibility exercise. A comparative analysis was conducted between the two groups. RESULTS Patients in the experimental group were significantly less fatigued or anxious (p < 0.01). They reported significantly improved QoL (p < 0.05) compared to those in the control group. Natural killer cell activity was significantly higher in the exercise group compared to that in the control group (p < 0.05). CONCLUSION A home-based exercise program is effective in reducing fatigue and anxiety, improving QoL, and increasing immune function in patients taking thyroid hormone replacement after thyroidectomy. Therefore, such a home-based exercise program can be used as an intervention for patients who are taking thyroid hormone replacement after thyroidectomy.
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Affiliation(s)
- Kyunghee Kim
- 1 Department of Otolaryngology, Gyeongsang National University , Jinju, Korea
- 2 Department of Nursing Graduate School, Gyeongsang National University , Jinju, Korea
| | - Mee Ock Gu
- 3 College of Nursing, Gyeongsang National University , Jinju, Korea
- 4 Institute of Health Sciences, Gyeongsang National University , Jinju, Korea
| | - Jung Hwa Jung
- 4 Institute of Health Sciences, Gyeongsang National University , Jinju, Korea
- 5 Department of Internal Medicine, Gyeongsang National University , Jinju, Korea
| | - Jong Ryeal Hahm
- 4 Institute of Health Sciences, Gyeongsang National University , Jinju, Korea
- 5 Department of Internal Medicine, Gyeongsang National University , Jinju, Korea
| | - Soo Kyoung Kim
- 4 Institute of Health Sciences, Gyeongsang National University , Jinju, Korea
- 5 Department of Internal Medicine, Gyeongsang National University , Jinju, Korea
| | - Jin Hyun Kim
- 6 Biomedical Research Institute, Gyeongsang National University , Jinju, Korea
| | - Seung Hoon Woo
- 1 Department of Otolaryngology, Gyeongsang National University , Jinju, Korea
- 5 Department of Internal Medicine, Gyeongsang National University , Jinju, Korea
- 7 Beckman Laser Institute, University of California , Irvine, California
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Dionigi G, Wu CW, Tufano RP, Rizzo AG, Anuwong A, Sun H, Carcoforo P, Antonino C, Portinari M, Kim HY. Monitored transoral endoscopic thyroidectomy via long monopolar stimulation probe. J Vis Surg 2018; 4:24. [PMID: 29445610 PMCID: PMC5803135 DOI: 10.21037/jovs.2017.12.25] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Accepted: 12/27/2017] [Indexed: 12/14/2022]
Abstract
This video aimed to describe the role of intraoperative neuromonitoring (IONM) during transoral endoscopic thyroidectomy vestibular approach (TOETVA) with emphasis given to IONM technical and technological notes, the identification of recurrent laryngeal nerve (RLN). Standardized technique of IONM consist in identifying and monitoring both the vagus nerve and the RLNs before and after resection (V1, V2, R1, R2). According to this report, IONM during TOETVA is feasible and safe in providing identification and function of laryngeal nerves. IONM enable surgeons to feel more comfortable with their initial approach to TOETVA or extended indications. Larger series are needed for appropriated evaluation of IONM in reduction of the rates for RLN complications.
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Affiliation(s)
- Gianlorenzo Dionigi
- Division for Endocrine and Minimally Invasive Surgery, Department of Human Pathology in Adulthood and Childhood ''G. Barresi'', University Hospital G. Martino, University of Messina, Messina, Italy
| | - Che-Wei Wu
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Otolaryngology-Head and Neck Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ralph P. Tufano
- Department of Otolaryngology-Head and Neck Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Antonio Giacomo Rizzo
- Division for Endocrine and Minimally Invasive Surgery, Department of Human Pathology in Adulthood and Childhood ''G. Barresi'', University Hospital G. Martino, University of Messina, Messina, Italy
| | - Angkoon Anuwong
- Division of Head and Neck Endocrine Surgery, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Hui Sun
- Minimally Invasive and Endocrine Division, Department of Surgery, Police General Hospital, Bangkok, Thailand
| | - Paolo Carcoforo
- Division of Thyroid Surgery, Jilin Provincial Key Laboratory of Surgical Translational Medicine, China Japan Union Hospital of Jilin University, Changchun 130033, China
- Department of Surgery, S. Anna University Hospital, Ferrara, Italy
| | - Cancellieri Antonino
- Division for Endocrine and Minimally Invasive Surgery, Department of Human Pathology in Adulthood and Childhood ''G. Barresi'', University Hospital G. Martino, University of Messina, Messina, Italy
| | - Mattia Portinari
- Division of Thyroid Surgery, Jilin Provincial Key Laboratory of Surgical Translational Medicine, China Japan Union Hospital of Jilin University, Changchun 130033, China
- Department of Surgery, S. Anna University Hospital, Ferrara, Italy
| | - Hoon Yub Kim
- Department of Morphology, Surgery, and Experimental Medicine, University of Ferrara, Ferrara, Italy
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20
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Dionigi G, Tufano RP, Russell J, Kim HY, Piantanida E, Anuwong A. Transoral thyroidectomy: advantages and limitations. J Endocrinol Invest 2017; 40:1259-1263. [PMID: 28432675 DOI: 10.1007/s40618-017-0676-0] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2017] [Accepted: 04/10/2017] [Indexed: 01/29/2023]
Abstract
In this opinion paper of the Journal of Endocrinological Investigation, leading experts in the field report on their current clinical experience with a novel approach for thyroid gland surgery, namely, "transoral thyroidectomy" (TOT). This feasible and novel surgical procedure does not require visible incisions and is, therefore, a truly scarless surgery. Patients meeting the following criteria can be considered as candidates for TOT: (a) an ultrasonographically (US) estimated thyroid diameter ≤10 cm; (b) US-estimated gland volume ≤45 mL; (c) nodule size ≤50 mm; (d) presence of a benign tumor such as a thyroid cyst or a single- or multi-nodular goiter; (e) Bethesda 3 and/or 4 category and (f) papillary microcarcinoma without the evidence of metastasis. The procedure is conducted via a three-port technique at the oral vestibule using a 10-mm port for the 30° endoscope and two additional 5-mm ports for the dissecting and coagulating instruments. TOT is performed using conventional endoscopic instruments and is probably the best scarless approach to the thyroid because of the short distance between the thyroid and the incisions placed intra-orally that do not result in any cutaneous scar and upon following the surgical planes. Experts in TOT organized a working group of general, endocrine, head and neck ENT surgeons and endocrinologist to develop the standards for practicing this emerging technique.
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Affiliation(s)
- G Dionigi
- 1st Division of General Surgery, Department of Surgical Sciences and Human Morphology, Research Center for Endocrine Surgery, University of Insubria (Varese-Como), via Guicciardini, 9, 21100, Varese, Italy
| | - R P Tufano
- Division of Head and Neck Endocrine Surgery, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - J Russell
- Division of Head and Neck Endocrine Surgery, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - H Y Kim
- Division of Breast and Endocrine Surgery, Department of Surgery, Minimally Invasive Surgery and Robotic Surgery Center, KUMC Thyroid Center Korea University, Anam Hospital, Seoul, 08308, Korea.
| | - E Piantanida
- Endocrine Unit, Department of Medicine and Surgery, University of Insubria, ASST dei Sette Laghi, Viale Borri, 57, 21100, Varese, Italy
| | - A Anuwong
- Minimally Invasive and Endocrine Division, Department of Surgery, Police General Hospital, Bangkok, Thailand
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21
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Anuwong A, Sasanakietkul T, Jitpratoom P, Ketwong K, Kim HY, Dionigi G, Richmon JD. Transoral endoscopic thyroidectomy vestibular approach (TOETVA): indications, techniques and results. Surg Endosc 2017; 32:456-465. [PMID: 28717869 DOI: 10.1007/s00464-017-5705-8] [Citation(s) in RCA: 176] [Impact Index Per Article: 25.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Accepted: 07/03/2017] [Indexed: 10/19/2022]
Abstract
INTRODUCTION The Transoral Neck Surgery (TONS) Study Group was established at the 1st International Thyroid NOTES Conference in February 2016 with the intention of standardizing and refining thyroid NOTES techniques, including both transoral endoscopic and robotic thyroidectomy approaches. Herein, the authors report the modification of indications, preparation, and step-by-step explanations for operative techniques, as well as results and postoperative care for transoral endoscopic thyroidectomy vestibular approach (TOETVA). METHODS Between February 2015 and December 2015, a total of 200 patients comprising 8 males (4%) and 192 females (96%) underwent TOETVA using 3 laparoscopic ports inserted at the oral vestibule. Of these patients, 111 presented with single thyroid nodules (55.5%), while 66 patients had multinodular goiters (33%), 12 had Graves' disease (6%) and 11 had papillary microcarcinoma (5.5%). The CO2 insufflation pressure was maintained at 6 mmHg. Each surgery was performed using laparoscopic instruments and ultrasonic devices. RESULTS TOETVA was performed on 200 consecutive patients. No conversion to conventional open surgery was necessary. Average tumor size was 4.1 ± 1.78 cm (1-10 cm). Median operative time was 97 ± 40.5 min (45-300 min). Median blood loss was 30 ± 46.25 mL (6-300 mL). Mean visual analog scale measurements were 2.41 ± 2.04 (2-7), 1.17 ± 1.4 (0-5), and 0.47 ± 0.83 (0-3) on the first, second, and third days, respectively. Temporary hoarseness and hypoparathyroidism occurred in 8 patients (4%) and 35 patients (17.5%), respectively. No permanent hoarseness or hypoparathyroidism occurred. Mental nerve injury occurred in 3 patients (1.5%). One patient (0.5%) developed a post-operative hematoma that required open surgery. No infection was identified. CONCLUSION TOETVA was shown to be safe and feasible with a reasonable surgical duration and minimal pain scores. This approach shows promise for those patients who are motivated to avoid a neck scar.
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Affiliation(s)
- Angkoon Anuwong
- Minimally-Invasive and Endocrine Surgery Division, Department of Surgery, Police General Hospital, 492/1 Rama I Road, Pathumwan, Bangkok, 10330, Thailand.
| | - Thanyawat Sasanakietkul
- Minimally-Invasive and Endocrine Surgery Division, Department of Surgery, Police General Hospital, 492/1 Rama I Road, Pathumwan, Bangkok, 10330, Thailand
| | - Pornpeera Jitpratoom
- Minimally-Invasive and Endocrine Surgery Division, Department of Surgery, Police General Hospital, 492/1 Rama I Road, Pathumwan, Bangkok, 10330, Thailand
| | - Khwannara Ketwong
- Minimally-Invasive and Endocrine Surgery Division, Department of Surgery, Police General Hospital, 492/1 Rama I Road, Pathumwan, Bangkok, 10330, Thailand
| | - Hoon Yub Kim
- Department of Surgery, KUMC Thyroid Center, Korea University Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Gianlorenzo Dionigi
- Division of Endocrine Surgery, Department of Human Pathology in Adulthood and Childhood "G. Barresi", Department of Surgical Oncology, University Hospital - Policlinico "G.Martino", University of Messina, Via Consolare Valeria, 98125, Messina, Italy
| | - Jeremy D Richmon
- Department of Otolaryngology Head Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, USA
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22
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Dionigi G, Lavazza M, Wu CW, Sun H, Liu X, Tufano RP, Kim HY, Richmon JD, Anuwong A. Transoral thyroidectomy: why is it needed? Gland Surg 2017; 6:272-276. [PMID: 28713699 DOI: 10.21037/gs.2017.03.21] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Transoral thyroidectomy (TOT) represents reasonably the desirable minimally invasive approach to the gland due to the scarless non-visible incisions, the limited distance between the gland and the access that minimize tissue dissection and respect of the surgical anatomical planes. Patients are routinely selected according to an extensive inclusion criteria: (I) ultrasonographically (US) estimated thyroid diameter not larger than 10 cm; (II) US gland volume ≤45 mL; (III) nodule size ≤50 mm; (IV) a benign tumor, such as a thyroid cyst, single-nodular goiter, or multinodular goiter; (V) follicular neoplasm; (VI) papillary microcarcinoma without lymph node metastasis. The operation is realized through median, central approach which allows bilateral exploration of the thyroid gland and central compartment. TOT is succeed both endoscopically adopting ordinary endoscopic equipments or robotically. In detail three ports are placed at the inferior oral vestibule: one 10-mm port for 30° endoscope and two 5-mm ports for dissecting, coagulating and neuromonitoring instruments. Low CO2 insufflation pressure is set at 6 mmHg. An anterior cervical subplatysmal space is created from the oral vestibule down to the sternal notch, laterally to the sterncleidomuscles similar to that of conventional thyroidectomy. TOT is now reproducible in selective high volume endocrine centers.
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Affiliation(s)
- Gianlorenzo Dionigi
- 1st Division of Surgery, Research Center for Endocrine Surgery, Department of Medicine and Surgery, University of Insubria (Como-Varese), Varese, Italy
| | - Matteo Lavazza
- 1st Division of Surgery, Research Center for Endocrine Surgery, Department of Medicine and Surgery, University of Insubria (Como-Varese), Varese, Italy
| | - Chei-Wei Wu
- Institute of Clinical Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Faculty of Medicine, College of Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Otolaryngology-Head and Neck Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hui Sun
- Division of Thyroid Surgery, Jilin Provincial Key Laboratory of Surgical Translational Medicine, China Japan Union Hospital of Jilin University, Changchun 130031, China
| | - Xiaoli Liu
- Division of Thyroid Surgery, Jilin Provincial Key Laboratory of Surgical Translational Medicine, China Japan Union Hospital of Jilin University, Changchun 130031, China
| | - Ralph P Tufano
- Division of Head and Neck Endocrine Surgery, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Hoon Yub Kim
- Department of Surgery, KUMC Thyroid Center, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Jeremy D Richmon
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA, USA
| | - Angkoon Anuwong
- Department of Surgery, Police General Hospital, Faculty of Medicine, Siam University, Bangkok, Thailand
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23
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Anuwong A, Kim HY, Dionigi G. Transoral endoscopic thyroidectomy using vestibular approach: updates and evidences. Gland Surg 2017; 6:277-284. [PMID: 28713700 DOI: 10.21037/gs.2017.03.16] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Recently, natural orifice transluminal endoscopic surgery (NOTES) has been applied in thyroid surgery with transoral access. The benefit of transoral endoscopic thyroidectomy is the potential for scar-free surgery. However, there are many concerns over some aspects, such as infection, recurrent laryngeal nerve injury, and oncological outcome. In this paper, we have reviewed the development history and the current clinical evidence of this innovative surgery. We conclude that the transoral endoscopic thyroidectomy vestibular approach (TOETVA) is feasible and can be considered no longer an experimental operation.
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Affiliation(s)
- Angkoon Anuwong
- Department of Surgery, Minimally Invasive and Endocrine Surgery Division, Police General Hospital, Bangkok, Thailand
| | - Hoon Yub Kim
- Department of Surgery, KUMC Thyroid Center, Korea University College of Medicine, Seoul, Korea
| | - Gianlorenzo Dionigi
- Department of Surgical Sciences and Human Morphology, 1st Division of Surgery, Research Center for Endocrine Surgery, University of Insubria (Como-Varese), Varese, Italy
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24
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Dionigi G, Bacuzzi A, Lavazza M, Inversini D, Boni L, Rausei S, Kim HY, Anuwong A. Transoral endoscopic thyroidectomy: preliminary experience in Italy. Updates Surg 2017; 69:225-234. [PMID: 28405949 DOI: 10.1007/s13304-017-0436-x] [Citation(s) in RCA: 81] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Accepted: 04/01/2017] [Indexed: 12/17/2022]
Abstract
Transoral endoscopic thyroidectomy vestibular approach (TOETVA) is a feasible novel surgical procedure that does not need visible incisions. We describe our initial experience with TOETVA. We recruited 15 patients who were willing to undergo TOETVA. Inclusion criteria were (a) patients who had a neck ultrasound (US) with a estimated thyroid diameter not larger than 10 cm; (b) US estimated gland volume ≤45 mL; (c) nodule size ≤50 mm; (d) a benign tumor, such as a thyroid cyst, single-nodular goiter, or multinodular goiter; (e) follicular neoplasm; (f) papillary microcarcinoma without evidence of metastasis. The procedure is carried out through a three-port technique placed at the oral vestibule, one 10-mm port for 30° endoscope and two additional 5-mm ports for dissecting and coagulating instruments. CO2 insufflation pressure is set at 6 mmHg. An anterior cervical subplatysmal space is created from the oral vestibule down to the sternal notch, laterally to the sternocleidomastoid muscle. Thyroidectomy is done fully endoscopically using conventional endoscopic instruments and intraoperative neuromonitoring. There were 34% total thyroidectomies and 66% hemithyroidectomies. All TOETVA procedures were performed successfully with no conversions. The mean operative time was 87.6 (59-118) min for lobectomy and 107.6 (99-135) min for bilateral procedure. We observed one case of transient postoperative hypocalcemia. There was no recurrent laryngeal nerve palsy. The cosmetic result was excellent in all patients. This is the first case series of TOETVA in Italy. TOETVA may provide a method for ideal cosmetic results. The results are encouraging, and we are optimistic about the future expansion of its applicability.
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Affiliation(s)
- Gianlorenzo Dionigi
- 1st Division of Surgery, Department of Medicine and Surgery, Endocrine Surgery Research Center, University of Insubria, Varese, Italy.
| | - Alessandro Bacuzzi
- Division of Anesthesia, Ospedale di Circolo, Fondazione Macchi, Varese, Italy
| | - Matteo Lavazza
- 1st Division of Surgery, Department of Medicine and Surgery, Endocrine Surgery Research Center, University of Insubria, Varese, Italy
| | - Davide Inversini
- 1st Division of Surgery, Department of Medicine and Surgery, Endocrine Surgery Research Center, University of Insubria, Varese, Italy
| | - Luigi Boni
- Department of General and Emergency Surgery at the IRCCS - Ca Granda, Policlinico Hospital in Milan, University of Milan, Milano, Italy
| | - Stefano Rausei
- 1st Division of Surgery, Department of Medicine and Surgery, Endocrine Surgery Research Center, University of Insubria, Varese, Italy
| | - Hoon Yub Kim
- Department of Surgery, Korea University College of Medicine, Seoul, Republic of Korea
| | - Angkoon Anuwong
- Minimally Invasive and Endocrine Surgery Division, Department of Surgery Police General Hospital, Bangkok, Thailand
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25
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Russell JO, Noureldine SI, Al Khadem MG, Chaudhary HA, Day AT, Kim HY, Tufano RP, Richmon JD. Transoral robotic thyroidectomy: a preclinical feasibility study using the da Vinci Xi platform. J Robot Surg 2017; 11:341-346. [PMID: 28155047 DOI: 10.1007/s11701-016-0661-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 12/04/2016] [Indexed: 10/20/2022]
Abstract
Transoral thyroid surgery allows the surgeon to conceal incisions within the oral cavity without significantly increasing the amount of required dissection. TORT provides an ideal scarless, midline access to the thyroid gland and bilateral central neck compartments. This approach, however, presents multiple technical challenges. Herein, we present our experience using the latest generation robotic surgical system to accomplish transoral robotic thyroidectomy (TORT). In two human cadavers, the da Vinci Xi surgical system (Intuitive Surgical, Sunnyvale, CA, USA) was used to complete TORT. Total thyroidectomy and bilateral central neck dissection was successfully completed in both cadavers. The da Vinci Xi platform offered several technologic advantages over previous robotic generations including overhead docking, narrower arms, and improved range of motion allowing for improved execution of previously described TORT techniques.
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Affiliation(s)
- Jonathon O Russell
- Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Salem I Noureldine
- Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mai G Al Khadem
- Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Hamad A Chaudhary
- Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Andrew T Day
- Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Hoon Yub Kim
- Department of Surgery, Korea University College of Medicine, Seoul, Korea
| | - Ralph P Tufano
- Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jeremy D Richmon
- Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA. .,Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA, USA.
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26
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Woo SH, Park JJ, Kwon M, Pyeong Kim J. “Hidden scar” submandibular gland excision using an endoscope-assisted hairline approach. Oral Oncol 2017; 65:83-88. [DOI: 10.1016/j.oraloncology.2016.12.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Revised: 12/16/2016] [Accepted: 12/17/2016] [Indexed: 10/20/2022]
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27
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Abstract
There is currently significant demand for minimally invasive thyroid surgery; however the majority of proposed surgical approaches necessitate a compromise between minimal tissue dissection with a visible cervical scar or extensive tissue dissection with a remote, hidden scar. The development of transoral endoscopic thyroid surgery however provides an approach which is truly minimally invasive, as it conceals the incision within the oral cavity without significantly increasing the amount of required dissection. The transoral endoscopic approach however presents multiple technical challenges, which could be overcome with the incorporation of a robotic operating system. This manuscript summarizes the literature on the feasibility and current clinical experience with transoral robotic thyroid surgery.
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Affiliation(s)
- James H Clark
- 1 Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, MD, USA ; 2 Department of Surgery, Korea University College of Medicine, Seoul, Korea
| | - Hoon Yub Kim
- 1 Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, MD, USA ; 2 Department of Surgery, Korea University College of Medicine, Seoul, Korea
| | - Jeremy D Richmon
- 1 Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, MD, USA ; 2 Department of Surgery, Korea University College of Medicine, Seoul, Korea
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28
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Woo SH, Park JJ, Hong JC, Wang SG, Park GC, Eun YG, Kim JP, Jeong HS. Endoscope-assisted transoral removal of a thyroglossal duct cyst using a frenotomy incision: A prospective clinical trial. Laryngoscope 2015; 125:2730-5. [DOI: 10.1002/lary.25508] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Revised: 06/02/2015] [Accepted: 06/22/2015] [Indexed: 11/06/2022]
Affiliation(s)
- Seung Hoon Woo
- Department of Otolaryngology; Gyeongsang National University; Jinju Korea
- Institute of Health Sciences, Gyeongsang National University; Jinju Korea
| | - Jung Je Park
- Department of Otolaryngology; Gyeongsang National University; Jinju Korea
| | - Jong Chul Hong
- Department of Otorhinolaryngology-Head and Neck Surgery; Dong-A University Hospital; Busan Korea
| | - Soo-Geun Wang
- Department of Otorhinolaryngology-Head and Neck Surgery; Busan National University School of Medicine; Busan Korea
| | - Gi Cheol Park
- Department of Otolaryngology; Samsung Changwon Hospital, Sungkyunkwan University School of Medicine; Changwon Korea
| | - Young Gyu Eun
- Department of Otolaryngology; Kyung Hee University School of Medicine; Seoul Korea
| | - Jin Pyeong Kim
- Department of Otolaryngology; Gyeongsang National University; Jinju Korea
| | - Han-Sin Jeong
- Department of Otorhinolaryngology-Head and Neck Surgery; Sungkyunkwan University School of Medicine, Samsung Medical Center; Seoul Korea
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29
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Benhidjeb T. Transoral Video-Assisted Thyroidectomy and Its Clinical Implementation. J Laparoendosc Adv Surg Tech A 2015; 25:514-5. [PMID: 25920012 DOI: 10.1089/lap.2015.0082] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Tahar Benhidjeb
- Center for Minimally Invasive and Scarless Surgery, Department of General, Visceral, Bariatric, and Endocrine Surgery, Burjeel Hospital , Abu Dhabi, United Arab Emirates
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30
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Endoscopic-Assisted Total Thyroidectomy via Lateral Keloid Scar Incision. Clin Exp Otorhinolaryngol 2014; 7:338-41. [PMID: 25436057 PMCID: PMC4240495 DOI: 10.3342/ceo.2014.7.4.338] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Revised: 11/08/2013] [Accepted: 11/09/2013] [Indexed: 11/08/2022] Open
Abstract
Thyroidectomy is traditionally performed by the transcervical approach. To avoid or reduce visible scarring, diverse innovative surgical trials have been reported. Here we report a patient who underwent endoscopic thyroidectomy via a lateral keloid scar due to a previous traffic accident. A 30-year-old woman presented with a papillary thyroid carcinoma. Total thyroidectomy was performed via a keloid scar incision. The keloid scar was then revised. The total thyroidectomy was successful, resulting in no acute complications, such as neural injury, hematoma, or seroma formation. The keloid scar healed with excellent cosmetic results and the patient remains free of disease 12 months after excision. Endoscopic total thyroidectomy via a lateral keloid scar incision healed not only the physical disease but also the mental disease.
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