Utility of a novel elastic traction system in endoscopic thyroidectomy via breast approach: initial experience with 34 patients

Clinical analysis of a new multifunctional instrument set for gasless endoscopic thyroidectomy with two different approaches

BACKGROUND

Following the rapid development of endoscopic thyroidectomy techniques, various surgical procedures have been developed (e.g., transoral, submandibular, areolar, axillary, retroauricular, and combined procedures), and each of these procedures has its own advantages. In recent years, gasless endoscopic thyroidectomy has emerged as a feasible procedure, and it has replaced traditional CO2 insufflation approaches because of advantages such as stable cavity construction, pollution reduction, resource saving, and risk reduction. However, each gasless procedure requires special instruments for cavity construction, and this results in enormous wastage of medical resources. In the present study, we introduced a set of instruments developed by our team. This set of instruments is designed to be compatible with the current gasless endoscopic thyroidectomy approaches, including transoral, submandibular, transareolar, transaxillary, retroauricular, combined, and lateral cervical lymph node dissection. Here, we introduced this set of instruments for two gasless endoscopic thyroidectomy procedures (transaxillary and transareolar). Following the incorporation of this set of instruments in regular clinical practice, it could be used for more gasless endoscopic thyroidectomy procedures in the future.

OBJECTIVE

To investigate the feasibility, safety, and efficacy of the self-developed instruments for gasless endoscopic thyroidectomy in two different approaches.

METHODS

A total of 180 patients diagnosed to have papillary thyroid carcinoma (PTC) between January 2020 and April 2022 were retrospectively investigated. The patients were assigned to a gasless transaxillary group (group A) and a gasless transareolar group (group B). The same gasless endoscopic-assisted instruments were used for both groups. The clinical characteristics, treatment results, and complications were compared between the two groups.

RESULTS

All 180 patients were successfully operated. The extent of surgical resection in all patients was the same: "unilateral glandular lobectomy + isthmus combined with ipsilateral central zone lymph node dissection." There were 130 and 50 patients in group A and group B, respectively; one patient in the former group was converted to open surgery due to intraoperative bleeding. No significant difference was observed between the two groups in terms of gender, age, body mass index (BMI), education level, and proportion of concomitant Hashimoto's thyroiditis (P > 0.05). The establishment of cavity time was significantly longer in group A than in group B (35.62 ± 5.07 min vs. 17.46 ± 2.55 min, P < 0.01). The number of lymph nodes cleared was slightly less in group A than in group B (4.06 ± 2.93 vs. 4.52 ± 2.38, P = 0.07). Moreover, the two groups showed no significant differences (P > 0.05) in the total operative time (145.54 ± 45.11 min vs. 143.06 ± 46.70 min), tumor size (0.68 ± 0.46 cm vs. 0.71 ± 0.49 cm), postoperative hospital stay (4.08 ± 1.48 days vs. 3.72 ± 1.07 days), vocal cord paralysis [4 (3.1%) vs. 2 (4%)], postoperative swallowing discomfort [24 (18.5%) vs. 5 (10%)], and postoperative recurrence and satisfaction scores (3.27 ± 1.52 vs. 3.28 ± 1.53).

CONCLUSION

Although the two approaches of gasless endoscopic surgery have different operative paths and different time periods for cavity construction, both approaches are similar in terms of the principle of cavity construction, safe and reliable postoperative efficacy, and good cosmetic effect. Therefore, the same set of instruments can be used to complete the surgery in both approaches, thus saving medical resources and facilitating the popularization of this technology.

"Elastic stretch cavity building" system in endoscopic thyroidectomy via the axillary approach: a case series

Background

Patients undergoing conventional endoscopic thyroidectomy via the axillary approach, which is commonly used clinically, suffered from a range of postoperative complications. This study aimed to prevent postoperative complications and evaluate patients' satisfaction with cosmetic outcomes in endoscopic thyroidectomy via the axillary with the use of "Elastic Stretch Cavity Building" System.

Methods

In this retrospective case series study, the clinical data of patients who were admitted to the Thyroid Surgery Department of Ningbo Medical Centre Lihuili Hospital between December 2020 and December 2021 for endoscopic thyroidectomy via the axillary approach under the "Elastic Stretch Cavity Building" System.

Results

A total of 67 patients were included, all surgeries were successfully completed. The operation time was 75.61 ± 13.67 minutes; the postoperative drainage volume was 109.97 ± 37.54 ml; the average postoperative hospital stay was 4 (2-6) days. There was no skin ecchymosis, effusion or infection, hypocalcemia, convulsions, upper extremity dyskinesia, and temporary hoarseness after the surgery. The patients were satisfied with the cosmetic effects, and the cosmetic score was 4 (3-4).

Conclusion

The "Elastic Stretch Cavity Building" System in endoscopic thyroid surgery via the axillary approach might reduce the risks of complications and achieve satisfactory results with the cosmetic outcomes.

Pros and Cons of Transoral Endoscopic Thyroidectomy Via Vestibular Approach: A Comparative Study

OBJECTIVE

The objective of this study was to explore the feasibility and safety of transoral endoscopic thyroidectomy via vestibular approach (TOETVA) compared with endoscopic thyroidectomy via bilateral areola approach (ETBAA) in the treatment of patients with benign thyroid nodules.

MATERIALS AND METHODS

From January 2017 to December 2018, 60 patients who received TOETVA were enrolled as the research group; 65 patients who underwent ETBAA were included as the control group. A retrospective study was performed using the clinical data for these cases. All patients were diagnosed with benign nodules by preoperative examinations. Parameters including surgical trauma, complications, cosmetic satisfaction, and postoperative discomfort were compared between the 2 groups.

RESULTS

All operations were completed without incident. There were significant differences in operation time (137.8±18.7 vs. 95.7±17.2 min), intraoperative blood loss (16.8±9.1 vs. 24.6±16.6 mL), drainage volume (123.1±20.9 vs. 153.6±40.2 mL), C-reactive protein level (7.2±5.2 vs. 9.0±4.7 mg/L), drainage time (3.2±0.6 vs. 3.9±1.3 d), postoperative hospital stay (3.3±0.8 vs. 4.1±1.5 d), and sense of skin tension on the neck (0% vs. 10.8%) between the TOETVA and ETBAA groups (P<0.05). There were no significant differences in pain score, incidence of recurrent laryngeal nerve injury, transient hypoparathyroidism, infection, inadvertent parathyroidectomy, or swallow discomfort between the 2 groups. The cosmetic satisfaction score in the TOETVA group was significantly higher than that in the ETBAA group at 1 month after surgery (9.8±0.5 vs. 9.4±0.9, P<0.05), but at 3 months after the operation, the difference was not statistically significant.

CONCLUSIONS

TOETVA was accompanied by less surgical trauma and skin tension on the neck than ETBAA, and the cosmetic effect of this approach was better than that of ETBAA in the early postoperative period. TOETVA for benign thyroid nodules is safe and feasible. However, there are disadvantages with TOETVA, such as a long surgical period. More cases and further research are needed to delve further into this approach.

Endoscopic Lateral Neck Dissection (IIA, IIB, III, and IV) Using a Breast Approach: Outcomes From a Series of the First 24 Cases

INTRODUCTION

In order to avoid large neck scar caused by conventional lateral neck dissection. We have explored and introduced endoscopic lateral neck dissection (IIA, IIB, III, and IV) using a breast approach. Now, we summarized and shared the outcomes of the first 24 cases.

MATERIALS AND METHODS

All the patients were treated in our institute from January 2017 to May 2018, and followed-up for more than 1 year. The details of patients and this technique have been summarized and analyzed retrospectively.

RESULTS

A series of first 24 cases were successfully managed with this technique, and no cases were converted to an open approach. Among these 24 patients, levels III + IV dissection had been performed in 6 patients and levels II+III+IV dissection had been performed in 18 patients. The mean age, body mass index, and sex were 39.3±10.5 years old, 24.1±3.5, and 2 male/22 female, respectively. The average operative time of total operation and lateral neck dissection was 238.8±37.2 minutes and 128.8±21.1 minutes, respectively. The mean dissected lateral lymph nodes were 5.9±2.2 (level II) in 18 cases and 15.9±3.9 (levels III+IV) in 24 cases. In addition, with no severe complications to date, such as asphyxia, main nerves injury (cervical plexus, vagus nerve, etc.), and permanent hypoparathyroidism, nor permanent recurrent laryngeal nerve injury, and so on. However, unexpectedly, had some mild and common complications like transient hypocalcemia in 4 cases (16.67%), transient horse 1 case (4.2%), controllable lymphatic leakage in 2 cases (8.3%), and controllable jugular vein injury in 2 cases (8.3%). One year after the operation, 1 case found lung metastasis but no local recurrence. In other 23 patients, no recurrence/metastasis and the average of serum thyroglobulin is 3.2±3.8 ng/mL.

CONCLUSIONS

This technique can yield adequate oncological dissection for selected patients. Endoscopic thyroidectomy along with lateral neck dissection using a breast approach may provide an option for selected patients who favor avoiding a visible neck incision.