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Hussein M, Issa PP, LaForteza A, Omar M, Magazine B, Abdelhady A, Hossam E, Shama M, Toraih E, Kandil E. Evaluating the Efficacy and Safety of Robotic Versus Conventional Completion Thyroidectomy: A 10-year Experience. Surg Innov 2024:15533506241273345. [PMID: 39099097 DOI: 10.1177/15533506241273345] [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: 08/06/2024]
Abstract
BACKGROUND Robotic thyroidectomy is gaining popularity, yet its role in completion thyroidectomy remains unclear. We aimed to compare robotic vs conventional completion thyroidectomy for thyroid nodules. METHODS This retrospective study analyzed patients undergoing completion thyroidectomy from 2010-2020, either by conventional open technique (n = 87) or a robotic remote-access approach (n = 44). Outcomes were compared between groups. RESULTS A total of 131 patients were included. The robotic cohort was younger (45.3 ± 14.0 vs 55.5 ± 14.5 years, P < 0.001) with a lower BMI (25.9 ± 5.5 vs 33.7 ± 7.8 kg/m2, P < 0.001). Operative time was longer for robotic procedures (139 min vs 99 min, P < 0.001). Hospital stay was shorter after robotic surgery, with 25% discharged the same day as compared to 5.7% in the open thyroidectomy cohort (P = 0.006). Overall rates of complication were comparable (P = 0.65). Transient recurrent laryngeal nerve palsy occurred in 4.6% of patients, which was similar between both cohorts (P = 0.66). CONCLUSION Robotic completion thyroidectomy appears safe and effective, achieving shorter hospitalization than conventional open approaches despite longer operative times. Appropriate patient selection and surgical technique optimization are key. Larger prospective studies should investigate costs and long-term patient-reported outcomes.
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Affiliation(s)
- Mohammad Hussein
- Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - Peter P Issa
- Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - Alexandra LaForteza
- Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - Mahmoud Omar
- Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - Brandon Magazine
- Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - Ali Abdelhady
- Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - Eslam Hossam
- Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - Mohamed Shama
- Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - Eman Toraih
- Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - Emad Kandil
- Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA
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Harsha MP, Padha K. Natural orifice trans-oral, trans-vestibular endoscopic thyroidectomy: Surgical steps and technique. J Minim Access Surg 2024:01413045-990000000-00060. [PMID: 38958020 DOI: 10.4103/jmas.jmas_31_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Accepted: 04/24/2024] [Indexed: 07/04/2024] Open
Abstract
ABSTRACT Natural orifice scarless cosmetic surgeries are becoming a reality with increasing experience of advanced laparoscopic surgeries and availability of modern energy sources. Many techniques of minimally invasive video-assisted thyroidectomy through cervical and extra-cervical routes such as chest wall, trans-axillary, sub-mental, post-auricular and trans-luminal approach have been attempted. However, trans-oral trans-vestibular endoscopic thyroidectomy with its excellent cosmetic effect has become the more popular option among the surgical community with advantages such as decreased hospital stay and minimal complications. In this case report, we describe natural orifice trans-oral, trans-vestibular endoscopic thyroidectomy approach (NO-TOTVET) and add to literature the technique in which NO-TOTVET can be utilised, thus adding to the repertoire of the operating surgeon.
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Affiliation(s)
- M P Harsha
- General Surgeon, Command Hospital (Eastern Command), Kolkata, West Bengal, India
| | - Karan Padha
- Oral and Maxillofacial Surgeon, 1202 Dental Unit, Simtokha, Bhutan
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Mao Y, Zhou S, Wu P, Li W, Li H, Wang Z, Xia X, Song X, Wang M, Peng X. Postoperative rehabilitation and quality of life evaluation for transoral endoscopic thyroidectomy vestibular approach. Sci Rep 2024; 14:14747. [PMID: 38926508 PMCID: PMC11208515 DOI: 10.1038/s41598-024-65589-x] [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: 02/26/2024] [Accepted: 06/21/2024] [Indexed: 06/28/2024] Open
Abstract
There are no targeted rehabilitation training modalities and assessment tools for patients after transoral endoscopic thyroidectomy vestibular approach (TOETVA). Herein, we develop a new assessment questionnaire and rehabilitation training modality and evaluate its safety and effectiveness. The THYCA-QoL-TOETVA questionnaire was compiled, and reliability and validity analyses were performed. Patients were divided into the new rehabilitation training group (N) or the conventional rehabilitation training group (C), and 1:1 propensity score matching (PSM) was performed after administering questionnaires to patients in both groups. Cervical range of motion (CROM) data were also measured and collected for statistical analysis. The questionnaire used in this study showed good expert authority, coordination, internal consistency, and questionnaire reliability. A total of 476 patients were included after PSM, and the questionnaire results showed that recovery and quality of life were better in the N group than in the C group (124.55 ± 8.171 vs. 122.94 ± 8.366, p = 0.026). Analysis of cervical spine mobility showed that rehabilitation was better in the N group compared to the C group at postoperative one month (flexion: 1.762°, extension: 4.720°, left lateral bending: 3.912°, right lateral bending: 4.061°, left axial rotation: 5.180°, right axial rotation: 5.199°, p value all of these < 0.001), and at postoperative three months (flexion: 2.866°, extension: 2.904°, left lateral bending: 3.927°, right lateral bending: 3.330°, left axial rotation: 4.395°, right axial rotation: 3.992°, p value all of these < 0.001). The THYCA-QoL-TOETVA provides an appropriate and effective tool for measuring the postoperative quality of life of TOETVA patients. This new rehabilitation training can effectively alleviate the problem of limited neck movement and improve the quality of life of patients after TOETVA surgery.Trial registration: ChiCTR2300069097.
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Affiliation(s)
- Yu Mao
- Department of Thyroid Surgery, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University/Hunan Cancer Hospital, Changsha, 410013, Hunan Province, People's Republic of China
- Department of Thyroid Surgery, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, People's Republic of China
| | - Shiwei Zhou
- Department of Thyroid Surgery, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University/Hunan Cancer Hospital, Changsha, 410013, Hunan Province, People's Republic of China
| | - Peng Wu
- Department of Thyroid Surgery, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University/Hunan Cancer Hospital, Changsha, 410013, Hunan Province, People's Republic of China
| | - Wu Li
- Department of Thyroid Surgery, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University/Hunan Cancer Hospital, Changsha, 410013, Hunan Province, People's Republic of China
| | - Hui Li
- Department of Thyroid Surgery, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University/Hunan Cancer Hospital, Changsha, 410013, Hunan Province, People's Republic of China
| | - Zhiyuan Wang
- Department of Medical Ultrasound, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University/Hunan Cancer Hospital, Changsha, 410013, Hunan, People's Republic of China
| | - Xibin Xia
- Department of Diagnostic Radiology, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University/Hunan Cancer Hospital, Changsha, 410013, Hunan, People's Republic of China
| | - Xiaohua Song
- Department of Thyroid Surgery, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University/Hunan Cancer Hospital, Changsha, 410013, Hunan Province, People's Republic of China
| | - Mingming Wang
- Department of Thyroid Surgery, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, People's Republic of China
| | - Xiaowei Peng
- Department of Thyroid Surgery, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University/Hunan Cancer Hospital, Changsha, 410013, Hunan Province, People's Republic of China.
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Laohathai S, Jamikorn T, Anuwong A. First case report of benign subcutaneous thyroid tissue implantation following transoral endoscopic thyroidectomy vestibular approach (TOETVA). AME Case Rep 2024; 8:73. [PMID: 39091559 PMCID: PMC11292079 DOI: 10.21037/acr-24-15] [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: 01/26/2024] [Accepted: 04/18/2024] [Indexed: 08/04/2024]
Abstract
Background Following the era of remote access thyroid surgery in the 1990s, several techniques were developed including transoral endoscopic thyroidectomy vestibular approach (TOETVA), which was invented in 2016. TOETVA has gained acceptance and proven comparable results to the conventional open thyroidectomy. Despite the potential complications that may occur as a result of remote access thyroid surgery, such as nerve, vascular, and tracheal injury, seroma, and hypoparathyroidism, there was an extremely rare late complication of a benign subcutaneous thyroid implantation, which have not been reported following TOETVA. Case Description A 28-year-old female was developed multiple subcutaneous nodules after undergoing right lobe TOETVA for 2 years due to a 3.1 cm benign nodular goiter. The nodules were excised via submandibular incision and the pathological results were shown as benign. Conclusions Thyroid tissue implantation may result from intracorporeal thyroid tissue rupture, as reported in this research. Extending the vestibular incision to 2-2.5 cm and partially cutting the specimen within the retrieval bag were options to prevent further tissue damage or spillage during specimen extraction. Meanwhile, a separate incision, such as the axillary or submandibular incision, may be required to retrieve the larger nodules. Even though there were no absolute guidelines or contraindications for patient selection in TOETVA, an awareness of tissue breakage should always be considered. The optimal size of the nodule for vestibular removal, which would minimize the risk of tissue breakage, still required additional research.
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Affiliation(s)
- Sirasit Laohathai
- Minimally Invasive and Endocrine Surgery Division, Department of Surgery, Police General Hospital, Bangkok, Thailand
| | - Tanyanan Jamikorn
- Minimally Invasive and Endocrine Surgery Division, Department of Surgery, Police General Hospital, Bangkok, Thailand
| | - Angkoon Anuwong
- Minimally Invasive and Endocrine Surgery Division, Department of Surgery, Police General Hospital, Bangkok, Thailand
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Zheng H, Chou J, Lai V, Carroll NM, Rosen JE, Felger EA. Endocrine Patients' Views on Transoral Endoscopic Thyroidectomy via Vestibular Approach (TOETVA). Indian J Surg Oncol 2023; 14:890-899. [PMID: 38187833 PMCID: PMC10767177 DOI: 10.1007/s13193-023-01787-9] [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: 03/06/2023] [Accepted: 06/20/2023] [Indexed: 01/09/2024] Open
Abstract
TOETVA's adoption has been slow in the Western hemisphere. Our study aimed to evaluate how endocrine patients in the United States perceive the risks and benefits of TOETVA. This was a cross-sectional study where a de novo survey was sent via email to patients seen from 2018 to 2020. The survey asked how each of TOETVA's risks and benefits affect their choice between traditional thyroidectomy (TT) and TOETVA on a scale from 1 (favors TT) to 10 (favors TOETVA). Statistical significance was determined at p < 0.05. Of 422 patients (3.2% response rate), 76.0% were female, 28.9% were non-Whites, 58.3% possessing graduate/professional degrees, and 34.1% were diagnosed with thyroid cancer. Significant differences were found between groups of age, race, educational attainment, thyroid cancer diagnosis, and history of thyroid or parathyroid surgery with respect to their preference for thyroidectomy between TT and TOETVA. In multivariate analysis, attitudes towards longer operative time (estimate 0.130, 95% CI 0.026-0.235, p = 0.002), limited outcome data (estimate 0.142, 95% CI 0.029-0.254, p = 0.024), having less pain (estimate 0.108, 95% CI 0.004-0.212, p = 0.042), travel to seek care (estimate 0.166, 95% CI 0.042-0.290, p = 0.009), as well as African American race (estimate 0.714, 95% CI 0.093-1.334, p = 0.024), and history of surgery (estimate - 0.843, 95% CI - 1.364- - 0.323, p = 0.002) were independently predictive of overall preferences. TOETVA's risks and benefits may carry varying degrees of significance in patients' decision-making process, which helps tailor the discussion to choose the right procedure for patients.
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Affiliation(s)
- Hui Zheng
- Division of Endocrine Surgery, MedStar Washington Hospital Center, 106 Irving St NW, POB 2200 North, Washington, DC 20010 USA
| | - Jiling Chou
- Center for Biostatistics, Informatics and Data Science, MedStar Health Research Institute, 6525 Belcrest Road, Suite 700, Hyattsville, MD 20782 USA
| | - Victoria Lai
- Division of Endocrine Surgery, MedStar Washington Hospital Center, 106 Irving St NW, POB 2200 North, Washington, DC 20010 USA
| | - Nancy M. Carroll
- Division of Endocrine Surgery, MedStar Washington Hospital Center, 106 Irving St NW, POB 2200 North, Washington, DC 20010 USA
| | - Jennifer E. Rosen
- Division of Endocrine Surgery, MedStar Washington Hospital Center, 106 Irving St NW, POB 2200 North, Washington, DC 20010 USA
| | - Erin A. Felger
- Division of Endocrine Surgery, MedStar Washington Hospital Center, 106 Irving St NW, POB 2200 North, Washington, DC 20010 USA
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Seo S, Ali KM, Wolfe SA, Nagururu NV, Ding AS, Desai D, Harbison RA, Kim Y, Ning B, Cha RJ, Russell JO. TOETVA parathyroid autofluorescence detection: hANDY-i endoscopy attachment. Front Endocrinol (Lausanne) 2023; 14:1233956. [PMID: 37693365 PMCID: PMC10484600 DOI: 10.3389/fendo.2023.1233956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Accepted: 07/12/2023] [Indexed: 09/12/2023] Open
Abstract
Background Treatment options for thyroid pathologies have expanded to include scarless and remote access methods such as the transoral endoscopic thyroidectomy vestibular approach (TOETVA). Currently, no standardized methods exist for locating parathyroid glands (PGs) in patients undergoing TOETVA, which can lead to parathyroid injury and subsequent hypocalcemia. This early feasibility study describes and evaluates the hANDY-i endoscopic attachment for detecting PGs in transoral thyroidectomy. Methods We used a prototype parathyroid autofluorescence imager (hANDY-i) that was mounted to a 10-mm 0-degree endoscope. The device delivers a split screen view of Red-green-blue (RGB) and near-infrared autofluorescence (NIRAF) which allows for simultaneous anatomical localization and fluorescence visualization of PGs during endoscopic thyroid dissection. Results One cadaveric case and two patient cases were included in this study. The endoscopic hANDY-i imaging system successfully visualized PGs during all procedures. Conclusion The ability to leverage parathyroid autofluorescence during TOETVA may lead to improved PG localization and preservation. Further human studies are needed to assess its effect on postoperative hypocalcemia and hypoparathyroidism.
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Affiliation(s)
- Stefanie Seo
- Department of Otolaryngology – Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Khalid Mohamed Ali
- Department of Otolaryngology – Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Samantha A. Wolfe
- Department of Endocrine Surgery, University Health Network, Toronto, ON, Canada
| | - Nimesh V. Nagururu
- Department of Otolaryngology – Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Andy S. Ding
- Department of Otolaryngology – Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Dipan Desai
- Department of Otolaryngology – Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - R. Alex Harbison
- Department of Otolaryngology – Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Yoseph Kim
- Department of Research, Optosurgical, LLC, Columbia, MD, United States
| | - Bo Ning
- Sheikh Zayed Institute, Children’s National Hospital, Washington, DC, United States
| | - Richard Jaepyeong Cha
- Department of Research, Optosurgical, LLC, Columbia, MD, United States
- Sheikh Zayed Institute, Children’s National Hospital, Washington, DC, United States
- Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, DC, United States
| | - Jonathon O. Russell
- Department of Otolaryngology – Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, MD, United States
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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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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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Broekhuis JM, James BC, Grogan RH. Scarless Surgery: Clinical Indications for Transoral Endocrine Surgery and Implications for Pathologists. Surg Pathol Clin 2023; 16:163-166. [PMID: 36739163 DOI: 10.1016/j.path.2022.10.002] [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: 12/13/2022]
Abstract
Transoral endocrine surgery (TES) is a scarless approach to thyroidectomy and parathyroidectomy for well-selected patients. Criteria for the TES approach to thyroidectomy include thyroid diameter less than or equal to 10 cm, benign nodule less than or equal to 6 cm, or confirmed or suspected malignant nodule less than or equal to 2 cm. Although fragmentation of surgical specimens has been reported in TES, additional studies are needed to evaluate the implications of TES on pathologic examination.
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Affiliation(s)
- Jordan M Broekhuis
- Harvard Medical School, Boston, MA, USA; Department of Surgery, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215, USA
| | - Benjamin C James
- Harvard Medical School, Boston, MA, USA; Department of Surgery, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215, USA
| | - Raymon H Grogan
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, 7200 Cambridge Street, 7th Floor, Room A07-103, Houston, TX 77030, USA.
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Karakas E, Klein G, Schopf S. Transoral thyroid surgery vestibular approach. Innov Surg Sci 2022; 7:107-113. [PMID: 36561507 PMCID: PMC9742272 DOI: 10.1515/iss-2021-0033] [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: 07/13/2021] [Accepted: 09/01/2021] [Indexed: 12/25/2022] Open
Abstract
Objectives Transoral thyroid surgery vestibular approach (TOETVA) is a novel and feasible surgical technique that allows for cervical surgery without visible incisions. TOETVA represents a new frontier in endocrine surgery since aesthetic results play a more and more decisive role in elective surgery. However, acceptance is different around the world with widespread prevalence in Asian countries and some high-volume centres in the US. While inclusion criteria for TOETVA are limited regarding size and volume a combination with other extracervical techniques like the retroauricular endoscopic cephalic access thyroid surgery (EndoCATS) approach or transaxillary access is an option. Methods TOETVA is carried out through a three-port technique placed at the oral vestibule. Originally one 10-mm port for a 30° endoscope and two additional 5-mm ports for dissecting and coagulating instruments are used. Alternatively, one 5-mm and one or two 3 mm ports can be used. CO2 insufflation pressure is set at 6 mmHg. An additional device to optimize gas outflow for optimum view might be helpful. An anterior cervical subplatysmal space is created by hydrodissection from the oral vestibule to the sternal notch, laterally to the sternocleidomastoid muscle. Conventional endoscopic instruments are used. Combination of TOETVA with a modified retroauricular access includes insertion of a 10-12 mm trocar placed subcutaneously via a skin incision on the scalp, behind the ear by blunt dissection. Results Since Anuwong published the first case series of 60 patients who underwent scarless thyroidectomy via the lower vestibule of the mouth with excellent results in 2016 almost 1,000 cases are reported in literature to date with comparable results especially regarding traditional complications. In contrast to other extracervical approaches, areolar or axillary for example, the transoral access route is short and the dissection planes are rather like transcervical surgery. Surgical indications and contraindications have been modified since its first description and are partly institution specific to date. To amend indications combination with other extracervical techniques is an option. In addition, patients must carefully be selected for and surgeons` candidacy is of utmost importance in transoral surgery. Conclusions Transoral surgery will likely continue to gain attraction as surgeons become more experienced with the technique. With increased operative use and surgeon experience the gap in conventional outcomes between transoral surgery and the transcervical approach will narrow, with both operative time and the incidence of specific complications diminishing. Experience in thyroid and endoscopic surgery is required to achieve excellent results with low complication rates. However, the new transoral technique is related to novel complications that must be evaluated.
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Affiliation(s)
- Elias Karakas
- Dept. of General-, Abdominal- and Endocrine Surgery, Hospital Maria Hilf, Alexianer GmbH, Krefeld, Germany
| | - Günther Klein
- Dept. of General Surgery, Landesklinikum Wiener Neustadt, Wiener Neustadt, Austria
| | - Stefan Schopf
- Dept. of General-, Abdominal- and Endocrine Surgery, RoMed Hospital, Bad Aibling, Germany
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Transoral Endoscopic Thyroidectomy Vestibular Approach (TOETVA)—a Case Series Analysis. Indian J Surg 2022. [DOI: 10.1007/s12262-022-03558-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
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12
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王 登, 张 冉, 冯 恩, 袁 晓, 吴 锡, 杨 洁. [Effectiveness of transoral endoscopic thyroid surgery for lymph node dissection in the central region of thyroid cancer]. LIN CHUANG ER BI YAN HOU TOU JING WAI KE ZA ZHI = JOURNAL OF CLINICAL OTORHINOLARYNGOLOGY, HEAD, AND NECK SURGERY 2022; 36:540-558. [PMID: 35822383 PMCID: PMC10128395 DOI: 10.13201/j.issn.2096-7993.2022.07.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Indexed: 06/15/2023]
Abstract
Objective:To investigate the effect of transoral endoscopic thyroid surgery in the central lymph node dissection of thyroid cancer. Methods:Twenty patients underwent endoscopic thyroidectomy via oral vestibular approach (TOETVA group) and 20 gender and age matched patients underwent conventional open thyroidectomy were selected in this study. The clinical data, number of lymph node dissection and postoperative complications of the two groups were collected and analyzed. SPSS 24.0 statistical software was used for data analysis. Results:There was no significant differences in age, BMI, tumor size or the number of Hashimoto's thyroiditis patients between the TOETVA group and the open group(P>0.05). The operation time([117.30±10.54]min) and postoperative drainage volume([146.05±30.66]mL) in the TOETVA group were significantly higher than those in the open group([59.05±6.40]min, [77.90±22.18]mL), P<0.001. The pain in the open group 24 h after surgery was more severe than that in the TOETVA group(P<0.05). The total number of central lymph nodes, the number of pre-laryngeal lymph nodes and the number of pre-tracheal lymph nodes cleared by the two groups were similar, and the number of final positive lymph nodes had no significant difference. However, the number of paratracheal lymph nodes removed in the TOETVA group was more(7.8±4.2) nodes than that in the open group(6.4±3.9) nodes, P<0.05. There was no significant difference in postoperative complications between the two groups. The scores of cosmetic evaluation and rating of cicatrices in the TOETVA group six months after surgery were(0.77±0.58) significantly lower than those in the open group(4.30±1.54), P<0.001. Conclusion:In central lymph node dissection, the efficiency of TOETVA is similar to that of traditional open thyroid surgery. For special anatomical regions, endoscopic surgery is more efficient. At the same time, TOETVA does not increase the incidence of related complications, and has good cosmetic effect.
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Affiliation(s)
- 登欢 王
- 昆明医科大学第三附属医院头颈外科(昆明,650118)Department of Head and Neck Surgery, the third Affiliated Hospital of Kunming Medical University, Kunming, 650118, China
| | - 冉 张
- 昆明医科大学第三附属医院头颈外科(昆明,650118)Department of Head and Neck Surgery, the third Affiliated Hospital of Kunming Medical University, Kunming, 650118, China
| | - 恩梓 冯
- 昆明医科大学第三附属医院头颈外科(昆明,650118)Department of Head and Neck Surgery, the third Affiliated Hospital of Kunming Medical University, Kunming, 650118, China
| | - 晓凤 袁
- 昆明医科大学第三附属医院头颈外科(昆明,650118)Department of Head and Neck Surgery, the third Affiliated Hospital of Kunming Medical University, Kunming, 650118, China
| | - 锡芳 吴
- 昆明医科大学第三附属医院头颈外科(昆明,650118)Department of Head and Neck Surgery, the third Affiliated Hospital of Kunming Medical University, Kunming, 650118, China
| | - 洁 杨
- 昆明医科大学第三附属医院头颈外科(昆明,650118)Department of Head and Neck Surgery, the third Affiliated Hospital of Kunming Medical University, Kunming, 650118, China
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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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Deroide G, Leiritz E, Trésallet C. Trans oral Thyroidectomy technique via anterior vestibular approach (TOETVA) with video. J Visc Surg 2022; 159:173-174. [DOI: 10.1016/j.jviscsurg.2021.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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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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Fang J, Liu J, Zheng X, Wang S. Novel Trocars and Suspension System Application in Gasless Transoral Endoscopic Thyroidectomy Vestibular Approach Oral Endoscopic Surgery. Front Oncol 2021; 11:694133. [PMID: 34485129 PMCID: PMC8416175 DOI: 10.3389/fonc.2021.694133] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 06/14/2021] [Indexed: 11/13/2022] Open
Abstract
In the current study, we reported our initial experience of gasless transoral endoscopic thyroidectomy vestibular approach (TOETVA) by novel trocars and a suspension system. Between February 2019 to September 2020, thyroid cancer patients with indicated central lymph node metastasis by imaging examination who had received gasless TOETVA by our designed trocars and suspension system in The First Affiliated Hospital of University of Science and Technology of China were reviewed. A total of 95 thyroid cancer patients that received gasless TOETVA were included in this analysis. Of note, 73 cases underwent one-sided lobectomy and the remaining 22 cases underwent total thyroidectomy. All thyroid cancer patients underwent central lymph node dissection (CND). The average total examined lymph nodes number was 8.55 ± 5.67 per individual. No serious complications occurred during or after the operation besides one patient who had a short-term recurrent laryngeal nerve (RLN) deficit and one patient who had delayed postoperative bleeding. In conclusion, the use of novel trocars and a suspension system can effectively improve the safety and efficacy of TOETVA.
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Affiliation(s)
- Jing Fang
- Department of Head and Neck Surgery, West District of The First Affiliated Hospital of University of Science and Technology of China, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China.,Department of Head and Neck Surgery, Anhui Provincial Cancer Hospital, Hefei, China
| | - Jianjun Liu
- Department of Head and Neck Surgery, West District of The First Affiliated Hospital of University of Science and Technology of China, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China.,Department of Head and Neck Surgery, Anhui Provincial Cancer Hospital, Hefei, China
| | - Xucai Zheng
- Department of Head and Neck Surgery, West District of The First Affiliated Hospital of University of Science and Technology of China, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China.,Department of Head and Neck Surgery, Anhui Provincial Cancer Hospital, Hefei, China
| | - Shengying Wang
- Department of Head and Neck Surgery, West District of The First Affiliated Hospital of University of Science and Technology of China, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China.,Department of Head and Neck Surgery, Anhui Provincial Cancer Hospital, Hefei, China
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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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Transoral Endoscopic Thyroidectomy Vestibular Approach: An Initial Experience in Vietnam. Surg Laparosc Endosc Percutan Tech 2021; 30:209-213. [PMID: 32032330 DOI: 10.1097/sle.0000000000000764] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Transoral endoscopic thyroidectomy vestibular approach (TOETVA) can be applied to many health facilities worldwide, even in places whose medical facilities have not developed yet. To that end, our hospital is the first hospital to deploy this novel technique in Vietnam. In the study, the authors will evaluate the safety and efficacy of TOETVA, which was initially performed on patients in Vietnam. MATERIALS AND METHODS A TOETVA research was conducted on 28 patients in hospital K from January 1, 2018 to May 31, 2019. The surgical outcomes, cosmetic results, and complications were evaluated. RESULTS The mean operative time was 91 minutes (70 to 130 min). There were no cases with temporary and permanent hypoparathyroidism in the patients. One patient had temporary mental nerve injury recovered completely after 14-day surgery. No case used drains in patients. All patients were highly satisfied with the surgical outcome, especially, cosmetic results. CONCLUSIONS TOETVA is a safe and feasible technique with acceptable complication rates and good outcomes. The authors will carry on this procedure for selected patients. TOETVA should not only be performed in some countries with well-developed health care systems but also be done in other developing countries worldwide.
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Deroide G, Honigman I, Berthe A, Branger F, Cussac-Pillegand C, Richa H, Anuwong A. Trans oral endoscopic thyroidectomy (TOETVA): First French experience in 90 patients. J Visc Surg 2021; 158:103-110. [PMID: 33676861 DOI: 10.1016/j.jviscsurg.2021.02.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Thyroidectomy techniques using extracervical approaches have grown in popularity for about 20 years and their feasibility has now been demonstrated. We wanted to evaluate one of these new approaches: the anterior vestibular endoscopic approach (TOETVA). The aim of this study was to evaluate the results of an initial series patients who underwent an anterior trans-vestibular endoscopic oral thyroidectomy. METHODS From February 2018 to September 2020, this technique was offered to patients aged 18 to 70, ASA I or II, who presented with an indication for thyroid surgery and who wished to avoid cervical scars. The approach was through the anterior vestibule of the mouth and the specimen was extracted either transorally or via the axilla depending on its size. Apart from the first ten cases, all patients underwent recurrent nerve neuromonitoring. The patients were operated on by two surgeons experienced in thyroid surgery. All the patients had follow-up visits on D15, D30 and at 2 months. The pre- and intra-operative data, length of stay and complications were evaluated. RESULTS A total of 90 consecutive patients (87 women) aged 46±12.4 years (18 to 69) with a mean BMI of 24.4±4 were included. The indications for surgery included 11 papillary cancers, 5 oncocytic nodules, 15 toxic nodules, 13 cases of Graves disease and 46 symptomatic goiters and/or nodules. The mean pre-operative diameter of the nodules was 3.61±1.99 (0.44 to 7.3) cm. The interventions performed were 44 lobo-isthmectomies, 41 total thyroidectomies and 5 isthmectomies. The mean operating time was 134±45min (40 to 255). On D1, the post-operative ionized calcium was 1.09±0.11mmol/L (4.3685±0.44mg/dL) (normal 0.8-1.15mmol/L) (3.206-4.609mg/dL)) and the total serum calcium was 2.07±0.11mmol/L 8.296±0.44mg/dL (normal 2.2-2.5mmol/L) (8.817-10.019mg/dL). Five patients underwent conversion from endoscopic to open cervical approach (5.5%). The complications were seven cases of transient recurrent nerve palsy (7.8%), eight cases of hypoparathyroidism (19%) including six transient and two permanent, one skin burn and 26 cases of transient chin numbness related to the electrocautery (29%). Ten patients (11%) presented with transient post-operative skin ecchymosis that resolved within 7-10 days. A spontaneous pneumo-mediastinum was observed on chest CT in three patients and evolved favorably. No hematoma, or surgical site infection, or complications related to axillary extraction were observed. All the patients declared themselves satisfied post-operatively and at the end of the follow-up. CONCLUSION The TOETVA route of entry is a safe and reliable technique in well-selected patients wishing to avoid a cervical scar.
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Affiliation(s)
- G Deroide
- Franco-British Hospital Institute, 4, Rue Kleber Hôpital Franco-Britannique, 92300 Levallois, France; Clinique Lambert Ramsay, La garenne Colombes, France.
| | - I Honigman
- Polyclinique de Saint-Jean-de-Luz, Saint-Jean-de-Luz, France
| | - A Berthe
- Clinique Lambert Ramsay, La garenne Colombes, France
| | - F Branger
- Franco-British Hospital Institute, 4, Rue Kleber Hôpital Franco-Britannique, 92300 Levallois, France; Clinique Lambert Ramsay, La garenne Colombes, France
| | - C Cussac-Pillegand
- Franco-British Hospital Institute, 4, Rue Kleber Hôpital Franco-Britannique, 92300 Levallois, France
| | - H Richa
- Franco-British Hospital Institute, 4, Rue Kleber Hôpital Franco-Britannique, 92300 Levallois, France
| | - A Anuwong
- Police General Hospital, Bangkok, Thailand
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Chen LW, Assadi N, Hefetz-Kirshenbaum L, Hong H, Razavi CR, Grogan RH, Tufano RP, Khafif A, Russell JO. Preferences for thyroidectomy technique: Comparing traditional and transoral approaches. Head Neck 2021; 43:1747-1758. [PMID: 33555089 DOI: 10.1002/hed.26627] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 12/14/2020] [Accepted: 01/21/2021] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND We investigated preferences between the transcervical and transoral thyroidectomy approach in the United States and Israel. METHODS An online survey assessing scar attitudes and surgical preferences, in English and Hebrew, was distributed on ThyCa.com and other platforms. RESULTS 928 and 339 responses from the United States and Israel cohorts, respectively, were analyzed. In both countries, individuals without prior thyroidectomy preferred a scarless approach when hypothetical risks equaled those of traditional thyroidectomy (77% United States, 76% Israel, p = 0.61). U.S. respondents without thyroidectomy had greater preference to avoid a scar and would pay more to do so than those with thyroidectomy (both p < 0.001). Many respondents with prior thyroidectomy still expressed interest in scarless alternatives (57% United States). CONCLUSIONS Populations in Israel and the United States prefer scarless thyroidectomy when risks equal the traditional approach. While individuals without prior thyroidectomy are more likely to favor a scarless option, former thyroidectomy patients may have preferred avoiding a scar.
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Affiliation(s)
- Lena W Chen
- Division of Head and Neck Endocrine Surgery, Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Niddal Assadi
- A.R.M. Otolaryngology - Head and Neck, Maxillofacial Clinics, Assuta Medical Center, Tel Aviv, Israel
| | - Lior Hefetz-Kirshenbaum
- A.R.M. Otolaryngology - Head and Neck, Maxillofacial Clinics, Assuta Medical Center, Tel Aviv, Israel
| | - Hanna Hong
- Division of Head and Neck Endocrine Surgery, Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Christopher R Razavi
- Division of Head and Neck Endocrine Surgery, Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Raymon H Grogan
- Endocrine Surgery Program, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - 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, USA
| | - Avi Khafif
- A.R.M. Otolaryngology - Head and Neck, Maxillofacial Clinics, Assuta Medical Center, Tel Aviv, Israel
| | - Jonathon O Russell
- Division of Head and Neck Endocrine Surgery, Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Razavi CR, Tanavde VA, Kim AS, Shaear M, Tufano RP, Russell JO. The variable direct cost and cost drivers of transoral endoscopic thyroidectomy vestibular approach. Gland Surg 2021; 10:521-528. [PMID: 33708535 DOI: 10.21037/gs-20-653] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background As transoral endoscopic thyroidectomy vestibular approach grows in popularity, there is a need for data on cost in order to better characterize its value to patients. To this end, we compared the variable direct cost of transoral endoscopic thyroidectomy vestibular approach and transcervical approach thyroidectomy and determined which factors drive the increased cost for the transoral approach. Methods Patients undergoing thyroid lobectomy and total thyroidectomy that met inclusion criteria for transoral endoscopic thyroidectomy vestibular approach, including those patients that opted for management via the transcervical approach, between 8/2016 and 4/2019 were reviewed. The variable direct cost for the surgical encounter was collected and means were compared between the transoral and transcervical cohorts for lobectomy and total thyroidectomy respectively. The operative time independent variable direct cost was similarly compared between cohorts. Results Out of 238 patients, 118 (50%) were managed via transoral endoscopic thyroidectomy vestibular approach and 120 (50%) were managed via transcervical approach thyroidectomy. Mean variable direct cost, our primary outcome, was $4,455 (SD 1,129, 95% CI: 4,204-4,706) for transoral lobectomy and $3,179 (SD 687, 95% CI: 2,990-3,369) for transcervical lobectomy [t(132.05)=8.09, P<0.001] representing a difference in cost of $1,276 (SD 158, 95% CI: 964-1,587). Mean variable direct cost was $4,681 (SD 829, 95% CI: 4,405-4,957) for transoral total thyroidectomy and $3,645 (SD 876, 95% CI: 3,431-3,858) for transcervical total thyroidectomy [t(79.92)=5.98, P<0.001], representing a difference in cost of $1,036 (SD 173, 95% CI: 691-1,381). Differences in energy devices alone account for $487.53 and $447.96 of the cost differences, respectively. Conclusions The differences in mean variable direct cost between transoral endoscopic vestibular approach and transcervical approach for lobectomy and total thyroidectomy were $1276 and $1036 respectively, amounts far less than some believe them to be. This data will be invaluable as we ultimately aim to define the value of transoral endoscopic thyroidectomy vestibular approach.
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Affiliation(s)
- Christopher R Razavi
- Department of Otolaryngology - Head & Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ved A Tanavde
- Department of Otolaryngology - Head & Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Alexander S Kim
- Department of Otolaryngology - Head & Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mohammad Shaear
- Department of Otolaryngology - Head & Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ralph P Tufano
- Department of Otolaryngology - Head & Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jonathon O Russell
- Department of Otolaryngology - Head & Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Tanavde VA, Razavi CR, Chen LW, Ranganath R, Tufano RP, Russell JO. Predictive model of operative time in transoral endoscopic thyroidectomy vestibular approach. Head Neck 2020; 43:1220-1228. [PMID: 33377212 DOI: 10.1002/hed.26581] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 11/01/2020] [Accepted: 12/08/2020] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Transoral Endoscopic Thyroidectomy Vestibular Approach (TOETVA) has demonstrated excellent safety and is receiving wider use in North America. Understanding which factors lead to operative difficulty, as evaluated by operative time (OT), may help to improve safety and refine indications for this procedure. METHODS Cases of TOETVA performed at our institution were reviewed. Multivariate linear regression was performed using patient demographics, thyroid characteristics, and operative variables to predict OT. RESULTS A total of 207 cases were included for analysis. A multivariate linear regression model, controlling for age, sex, and BMI, was developed from 104 cases with an R2 of 0.47 (p < 0.001). Cross-validation on 103 remaining cases showed root-mean-square error of 46.37. Total thyroidectomy and lobe size were the only significant predictors (p < 0.001). CONCLUSIONS We successfully developed a model to predict OT for TOETVA based on preoperative and operative variables. Lobe size, but not BMI, is a significant predictor of OT.
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Affiliation(s)
- Ved A Tanavde
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Christopher R Razavi
- Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Lena W Chen
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Rohit Ranganath
- 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
| | - Jonathon O Russell
- Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Ngo DQ, Tran TD, Le DT, Ngo QX, Le QV. Four-Trocar Approach for Transoral Endoscopic Thyroidectomy Through Vestibular Area: A Novel Technique. VideoEndocrinology 2020. [DOI: 10.1089/ve.2020.0192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Duy Quoc Ngo
- Department of Head and Neck Surgery, Vietnam National Cancer Hospital, Hanoi, Vietnam
| | - Toan Duc Tran
- Department of Head and Neck Surgery, Vietnam National Cancer Hospital, Hanoi, Vietnam
| | - Duong The Le
- Department of Head and Neck Surgery, Vietnam National Cancer Hospital, Hanoi, Vietnam
| | - Quy Xuan Ngo
- Department of Head and Neck Surgery, Vietnam National Cancer Hospital, Hanoi, Vietnam
| | - Quang Van Le
- Department of Head and Neck Surgery, Vietnam National Cancer Hospital, Hanoi, Vietnam
- Hanoi Medical University, Hanoi, Vietnam
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Anatomic Variations From 120 Mental Nerve Dissections: Lessons for Transoral Thyroidectomy. J Surg Res 2020; 256:543-548. [DOI: 10.1016/j.jss.2020.07.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 05/20/2020] [Accepted: 07/11/2020] [Indexed: 01/19/2023]
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Russell JO, Razavi CR, Shaear M, Liu RH, Chen LW, Pace-Asciak P, Tanavde V, Tai KY, Ali K, Fondong A, Kim HY, Tufano RP. Transoral Thyroidectomy: Safety and Outcomes of 200 Consecutive North American Cases. World J Surg 2020; 45:774-781. [PMID: 33205227 DOI: 10.1007/s00268-020-05874-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2020] [Indexed: 01/09/2023]
Abstract
BACKGROUND North American adoption of the transoral endoscopic thyroidectomy vestibular approach (TOETVA) has been limited due to concerns regarding the generalizability of published outcomes, as data are predominantly from Asian cohorts with a different body habitus. We describe our experience with TOETVA in a North American population in the context of the conventional transcervical approach thyroidectomy (TCA). STUDY DESIGN Cases of TOETVA and TCA were reviewed from August 2017 to March 2020 at a tertiary care center. Outcomes included operative time, major (permanent recurrent laryngeal nerve (RLN) injury, permanent hypoparathyroidism, hematoma, conversion to open surgery), and minor complications. The TOETVA cohort was stratified into body mass index (BMI) classes of underweight/normal < 25 kg/m2, overweight 25-29.9 kg/m2, and obese ≥ 30 kg/m2 for comparative analysis. Multivariable logistic regression analyses were performed for odds of cumulative complication. RESULTS Two hundred TOETVA and 333 TCA cases were included. There was no difference in incidence of major complications between the TOETVA and TCA cohorts (1.5% vs. 2.1%, p = 0.75). No difference was found in the rate of temporary RLN injury (4.5% vs. 2.1%, p = 0.124) or temporary hypoparathyroidism (18.2% vs. 12.5%, p = 0.163) for TOETVA and TCA, respectively. Surgical technique (TOETVA vs TCA) did not alter the odds of cumulative complication (OR 0.69 95% CI [0.26-1.85]) on logistic regression analysis. In the TOETVA cohort, higher BMI did not lead to a significantly greater odds of cumulative complication, 0.52 (95% CI [0.17-1.58]) and 1.69 (95% CI [0.74-3.88]) for the overweight and obese groups, respectively. CONCLUSION TOETVA can be performed in a North American patient population without a difference in odds of complication compared to TCA. Higher BMI is not associated with greater likelihood of complication with TOETVA.
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Affiliation(s)
- Jonathon O Russell
- Division of Head and Neck Endocrine Surgery, Department of Otolaryngology - Head and Neck Surgery, The Johns Hopkins University School of Medicine, 601 N. Caroline Street, 6th Floor, Baltimore, MD, 21287, USA.
| | - Christopher R Razavi
- Division of Head and Neck Endocrine Surgery, Department of Otolaryngology - Head and Neck Surgery, The Johns Hopkins University School of Medicine, 601 N. Caroline Street, 6th Floor, Baltimore, MD, 21287, USA
| | - Mohammad Shaear
- Division of Head and Neck Endocrine Surgery, Department of Otolaryngology - Head and Neck Surgery, The Johns Hopkins University School of Medicine, 601 N. Caroline Street, 6th Floor, Baltimore, MD, 21287, USA
| | - Rui H Liu
- Division of Head and Neck Endocrine Surgery, Department of Otolaryngology - Head and Neck Surgery, The Johns Hopkins University School of Medicine, 601 N. Caroline Street, 6th Floor, Baltimore, MD, 21287, USA
| | - Lena W Chen
- Division of Head and Neck Endocrine Surgery, Department of Otolaryngology - Head and Neck Surgery, The Johns Hopkins University School of Medicine, 601 N. Caroline Street, 6th Floor, Baltimore, MD, 21287, USA
| | - Pia Pace-Asciak
- Division of Head and Neck Endocrine Surgery, Department of Otolaryngology - Head and Neck Surgery, The Johns Hopkins University School of Medicine, 601 N. Caroline Street, 6th Floor, Baltimore, MD, 21287, USA
| | - Ved Tanavde
- Division of Head and Neck Endocrine Surgery, Department of Otolaryngology - Head and Neck Surgery, The Johns Hopkins University School of Medicine, 601 N. Caroline Street, 6th Floor, Baltimore, MD, 21287, USA
| | - Katherine Y Tai
- Division of Head and Neck Endocrine Surgery, Department of Otolaryngology - Head and Neck Surgery, The Johns Hopkins University School of Medicine, 601 N. Caroline Street, 6th Floor, Baltimore, MD, 21287, USA
| | - Khalid Ali
- Division of Head and Neck Endocrine Surgery, Department of Otolaryngology - Head and Neck Surgery, The Johns Hopkins University School of Medicine, 601 N. Caroline Street, 6th Floor, Baltimore, MD, 21287, USA
| | - Akeweh Fondong
- Division of Head and Neck Endocrine Surgery, Department of Otolaryngology - Head and Neck Surgery, The Johns Hopkins University School of Medicine, 601 N. Caroline Street, 6th Floor, Baltimore, MD, 21287, USA
| | - Hoon Yub Kim
- Department of Surgery, KUMC Thyroid Center, Korea University College of Medicine, Seoul, South Korea
| | - Ralph P Tufano
- Division of Head and Neck Endocrine Surgery, Department of Otolaryngology - Head and Neck Surgery, The Johns Hopkins University School of Medicine, 601 N. Caroline Street, 6th Floor, Baltimore, MD, 21287, USA
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Moreno Llorente P, A Gonzales Laguado E, Alberich Prats M, Francos Martínez JM, García Barrasa A. Surgical approaches to thyroid. Cir Esp 2020; 99:267-275. [PMID: 33069356 DOI: 10.1016/j.ciresp.2020.08.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 08/08/2020] [Accepted: 08/11/2020] [Indexed: 01/03/2023]
Abstract
Thyroidectomy is the most frequent procedure in endocrine surgery. The conventional approach through a collar incision, as described by Kocher in XIXth century, has become the "gold standard". It is continuously evolving in spite of, many years ago, it showed to be safe and efficient with quality standards difficult to beat. Endoscopic and robotic surgery have developed "new approaches" to thyroid in order to improve the cosmetic results, looking even for invisible scars. We have done a thoughtful review of most of them trying to understand their benefits and drawbacks. Currently none of these "new approaches" have been shown to be better than conventional open thyroidectomy beyond offering a better cosmetic result. Besides, only a small percentage of patients can benefit of them. However, most of these approaches will remain if they treat the diseased thyroid and also improve the quality of life of our patients.
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Affiliation(s)
- Pablo Moreno Llorente
- Unidad de Cirugía Endocrina, Hospital Universitari de Bellvitge, Universidad de Barcelona (UB), L'Hospitalet de Llobregat, Barcelona, España.
| | - Erick A Gonzales Laguado
- Unidad de Cirugía Endocrina, Hospital Universitari de Bellvitge, Universidad de Barcelona (UB), L'Hospitalet de Llobregat, Barcelona, España
| | - Marta Alberich Prats
- Unidad de Cirugía Endocrina, Hospital Universitari de Bellvitge, Universidad de Barcelona (UB), L'Hospitalet de Llobregat, Barcelona, España
| | - José Manuel Francos Martínez
- Unidad de Cirugía Endocrina, Hospital Universitari de Bellvitge, Universidad de Barcelona (UB), L'Hospitalet de Llobregat, Barcelona, España
| | - Arantxa García Barrasa
- Unidad de Cirugía Endocrina, Hospital Universitari de Bellvitge, Universidad de Barcelona (UB), L'Hospitalet de Llobregat, Barcelona, España
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Ngo DQ, Tran TD, Ngo QX, Van Le Q. Transoral Endoscopic Thyroidectomy via Vestibular Approach With 4 Trocars: A New Technique. EAR, NOSE & THROAT JOURNAL 2020; 101:170-174. [PMID: 32791908 DOI: 10.1177/0145561320943358] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVES The objective of this study was to report the feasibility and safety of a novel 4-trocar approach for transoral endoscopic thyroidectomy via the vestibular. METHODS In this study, we first used 4 trocars via vestibular area to perform transoral endoscopic thyroidectomy. We reported the safety and surgical feasibility of transoral endoscopic thyroidectomy using a 4-trocar technique in our institute from February 1, 2020, to May 10, 2020. RESULTS Transoral endoscopic thyroidectomy via the vestibular approach using 4 trocars was carried out in 5 patients. No complications such as bleeding, mental nerve injury, recurrent laryngeal nerve injury, or hypoparathyroidism were reported. All patients were completely satisfied with the cosmetic results. CONCLUSIONS Transoral endoscopic thyroidectomy with 4 trocars via vestibular approach is an effective and feasible method. Markedly, this technique can assist surgeons to expose and preserve both parathyroid glands and recurrent laryngeal nerve easily when performing transoral endoscopic thyroidectomy.
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Affiliation(s)
- Duy Quoc Ngo
- Department of Head and Neck Surgery, Vietnam National Cancer Hospital, Hanoi, Vietnam
| | - Toan Duc Tran
- Department of Head and Neck Surgery, Vietnam National Cancer Hospital, Hanoi, Vietnam
| | - Quy Xuan Ngo
- Department of Head and Neck Surgery, Vietnam National Cancer Hospital, Hanoi, Vietnam
| | - Quang Van Le
- Department of Head and Neck Surgery, Vietnam National Cancer Hospital, Hanoi, Vietnam.,Hanoi Medical University, Hanoi, Vietnam
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Chen LW, Razavi CR, Hong H, Fondong A, Ranganath R, Khatri S, Mydlarz WK, Mathur A, Ishii M, Nellis J, Shaear M, Tufano RP, Russell JO. Cosmetic outcomes following transoral versus transcervical thyroidectomy. Head Neck 2020; 42:3336-3344. [DOI: 10.1002/hed.26383] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 06/01/2020] [Accepted: 06/26/2020] [Indexed: 11/06/2022] Open
Affiliation(s)
- Lena W. Chen
- Division of Head and Neck Endocrine Surgery, Department of Otolaryngology‐Head and Neck Surgery Johns Hopkins University School of Medicine Baltimore MD USA
| | - Christopher R. Razavi
- Division of Head and Neck Endocrine Surgery, Department of Otolaryngology‐Head and Neck Surgery Johns Hopkins University School of Medicine Baltimore MD USA
| | - Hanna Hong
- Division of Head and Neck Endocrine Surgery, Department of Otolaryngology‐Head and Neck Surgery Johns Hopkins University School of Medicine Baltimore MD USA
| | - Akeweh Fondong
- Division of Head and Neck Endocrine Surgery, Department of Otolaryngology‐Head and Neck Surgery Johns Hopkins University School of Medicine Baltimore MD USA
| | - Rohit Ranganath
- Division of Head and Neck Endocrine Surgery, Department of Otolaryngology‐Head and Neck Surgery Johns Hopkins University School of Medicine Baltimore MD USA
| | - Surya Khatri
- Division of Head and Neck Endocrine Surgery, Department of Otolaryngology‐Head and Neck Surgery Johns Hopkins University School of Medicine Baltimore MD USA
| | - Wojciech K. Mydlarz
- Division of Head and Neck Surgery, Department of Otolaryngology‐Head and Neck Surgery Johns Hopkins University School of Medicine Baltimore MD USA
| | - Aarti Mathur
- Division of Surgical Oncology, Department of Surgery Johns Hopkins University School of Medicine Baltimore MD USA
| | - Masaru Ishii
- Division of Rhinology and Sinus, Department of Otolaryngology‐Head and Neck Surgery Johns Hopkins University School of Medicine Baltimore MD USA
| | - Jason Nellis
- Division of Head and Neck Surgery, Department of Otolaryngology‐Head and Neck Surgery Johns Hopkins University School of Medicine Baltimore MD USA
| | - Mohammad Shaear
- Division of Head and Neck Endocrine Surgery, Department of Otolaryngology‐Head and Neck Surgery Johns Hopkins University School of Medicine Baltimore MD USA
| | - Ralph 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
| | - Jonathon O. Russell
- Division of Head and Neck Endocrine Surgery, Department of Otolaryngology‐Head and Neck Surgery Johns Hopkins University School of Medicine Baltimore MD USA
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Tae K, Kim KH. Transoral robotic selective neck dissection for papillary thyroid carcinoma: Dissection of Levels III and IV. Head Neck 2020; 42:3084-3088. [PMID: 32794247 DOI: 10.1002/hed.26379] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 05/28/2020] [Accepted: 06/23/2020] [Indexed: 12/21/2022] Open
Abstract
We present the operative procedure of transoral robotic selective neck dissection for papillary thyroid carcinoma. A 28-year-old woman, diagnosed with papillary thyroid carcinoma and lymph node metastasis at right level IV, underwent total thyroidectomy, central neck dissection, and selective neck dissection involving levels III and IV via the transoral robotic approach. A 1.5-2-cm central incision was made near the base of the lower lip frenulum, and two lateral incisions were made close to the oral commissure. An additional right axillary port was made to place a third robotic instrument for counter-traction. The operation was completed successfully without conversion to the conventional transcervical approach. The working space and surgical view were enough to perform selective neck dissection of levels III and IV. There were no major postoperative complications. Transoral robotic selective neck dissection of levels III and IV is feasible and safe in selected patients.
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Affiliation(s)
- Kyung Tae
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Hanyang University, Seoul, Republic of Korea
| | - Keon-Ho Kim
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Hanyang University, Seoul, Republic of Korea
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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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Ryan MA, Russell JO, Schoo DP, Upchurch PA, Walsh JM. Transoral Endoscopic Vestibular Thyroglossal Duct Cyst Excision. Ann Otol Rhinol Laryngol 2020; 129:1239-1242. [PMID: 32560593 DOI: 10.1177/0003489420936712] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Thyroglossal duct cysts (TGDCs) are relatively common congenital midline neck masses that are treated with surgical excision. Traditionally these are removed along with any associated tract and the central portion of the hyoid bone through an anterior neck incision. Some patients with TGDCs want to avoid an external neck scar. METHODS We describe the details of a transoral endoscopic vestibular excision of a TGDC and the associated hyoid bone in an adolescent patient. RESULTS This novel approach was successful and there were no complications. CONCLUSION We propose that cervical TGDCs can be safely and completely removed with this approach in appropriately selected patients while avoiding a neck scar.
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Affiliation(s)
- Marisa A Ryan
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, MD, USA
| | - Jonathon O Russell
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, MD, USA
| | - Desi P Schoo
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, MD, USA
| | - Patrick A Upchurch
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Jonathan M Walsh
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, MD, USA
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Razavi CR, Shaear M, Anuwong A, Russell JO. The role of surgeon-performed ultrasound in transoral endoscopic thyroidectomy vestibular approach (TOETVA). World J Otorhinolaryngol Head Neck Surg 2020; 6:150-154. [PMID: 33073208 PMCID: PMC7548380 DOI: 10.1016/j.wjorl.2020.01.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 01/19/2020] [Indexed: 10/28/2022] Open
Abstract
Transoral Endoscopic Thyroidectomy Vestibular Approach (TOETVA) is a recently described surgical technique where the thyroid and central neck can be accessed without a cutaneous incision. To date nearly 700 cases have been described within the English literature demonstrating the feasibility, safety, and efficacy of the technique. As more institutions begin to adopt the surgical approach, it is important that surgeons pay close attention to appropriate patient selection and surgical optimization to prevent experience-related complications. A valuable tool to facilitate these considerations is the utilization of surgeon-performed ultrasonography (US). While the merits of surgeon-performed US are well-documented within head & neck endocrine surgery as a whole, its value may be of even greater importance when implementing a novel surgical technique such as TOETVA. Here we highlight and summarize the role of surgeon-performed US within head & neck endocrine surgery, focusing on how it may influence patient selection and surgical planning with TOETVA.
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Affiliation(s)
- Christopher R Razavi
- Department of Otolaryngology - Head & Neck Surgery, John Hopkins Hospital, Baltimore, MD, USA
| | - Mohammad Shaear
- Department of Otolaryngology - Head & Neck Surgery, John Hopkins Hospital, Baltimore, MD, USA
| | - Angkoon Anuwong
- Minimally Invasive and Endocrine Surgery Division, Department of Surgery Police General Hospital Bangkok, Thailand
| | - Jonathon O Russell
- Department of Otolaryngology - Head & Neck Surgery, John Hopkins Hospital, Baltimore, MD, USA
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Al Bisher HM, Khidr AM, Alkhudair BH, Alammadi FS, Ibrahim AH. Transoral endoscopic thyroidectomy via vestibular approach: First case in Saudi Arabia. Int J Surg Case Rep 2020; 70:75-77. [PMID: 32413772 PMCID: PMC7226639 DOI: 10.1016/j.ijscr.2020.04.014] [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: 01/04/2020] [Revised: 03/30/2020] [Accepted: 04/16/2020] [Indexed: 12/05/2022] Open
Abstract
INTRODUCTION There has been increased interest in applying the principles of minimally invasive surgery in thyroid surgery which was promoted by Miccoli and his colleagues in 1999. Different surgical techniques since then were introduced, transcervical and extracervical approaches. PRESENTATION OF CASE A 33-year-old Saudi female presented with a swelling over the left side of her neck and dysphagia for three years. The patient underwent transoral endoscopic left thyroid lobectomy, isthmusectomy and sampling of the central compartment via vestibular approach (TOETVA). To the best of our knowledge, this is the first case underwent TOETVA successfully in Saudi Arabia and gulf cooperation council countries. DISCUSSION TOETVA is a novel promising procedure, an adaptation of the concept of natural orifice transluminal endoscopic surgery (NOTES) with advantages of scar-less result in excellent cosmesis while retaining the advantages of minimally invasive surgery and the potential value of the procedure outside the enhanced cosmesis continuous to be defined. The cosmetic superiority in avoiding visible scarring must be balanced against operative time, post-operative hospital stays, increased expense, surgical training, and steep learning curve required. The technique is novel, some thyroid surgeons opted for longer postoperative observation to exclude complications. As experience and confidence in the procedure increase, the length of stay should decrease dramatically. CONCLUSION This procedure is feasible and safe with excellent cosmetic result. It is in its initial stage in Saudi Arabia, gulf cooperation council countries and it has a potential to be performed more frequently in near future.
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Affiliation(s)
- Hassan M Al Bisher
- Imam Abdulrahman Bin Faisal University, King Fahad University Hospital, Department of Surgery, Saudi Arabia.
| | - Alaa M Khidr
- Imam Abdulrahman Bin Faisal University, King Fahad University Hospital, Department of Anesthesia, Saudi Arabia
| | - Badria H Alkhudair
- Imam Abdulrahman Bin Faisal University, King Fahad University Hospital, Department of Surgery, Saudi Arabia
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Russell JO, Sahli ZT, Shaear M, Razavi C, Ali K, Tufano RP. Transoral thyroid and parathyroid surgery via the vestibular approach-a 2020 update. Gland Surg 2020; 9:409-416. [PMID: 32420266 DOI: 10.21037/gs.2020.03.05] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Transoral endoscopic thyroidectomy and parathyroidectomy via the vestibular approach (TOET/PVA or TOETVA-TOEPVA) is the latest remote-access technique employed in the central neck. As the only approach that does not leave any cutaneous incision, (TOET/PVA) has become popular in both the Far East and Western series since its original description in 2015. More than just a "scarless" surgery, (TOET/PVA) has been associated with a short learning curve, access to the bilateral central neck compartments, few surgical contraindications, minimal complications, and minimal additional instrumentation. To date, more than 2,000 cases have been completed, including more than 400 in North America, demonstrating brisk utilization of a novel technique relative to earlier remote access central neck approaches. Herein, we describe updates that continue to improve the safety and efficacy of the procedure.
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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
| | - Zeyad T Sahli
- Department of Surgery, The University of Virginia Health System, Charlottesville, VA, USA
| | - Mohammad Shaear
- Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Christopher Razavi
- Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Khalid Ali
- Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ralph P Tufano
- Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Razavi CR, Tanavde V, Shaear M, Richmon JD, Russell JO. Simulations and simulators in head and neck endocrine surgery. ACTA ACUST UNITED AC 2020; 5. [PMID: 32395699 DOI: 10.21037/aot.2020.03.03] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Simulations and simulators have become an increasingly important tool in trainee education across many surgical disciplines, particularly for robotic and minimally invasive procedures. Thyroidectomy and parathyroidectomy are common procedures performed across multiple surgical disciplines, however, there is limited literature regarding training models/simulators for these operations. This is despite the advent and growing popularity of remote-access thyroidectomy techniques, where simulators may provide significant value in trainee education and safe implementation. Here we review the literature regarding available simulations/simulators in head and neck endocrine surgery for both conventional transcervical approaches and newer remote-access thyroidectomy techniques.
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Affiliation(s)
- Christopher R Razavi
- Division of Head & Neck Endocrine Surgery, Department of Otolaryngology, Head & Neck Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Ved Tanavde
- Division of Head & Neck Endocrine Surgery, Department of Otolaryngology, Head & Neck Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Mohammad Shaear
- Division of Head & Neck Endocrine Surgery, Department of Otolaryngology, Head & Neck Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Jeremy D Richmon
- Department of Otolaryngology, Head and Neck Surgery, Massachusetts Eye and Ear, Boston, MA, USA
| | - Jonathon O Russell
- Division of Head & Neck Endocrine Surgery, Department of Otolaryngology, Head & Neck Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
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Zhang M, Tufano RP, Russell JO, Zhang Y, Zhang Y, Qiao Z, Luo Y. Ultrasound-Guided Radiofrequency Ablation Versus Surgery for Low-Risk Papillary Thyroid Microcarcinoma: Results of Over 5 Years' Follow-Up. Thyroid 2020; 30:408-417. [PMID: 31910107 DOI: 10.1089/thy.2019.0147] [Citation(s) in RCA: 112] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Background: Papillary thyroid microcarcinoma (PTMC) typically carries an excellent prognosis regardless of the treatment option pursued. Radiofrequency ablation (RFA) for thyroid disease has been utilized for benign lesions and in patients who are poor surgical candidates for thyroid cancers with compression symptoms, but the efficacy and limitations of RFA as first-line therapy for PTMC has not been described in adequate detail. The purpose of our study was to investigate RFA versus thyroidectomy in terms of efficacy, oncologic outcomes, quality of life, complications, and costs over a 5-year period of follow-up. Methods: From January 2013 to November 2013, 174 consecutive patients with an isolated, solitary intrathyroidal PTMC were identified in a Chinese teaching hospital. Those with more aggressive or advanced PTMCs were not included. Ninety-four patients elected RFA and 80 patients elected surgery for treatment of these PTMC. Nodules were confirmed to be PTMC without an aggressive histological type by core needle biopsy in the RFA group and by final surgical pathology in the surgery group. The extent of surgery was decided based on patient preferences in consultation with the surgeons. Of all the patients, 58 (72.5%) underwent lobectomy, 22 (27.5%) underwent total thyroidectomy, and 53 (66.3%) underwent lymph node dissection. Pre- and post-treatment variables were compared between the two groups, including demographics, tumor characteristics, treatment, local tumor progression, lymph node metastasis, distant metastasis, local recurrence, complications, and quality-of-life findings. Results: Patient-specific variables were similar between groups, as were oncologic outcomes after 5 years of follow-up. When compared with RFA, surgery took longer, had a longer hospitalization time, and was costlier (all p < 0.001). The surgery group had three complications, with 2 (2.5%) permanent recurrent laryngeal nerve injuries and 1 (1.3%) case of permanent hypoparathyroidism, while none was reported in the RFA group (p = 0.095). The surgery group had a lower post-treatment thyroid-related quality of life. Conclusions: For carefully selected low-risk intrathyroidal PTMC, RFA was not oncologically inferior to open surgery, and it was associated with a higher quality of life and lower overall costs.
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Affiliation(s)
- Mingbo Zhang
- Department of Ultrasound, The First Medical Center, General Hospital of Chinese PLA, Beijing, China
| | - Ralph P Tufano
- Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jonathon O Russell
- Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ying Zhang
- Department of Ultrasound, The First Medical Center, General Hospital of Chinese PLA, Beijing, China
| | - Yan Zhang
- Department of Ultrasound, The First Medical Center, General Hospital of Chinese PLA, Beijing, China
| | - Zhi Qiao
- Department of General Surgery, The First Medical Center, General Hospital of Chinese PLA, Beijing, China
| | - Yukun Luo
- Department of Ultrasound, The First Medical Center, General Hospital of Chinese PLA, Beijing, China
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Felix C, Russell JO, Juman S, Medford S. Cervical scar satisfaction post conventional thyroidectomy. Gland Surg 2020; 8:723-728. [PMID: 32042680 DOI: 10.21037/gs.2019.11.17] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Thyroidectomy is a commonly performed procedure with large centres performing thousands of thyroid surgeries per year. The traditional Kocher mid-cervical incision has been the standard approach to thyroidectomy since the late 1870s with predictable results. The introduction of minimally invasive and remote access techniques seeks to reduce the morbidity of a mid-cervical scar incision. Methods Ninety-five [95] patients who underwent this approach over the thirty [30] months period from January 2015 to July 2017 were administered the validated Patient Scar Assessment Questionnaire and the collected data analysed. Results Forty-eight [48] patients, (50.5%) met inclusion criteria and provided responses with a mean time since surgery of 18.9 months. There is a high level of satisfaction with 91.7% of patients in the study having scores consistent with scar satisfaction after conventional thyroidectomy. While patients were satisfied with the appearance of their scars, a majority of patients (n=28, 58.3%) were at least slightly conscious of their incisions, with more than 10% of patients (n=5) reporting significant levels of self-consciousness. Patients of Mixed race were found to have slightly elevated scores on PSAQ compared with IndoTrinidadian and AfroTrinidadian races (P=0.002 and P=0.006). Conclusions Most patients were satisfied with their scar results in the years after thyroidectomy. Despite the high level of satisfaction, a majority of patients are self-conscious about the presence of a mid-cervical incision. Further research is needed to elucidate causes and the effects of this finding.
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Affiliation(s)
- Cherian Felix
- The University of the West Indies, Department of Otolaryngology, Head and Neck Surgery, St. Augustine, Trinidad
| | - Jonathon O Russell
- Johns Hopkins Medicine, Division of Head and Neck and Endocrine Surgery, Department of Otolaryngology, Head and Neck Surgery, Baltimore, MD, USA
| | - Solaiman Juman
- The University of the West Indies, Department of Otolaryngology, Head and Neck Surgery, St. Augustine, Trinidad
| | - Steve Medford
- Department of Otolaryngology, Head and Neck Surgery, San Fernando General Hospital, San Fernando, Trinidad
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Guo F, Wang W, Zhu X, Xiang C, Wang P, Wang Y. Comparative Study Between Endoscopic Thyroid Surgery via the Oral Vestibular Approach and the Areola Approach. J Laparoendosc Adv Surg Tech A 2020; 30:170-174. [PMID: 31621490 DOI: 10.1089/lap.2019.0562] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Affiliation(s)
- Fangdong Guo
- Department of Breast and Thyroid Surgery, The Affiliated Zhongshan Hospital of Dalian University, Dalian, China
| | - Wenrui Wang
- Department of Breast and Thyroid Surgery, Dezhou People's Hospital of Shandong Province, Dezhou, China
| | - Xiaoyu Zhu
- Department of Breast and Thyroid Surgery, The Affiliated Zhongshan Hospital of Dalian University, Dalian, China
| | - Cheng Xiang
- Department of Thyroid Surgery, The Second Affiliated Hospital of Zhejiang University College of Medicine, Hangzhou, China
| | - Ping Wang
- Department of Thyroid Surgery, The Second Affiliated Hospital of Zhejiang University College of Medicine, Hangzhou, China
| | - Yong Wang
- Department of Thyroid Surgery, The Second Affiliated Hospital of Zhejiang University College of Medicine, Hangzhou, China
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Pace-Asciak P, Russell JO, Shaear M, Tufano RP. Novel Approaches for Treating Autonomously Functioning Thyroid Nodules. Front Endocrinol (Lausanne) 2020; 11:565371. [PMID: 33250857 PMCID: PMC7673400 DOI: 10.3389/fendo.2020.565371] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 10/05/2020] [Indexed: 11/13/2022] Open
Abstract
Benign thyroid nodules are exceedingly common in the adult population. Only a small percentage of nodules are toxic or autonomously functioning thyroid nodules (AFTNs). The options clinicians have for treating the symptoms of hyperthyroidism include anti-thyroidal medications, radioactive iodine, or surgery. Depending on the patient population treated, these options may not be suitable or have inherent risks that are undesirable to the patient. On the other hand, untreated hyperthyroidism can lead to osteoporosis, atrial fibrillation, emotional lability, and neurological consequences. Thus, we present a review of two novel safe and effective approaches for treating AFTN; one surgical (transoral endoscopic thyroid surgery) and one non-surgical (radiofrequency ablation), as a means for expanding our treatment armamentarium.
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Shaha AR. Transoral parathyroidectomy-Why make a simple operation complicated? A surgical fantasy. Head Neck 2019; 41:3466-3467. [PMID: 31157936 DOI: 10.1002/hed.25829] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 05/22/2019] [Indexed: 12/28/2022] Open
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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