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He QQ, Ma YH, Zhu J, Wang M, Wang G, Zhou P, Wang D, Liu YX, Zheng LM, Zhuang DY, Yu F, Cao XJ, Liu CR, Li XL, Yue T, Wang YY, Jiang HP, Li YN, Xu J. Comparison of transoral vestibular robotic thyroidectomy with traditional low-collar incision thyroidectomy. J Robot Surg 2024; 18:88. [PMID: 38386236 DOI: 10.1007/s11701-024-01831-y] [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: 11/07/2023] [Accepted: 01/14/2024] [Indexed: 02/23/2024]
Abstract
Transoral vestibular robotic thyroidectomy can really make the patient's body surface free of scar. This study aimed to compare the surgical and patient-related outcomes between the transoral vestibular robotic thyroidectomy and traditional low-collar incision thyroidectomy. The clinical data of 120 patients underwent transoral vestibular robotic thyroidectomy (TOVRT) or traditional low-collar incision thyroidectomy (TLCIT) were collected from May 2020 to October 2021. Propensity score matching analysis was used to minimize selection bias. All these patients were diagnosed with papillary thyroid carcinoma (PTC) through ultrasound-guided fine-needle aspiration prior to surgical intervention and surgical plan was tailored for each patient. An intraoperative recurrent laryngeal nerve (RLN) detection system was used in all patients, whose RLNs were identified and protected. We performed transoral vestibular robotic thyroidectomy with three intraoral incisions. Additional right axillary fold incisions were adopted occasionally to enhance fine reverse traction of tissue for radical tumor dissection. Clinical data including gender, age, tumor size, BMI, operation time, postoperative drainage volume and time, pain score, postoperative length of stay (LOS),number of lymph nodes removed, complications, and medical expense were observed and analyzed. Propensity score matching was used for 1:1 matching between the TOVRT group and the TLCIT group. All these patients accepted total thyroidectomy(or lobectomy) plus central lymph node dissection and all suffered from PTC confirmed by postoperative pathology. No conversion to open surgery happened in TOVRT group. The operative time of TOVRT group was longer than that of TLCIT group (P < 0.05). The postoperative drainage volume of TOVRT group was more than that of TLCIT group (P < 0.05). The drainage tube placement time of TOVRT group were longer than that of TLCIT group (P < 0.05). Significant differences were also found in intraoperative bleeding volume, pain score and medical expense between the two groups (P < 0.05). The incidence of perioperative common complications such as hypoparathyroidism and vocal cord paralysis in the two groups was almost identical (P > 0.05). However, there were some specific complications such as surgical area infection (one case), skin burn (one case), oral tear (two cases), and paresthesia of the lower lip and the chin (two cases) were found in TOVRT group. Obviously, the postoperative cosmetic effect of the TOVRT group was better than TLCIT group (P < 0.05). TOVRT is safe and feasible for low to moderate-risk PTC patients and is a potential alternative for patients who require no scar on their neck. Patients accepted TOVRT can get more satisfaction and have less psychologic injury caused by surgery.
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Affiliation(s)
- Qing-Qing He
- Department of Thyroid and Breast Surgery, The 960th Hospital of the PLA Joint Logistics Support Force (Former Jinan Military General Hospital of People's Liberation Army), Jinan, 250031, Shandong, China.
| | - Yun-Han Ma
- Department of Thyroid and Breast Surgery, The 960th Hospital of the PLA Joint Logistics Support Force (Former Jinan Military General Hospital of People's Liberation Army), Jinan, 250031, Shandong, China
| | - Jian Zhu
- Department of Thyroid and Breast Surgery, The 960th Hospital of the PLA Joint Logistics Support Force (Former Jinan Military General Hospital of People's Liberation Army), Jinan, 250031, Shandong, China
| | - Meng Wang
- Department of Thyroid and Breast Surgery, The 960th Hospital of the PLA Joint Logistics Support Force (Former Jinan Military General Hospital of People's Liberation Army), Jinan, 250031, Shandong, China
| | - Gang Wang
- Department of Thyroid and Breast Surgery, The 960th Hospital of the PLA Joint Logistics Support Force (Former Jinan Military General Hospital of People's Liberation Army), Jinan, 250031, Shandong, China
| | - Peng Zhou
- Department of Thyroid and Breast Surgery, The 960th Hospital of the PLA Joint Logistics Support Force (Former Jinan Military General Hospital of People's Liberation Army), Jinan, 250031, Shandong, China
| | - Dan Wang
- Department of Thyroid and Breast Surgery, The 960th Hospital of the PLA Joint Logistics Support Force (Former Jinan Military General Hospital of People's Liberation Army), Jinan, 250031, Shandong, China
| | - Yong-Xiang Liu
- Department of Thyroid and Breast Surgery, The 960th Hospital of the PLA Joint Logistics Support Force (Former Jinan Military General Hospital of People's Liberation Army), Jinan, 250031, Shandong, China
| | - Lu-Ming Zheng
- Department of Thyroid and Breast Surgery, The 960th Hospital of the PLA Joint Logistics Support Force (Former Jinan Military General Hospital of People's Liberation Army), Jinan, 250031, Shandong, China
| | - Da-Yong Zhuang
- Department of Thyroid and Breast Surgery, The 960th Hospital of the PLA Joint Logistics Support Force (Former Jinan Military General Hospital of People's Liberation Army), Jinan, 250031, Shandong, China
| | - Fang Yu
- Department of Thyroid and Breast Surgery, The 960th Hospital of the PLA Joint Logistics Support Force (Former Jinan Military General Hospital of People's Liberation Army), Jinan, 250031, Shandong, China
| | - Xian-Jiao Cao
- Department of Thyroid and Breast Surgery, The 960th Hospital of the PLA Joint Logistics Support Force (Former Jinan Military General Hospital of People's Liberation Army), Jinan, 250031, Shandong, China
| | - Chang-Rui Liu
- Department of Thyroid and Breast Surgery, The 960th Hospital of the PLA Joint Logistics Support Force (Former Jinan Military General Hospital of People's Liberation Army), Jinan, 250031, Shandong, China
| | - Xiao-Lei Li
- Department of Thyroid and Breast Surgery, The 960th Hospital of the PLA Joint Logistics Support Force (Former Jinan Military General Hospital of People's Liberation Army), Jinan, 250031, Shandong, China
| | - Tao Yue
- Department of Thyroid and Breast Surgery, The 960th Hospital of the PLA Joint Logistics Support Force (Former Jinan Military General Hospital of People's Liberation Army), Jinan, 250031, Shandong, China
| | - Ying-Ying Wang
- Department of Thyroid and Breast Surgery, The 960th Hospital of the PLA Joint Logistics Support Force (Former Jinan Military General Hospital of People's Liberation Army), Jinan, 250031, Shandong, China
| | - Hui-Ping Jiang
- Department of Thyroid and Breast Surgery, The 960th Hospital of the PLA Joint Logistics Support Force (Former Jinan Military General Hospital of People's Liberation Army), Jinan, 250031, Shandong, China
| | - Yan-Ning Li
- Department of Thyroid and Breast Surgery, The 960th Hospital of the PLA Joint Logistics Support Force (Former Jinan Military General Hospital of People's Liberation Army), Jinan, 250031, Shandong, China
| | - Jing Xu
- Department of Thyroid and Breast Surgery, The 960th Hospital of the PLA Joint Logistics Support Force (Former Jinan Military General Hospital of People's Liberation Army), Jinan, 250031, Shandong, China
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Kurganov IA, Usmanov IS, Mamistvalov MS, Emelyanov SI. [Complications and technical aspects of safe tissue dissection in endoscopic hemithyroidectomy]. Khirurgiia (Mosk) 2024:66-74. [PMID: 39268738 DOI: 10.17116/hirurgia202409166] [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] [Indexed: 09/15/2024]
Abstract
OBJECTIVE To analyze the complications following endoscopic hemithyroidectomy and to develop the principles of tissue dissection for safe surgical intervention. MATERIAL AND METHODS The results of surgical treatment of 136 patients were studied. The main group consisted of 44 patients who underwent endoscopic hemithyroidectomy through a «gasless» axillary approach (EH group). The first control group consisted of 45 patients who underwent minimally invasive video-assisted hemithyroidectomy (MIVAH group). The second control group consisted of 47 patients who underwent open hemithyroidectomy (OH group). RESULTS. O Verall complication rate was significantly higher in the EH group (20.5% vs. 6.4% in the OH group and 4.4% in the MIVAH group; p<0.05). In the EH group, Clavien-Dindo grade I complications occurred in 11.4% of cases. There were no similar complications in the control groups (p<0.05). Clavien-Dindo grade II complications occurred in 9.1% of patients in the EH group, 4.3% in the OH group and no similar events were identified in the MIVAH group (p>0.05). Clavien-Dindo grade III complications occurred in 1 (2.1%) case in the OH group and 2 (4.4%) cases in the MIVAH group. There were no Clavien-Dindo grade III complications in the EH group. Thus, minor complications prevailed in the EH group. Their incidence decreased along with accumulation of experience. Moreover, endoscopic procedure is safer regarding the risk of severe complications. CONCLUSION Endoscopic hemithyroidectomy is safe, and the proposed principles of tissue dissection can further increase surgical safety.
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Affiliation(s)
| | - I S Usmanov
- Russian University of Medicine, Moscow, Russia
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Yang X, Zhao JG, Liu M, Wang S, Wang L. Management of Patients with Cervicofacial Edema and Paresthesia during Perioperative Period of Transoral Endoscopic Thyroidectomy. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:4775264. [PMID: 36213587 PMCID: PMC9534668 DOI: 10.1155/2022/4775264] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 08/11/2022] [Accepted: 08/23/2022] [Indexed: 11/18/2022]
Abstract
Objective To analyze the clinical intervention effect of transoral endoscopic thyroidectomy on the neck and face during perioperative period. Method From January 2019 to January 2020, 60 patients included in this study were randomly divided into observation group and control group according to the ratio of 1 : 1, with 30 cases in each group. Both groups underwent rapid surgical intervention during the perioperative period. The patients in the observation group received neck and face management. The degree of jaw swelling, the degree of facial microexpression completion, and the changes in jaw and neck sensation were compared between the two groups. Results There was no significant difference in neck and face swelling, pain, facial microexpression, and feeling between the two groups before operation. Patients with facial I/II swelling degree in the observation group were significantly more than in the control group, and the patients with III swelling degree were less than in the control group. There was significant difference for facial swelling between the two groups in the three intervention periods after the operation, and the difference was statistically significant (P < 0.05). The scores of facial microexpression in the observation group were higher than those in the control group during the three postoperative intervention periods, with statistical significance (P < 0.05). There was no significant difference in the pain score of the first day after surgery between the two groups (P = 0.298). In the other two postoperative intervention periods, the pain score of the observation group was lower than that of the control group, with a statistically significant difference, and the difference was statistically significant (P < 0.05). The threshold of chin and neck sensory pressure in the two groups was statistically significant (P < 0.05) except that the "cheek in area 4" (P = 0.290). Conclusion The results showed that these interventions, such as the elevation of bed after operation, 24-hour intermittent cryotherapy, ice cubes in mouth, and the "meter" functional training, have good clinical effects on the symptoms of facial swelling and abnormal sensation of neck and face. It can accelerate the speed of edema dissipation, improve the patients' postoperative comfort, and improve the satisfaction and quality of life of patients with the effect of surgery and beauty.
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Affiliation(s)
- Xia Yang
- Department of Thyroid and Breast Surgery, Wuhan Number 1 Hospital, Tongji Medical College, Huazhong University of Science and Technology, China
| | - Jian Guo Zhao
- Department of Thyroid and Breast Surgery, Wuhan Number 1 Hospital, Tongji Medical College, Huazhong University of Science and Technology, China
| | - Mengting Liu
- Department of Thyroid and Breast Surgery, Wuhan Number 1 Hospital, Tongji Medical College, Huazhong University of Science and Technology, China
| | - Shan Wang
- Department of Thyroid and Breast Surgery, Wuhan Number 1 Hospital, Tongji Medical College, Huazhong University of Science and Technology, China
| | - Li Wang
- Department of Nursing, Wuhan Number 1 Hospital, Tongji Medical College, Huazhong University of Science and Technology, China
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Weng YJ, Hu BL, Jiang J, Min L, Ai Q, Chen DB, Chen WC, Huang ZH. Delayed tracheal rupture following transoral endoscopic thyroidectomy vestibular approach: Case report and review of the literature. Head Neck 2022; 44:E38-E44. [PMID: 36069506 DOI: 10.1002/hed.27180] [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: 04/13/2022] [Revised: 08/10/2022] [Accepted: 08/18/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Although the transoral endoscopic thyroidectomy vestibular approach (TOETVA) has been proven to be a safe procedure for select patients, as it is a novel approach, all associated complications require adequate attention. METHODS We presented a 49-year old woman who underwent TOETVA developed delayed tracheal rupture 1 week after surgery. An extensive search of literature was carried out using PubMed, Embase, and Web of Science for studies reporting tracheal injury following endoscopic thyroidectomy. RESULTS Thirteen cases of endoscopic thyroidectomy were analyzed, including eight cases of TOETVA. Tracheal injury occurred during various procedures, including accidental dissection, surgical needle puncture, Hegar dilation and trocar placement, and thermal injury by the energy device. CONCLUSIONS Tracheal injury following TOETVA is an underreported complication that can be induced by various factors. Thermal injury to the trachea is more likely to cause a delayed rupture. Careful blunt dissection and standardized use of energy devices are suggested.
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Affiliation(s)
- Yu-Jing Weng
- Department of Surgery, The University of Hong Kong Shenzhen Hospital, Shenzhen, Guangdong, China
| | - Ben-Ling Hu
- Department of Surgery, The University of Hong Kong Shenzhen Hospital, Shenzhen, Guangdong, China
| | - Jiang Jiang
- Department of Surgery, The University of Hong Kong Shenzhen Hospital, Shenzhen, Guangdong, China
| | - Lei Min
- Department of Surgery, The University of Hong Kong Shenzhen Hospital, Shenzhen, Guangdong, China
| | - Qing Ai
- Department of Surgery, The University of Hong Kong Shenzhen Hospital, Shenzhen, Guangdong, China
| | - De-Biao Chen
- Department of Surgery, The University of Hong Kong Shenzhen Hospital, Shenzhen, Guangdong, China
| | - Wei-Chun Chen
- Department of Surgery, The University of Hong Kong Shenzhen Hospital, Shenzhen, Guangdong, China
| | - Zhi-Heng Huang
- Department of Surgery, The University of Hong Kong Shenzhen Hospital, Shenzhen, Guangdong, China
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Saavedra-Perez D, Manyalich M, Dominguez P, Vilaça J, Jordan J, Lopez-Boado MA, Rull R, Vidal O. Thyroidectomy via unilateral axillo-breast approach (UABA) with gas insufflation: prospective multicentre European study. BJS Open 2022; 6:6633734. [PMID: 35799351 PMCID: PMC9263156 DOI: 10.1093/bjsopen/zrac087] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 05/05/2022] [Accepted: 05/20/2022] [Indexed: 11/23/2022] Open
Abstract
Background Extracervical approaches for thyroidectomy are seldom explored in the western population. The objective of this study was to evaluate the outcomes of hemithyroidectomy via endoscopic unilateral axillo-breast approach (UABA) with gas insufflation. Method Consecutive patients undergoing UABA hemithyroidectomy for symptomatic benign or cytologically indeterminate nodules (Bethesda III lesions) of less than 5 cm from July 2015 to December 2020 at three European institutions were included. Patients were excluded if presenting with a BMI more than 25 kg/m2, had previous neck surgery and/or radiation, had bilateral thyroid lesions, retrosternal goitre, Hashimoto thyroiditis or Graves’ disease. Follow-up was carried out at 2 weeks, 3 months and 1 year. Outcomes of interest were surgical (including operating time, mean duration of hospital stay and complications) and self-assessed cosmetic outcomes. Results Out of 984 patients treated with hemithyroidectomy during the study interval, 253 were selected, including 214 women and 39 men. Patients’ mean age was of 46.6 years with a mean BMI of 22.57. Mean operating time was 72.9 minutes. A transient recurrent laryngeal nerve injury was reported in 3.6 per cent of the patients, but none was persistent. Transient pectoral/cervical hypoesthesia was noted in 24.1 per cent of patients, with no permanent hypoesthesia. Skin burns and subcutaneous hematoma developed in 2.4 per cent and 2 per cent of patients but resolved within the third month after surgery. There was no tracheal/oesophageal perforation, conversion to open surgery or reoperation. The final pathology revealed 241 benign nodules, nine underlying papillary thyroid carcinomas, and three cases of follicular carcinoma. Hospital discharge was achieved on the first in 68.8 per cent of the patients and on the second postoperative day in 31.2 per cent of the cases. All patients were satisfied with the cosmetic aspect. Conclusion In selected patients, UABA with gas insufflation for hemithyroidectomy could be performed for the treatment of unilateral thyroid pathologies.
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Affiliation(s)
- David Saavedra-Perez
- Unit of Medical and Surgical Endocrinology, Endocrine Surgery, Department of General and Digestive Surgery, Hospital Clinic of Barcelona, University of Barcelona , Barcelona , Spain
| | - Marti Manyalich
- Unit of Medical and Surgical Endocrinology, Endocrine Surgery, Department of General and Digestive Surgery, Hospital Clinic of Barcelona, University of Barcelona , Barcelona , Spain
| | - Paula Dominguez
- Unit of Medical and Surgical Endocrinology, Endocrine Surgery, Department of General and Digestive Surgery, Hospital Clinic of Barcelona, University of Barcelona , Barcelona , Spain
| | - Jaime Vilaça
- Endocrine Surgery, Department of General and Digestive Surgery, Hospital da Luz Arrábida, Universidade do Minho , Porto , Portugal
| | - Julio Jordan
- Endocrine Surgery, Department of General and Digestive Surgery, University Hospital Nuestra Señora de la Candelaria, La Laguna University , Tenerife , Spain
| | - Miguel A Lopez-Boado
- Unit of Medical and Surgical Endocrinology, Endocrine Surgery, Department of General and Digestive Surgery, Hospital Clinic of Barcelona, University of Barcelona , Barcelona , Spain
| | - Ramon Rull
- Unit of Medical and Surgical Endocrinology, Endocrine Surgery, Department of General and Digestive Surgery, Hospital Clinic of Barcelona, University of Barcelona , Barcelona , Spain
| | - Oscar Vidal
- Unit of Medical and Surgical Endocrinology, Endocrine Surgery, Department of General and Digestive Surgery, Hospital Clinic of Barcelona, University of Barcelona , Barcelona , Spain
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Bertelli AA, Lira RB, Gonçalves AJ, Kowalski LP. Transoral endoscopic thyroidectomy vestibular approach (TOETVA) and complications. Rev Col Bras Cir 2021; 48:e20213084. [PMID: 34468504 PMCID: PMC10683466 DOI: 10.1590/0100-6991e-20213084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 06/07/2021] [Indexed: 11/21/2022] Open
Affiliation(s)
- Antonio Augusto Bertelli
- - Faculdade de Ciências Médicas da Santa Casa de São Paulo, Departamento de Cirurgia - São Paulo - SP - Brasil
| | - Renan Bezerra Lira
- - AC Camargo Cancer Center, Departamento de Cirurgia de Cabeça e Pescoço - São Paulo - SP - Brasil
- - Hospital Israelita Albert Einstein, Departamento de Cirurgia - São Paulo - SP - Brasil
| | - Antonio José Gonçalves
- - Faculdade de Ciências Médicas da Santa Casa de São Paulo, Departamento de Cirurgia - São Paulo - SP - Brasil
| | - Luiz Paulo Kowalski
- - AC Camargo Cancer Center, Departamento de Cirurgia de Cabeça e Pescoço - São Paulo - SP - Brasil
- - Faculdade de Medicina da Universidade de São Paulo, Departamento de Cirurgia - São Paulo - SP - Brasil
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