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Nakai MY, Tenório LR, Oliveira JDSC, Ghirardello LB, Cavalcanti IR, Russell JO, Wolfe SA, Banuchi VE, Menezes MB, Gonçalves AJ. Transoral endoscopic vestibular approach Sistrunk procedure (TEVAS)-case report and scoping review. Gland Surg 2024; 13:236-247. [PMID: 38455358 PMCID: PMC10915416 DOI: 10.21037/gs-23-357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 01/11/2024] [Indexed: 03/09/2024]
Abstract
Background Thyroglossal duct cyst (TGDC) is the most common congenital neck mass among the pediatric population. Less than 10% of the cases occur in adults. The standard of care for TGDC is surgical treatment with the Sistrunk procedure via a traditional transverse cervicotomy. This technique involves the resection of the cyst with its tract and the central portion of the hyoid bone body to avoid recurrence. The transoral vestibular approach has gained popularity as an alternative approach to open neck surgery in order to eliminate the transcervical scar associated with these procedures. Methods We describe a case of an endoscopic Sistrunk procedure performed by the transoral vestibular approach. A scoping review of the transoral endoscopic vestibular approach Sistrunk procedure (TEVAS) was performed. The PubMed, Medline, Cochrane, Lilacs, Scielo, Mary Ann Libert and Scopus databases were systematically searched by using a Medical Subject Heading (MeSH)-optimized search strategy. The selection of papers followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines after setting inclusion and exclusion criteria. Results The case was successful and without complications. Five studies were included in the final analysis for this review. Conclusions This novel approach to the Sistrunk procedure is an effective alternative way to treat TGDC in selected patients who are motivated to avoid a visible neck scar.
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Affiliation(s)
- Marianne Yumi Nakai
- Head and Neck Surgery Division, Surgery Department, Santa Casa de São Paulo School of Medical Science, São Paulo, SP, Brazil
| | - Lucas Ribeiro Tenório
- Head and Neck Surgery Division, Surgery Department, Santa Casa de São Paulo School of Medical Science, São Paulo, SP, Brazil
| | | | | | | | - Jonathon O. Russell
- Division of Head and Neck Endocrine Surgery, Department of Otorhinolaryngology, Johns Hopkins Medicine, Baltimore, MD, USA
| | - Samantha A. Wolfe
- Division of Head and Neck Endocrine Surgery, Department of Otorhinolaryngology, Johns Hopkins Medicine, Baltimore, MD, USA
| | - Victoria E. Banuchi
- Division of Head and Neck Surgery, Department of Otorhinolaryngology, Weill Cornell Medical College, New York, NY, USA
| | - Marcelo Benedito Menezes
- Head and Neck Surgery Division, Surgery Department, Santa Casa de São Paulo School of Medical Science, São Paulo, SP, Brazil
| | - Antônio José Gonçalves
- Head and Neck Surgery Division, Surgery Department, Santa Casa de São Paulo School of Medical Science, São Paulo, SP, Brazil
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Karimov Z, Kim SM, Turk Y, Dionigi G, Moscoso ES, Ozdemir M, Frattini F, Ozgul S, Makay O. Complication and conversion outcomes in transoral endoscopic thyroidectomy vestibular approach (TOETVA): a retrospective multicenter propensity score-matched cohort study. Updates Surg 2024; 76:227-238. [PMID: 38095833 DOI: 10.1007/s13304-023-01721-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 11/29/2023] [Indexed: 01/24/2024]
Abstract
Transoral endoscopic thyroidectomy with vestibular approach (TOETVA) is a scarless thyroid surgery used as an alternative to open conventional surgery. Our aim was to investigate possible risk factors for complications and conversion during TOETVA. The study was conducted internationally by centres from Turkiye, the Republic of Korea, Italy, and Peru. A total of 406 patients who underwent TOETVA and were ≥ 18 years of age were included in the study. Demographic, pre-, intra-, and postoperative data were collected and compared between the groups with/without complication/conversion to identify possible predictors of complication/conversion. Subsequently, patients with complication/conversion were matched by the hospital, age, sex, and American Society of Anesthesiologists classification score using a propensity score (PSM) of 1:3 to eliminate confounding differences. Results were reported for the un-matched and matched groups. Complications occurred in 11 (2.7%) patients. High body mass index (26.4 ± 3.4 vs. 23.3 ± 3.7, p = 0.007), larger tumor size (1.7 ± 1.3 cm. vs. 1.1 ± 1.0 cm, p = 0.012), larger thyroid volume (20.0 ± 9.2 vs. 12.8 ± 8.5, p = 0.007) and long operation time (127.8 ± 45.0 min. vs. 97.7 ± 38.5 min., p = 0.008) were significantly associated with complications in un-matched analyses. Older age (42.7 ± 8.0 vs. 34.9 ± 9.2, p = 0.023), high BMI (26.7 ± 3.2 vs. 23.3 ± 3.7, p = 0.012), and longer operation time (160.1 ± 54.1 min. vs. 97.4 ± 37.8, p = 0.001) were significantly related to conversion in un-matched analyses. However, significance was lost after PSM for both complication and conversion. The data from this study conducted on TOETVA cases do not suggest a risk factor for complications and conversion with PSM.
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Affiliation(s)
- Ziya Karimov
- Medicine Program, Ege University Faculty of Medicine, Izmir, Turkey
| | - Seok-Mo Kim
- Department of Surgery, Thyroid Cancer Center, Gangnam Severance Hospital, Institute of Refractory Thyroid Cancer, Yonsei University College of Medicine, Seoul, South Korea
| | - Yigit Turk
- Division of Endocrine Surgery, Department of General Surgery, Ege University Hospital, Bornova, 35100, Izmir, Turkey
| | - Gianlorenzo Dionigi
- Division of Surgery, Istituto Auxologico Italiano IRCCS (Istituto di Ricovero e Cura a Carattere Scientifco), Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | | | - Murat Ozdemir
- Division of Endocrine Surgery, Department of General Surgery, Ege University Hospital, Bornova, 35100, Izmir, Turkey
| | - Francesco Frattini
- Division of Surgery, Istituto Auxologico Italiano IRCCS (Istituto di Ricovero e Cura a Carattere Scientifco), Milan, Italy
| | - Semiha Ozgul
- Department of Biostatistics and Medical Informatics, Ege University Faculty of Medicine, Izmir, Turkey
| | - Ozer Makay
- Division of Endocrine Surgery, Department of General Surgery, Ege University Hospital, Bornova, 35100, Izmir, Turkey.
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Huo J, Ou D, Guo Y, Chen C, Qu R, Zhao L. Safety and Efficacy of Transoral Endoscopic Thyroidectomy Vestibular Approach Versus Conventional Open Thyroidectomy: A Systematic Review and Meta-analysis. Surg Laparosc Endosc Percutan Tech 2023; 33:547-555. [PMID: 37523575 DOI: 10.1097/sle.0000000000001197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 06/02/2023] [Indexed: 08/02/2023]
Abstract
OBJECTIVE To evaluate the safety and efficacy of the transoral endoscopic thyroidectomy vestibular approach (TOETVA) versus conventional open thyroidectomy (COT) for some thyroid diseases. MATERIALS AND METHODS Databases PubMed, Embase, and Web of Science were searched. Full-text English papers that described TOETVA and COT for people with thyroid diseases were included. Randomized, nonrandomized, controlled, and uncontrolled trials were all included. Extracted data included population characteristics and intraoperative and postoperative complications. RESULTS A total of 2 randomized controlled trials and 10 retrospective studies, including 3048 patients, were included in the meta-analysis. Meta-analysis results suggested that the intraoperative conditions and postoperative complication rates did not differ significantly between the two groups. However, in the TOETVA group, there is a slightly longer operative time [weighted mean difference (WMD): 73.64; 95% CI: 49.34 to 97.94; P < 0.0001], drainage (WMD: 91.0; 95% CI: 35.52 to 146.48; P = 0.001), and hospital stay (WMD: 0.28; 95% CI: 0.18 to 0.38; P < 0.0001). CONCLUSION For most of the benign thyroid nodules and selected patients with papillary thyroid cancer, TOETVA seems to be as feasible and safe as COT.
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Affiliation(s)
- Jinlong Huo
- Departments of Breast and Thyroid Surgery
- Department of General Surgery, Digestive Disease Hospital, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
| | - Dong Ou
- Oncology, The Third Affiliated Hospital of Zunyi Medical University (The First People's Hospital of Zunyi)
| | | | - Chen Chen
- Departments of Breast and Thyroid Surgery
| | - Rui Qu
- Departments of Breast and Thyroid Surgery
| | - Lijin Zhao
- Department of General Surgery, Digestive Disease Hospital, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
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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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Zhou S, Wang D, Liu X, Li Z, Wang Y. Transoral thyroidectomy vestibular approach vs. conventional open thyroidectomy: a systematic review and meta-analysis. Endocrine 2023:10.1007/s12020-023-03321-x. [PMID: 36826685 DOI: 10.1007/s12020-023-03321-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 02/02/2023] [Indexed: 02/25/2023]
Abstract
The purpose of this study was to compare the intraoperative outcomes and postoperative complications of patients experiencing transoral thyroidectomy vestibular approach (TOTVA) and conventional open thyroidectomy (COT). PUBMED, EMBASE, the Cochrane Central Register of Controlled Trials in the Cochrane Library, and Web of science expanded between January 2007 and November 2022 comparing TOTVA and COT was exhaustively searched. Fifteen non-randomized controlled studies involving 2955 patients were included. The results of meta-analyses indicated that TOTVA was associated with longer operative time (WMD, 66.86; 95%CI, 47.15-86.56; P < 0.00001), more blood loss (WMD, 2.83; 95%CI, 1.77-3.90; P < 0.00001), higher incidence of wound infection (OR, 5.62; 95%CI, 1.57-20.10, P = 0.008). There was no significant difference in terms of transient recurrent laryngeal nerve (RLN) palsy and other postoperative outcomes. In conclusion, TOTVA appears to be a feasible and safe approach for the treatment of patients with benign thyroid nodules and selected differential thyroid carcinomas just like the COT.
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Affiliation(s)
- Shengliang Zhou
- Department of Thyroid & Parathyroid Surgery Center, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China
- West China School of Medicine, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Dun Wang
- Department of Thyroid & Parathyroid Surgery Center, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China
- West China School of Medicine, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Xueting Liu
- Department of Evidence-Based Medicine and Clinical Epidemiology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Zhihui Li
- Department of Thyroid & Parathyroid Surgery Center, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China
- Laboratory of Thyroid and Parathyroid Disease, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Yichao Wang
- Department of Thyroid & Parathyroid Surgery Center, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China.
- Laboratory of Thyroid and Parathyroid Disease, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China.
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Alnehlaoui F, Guraya SY. Transoral and submental thyroidectomy using intraoperative nerve stimulation and indocyanin green fluorescence imaging. BMJ Case Rep 2021; 14:e243306. [PMID: 34426423 PMCID: PMC8383884 DOI: 10.1136/bcr-2021-243306] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2021] [Indexed: 11/04/2022] Open
Abstract
There is a recent proliferation of clinical studies about the minimally invasive scarless thyroid surgery. The transoral endoscopic thyroidectomy vestibular approach (TOETVA) carries a great potential for being scarless surgery via a short dissection flap. However, TOETVA has limitations in extracting larger thyroid tumours via the transoral vestibular incision and due to its potential damage to the branches of the mental nerve. The rapidly evolving surgical innovations have now introduced transoral and submental thyroidectomy (TOaST) approach that allows extraction of large thyroid tumours with less flap dissection and minimal postoperative pain. We present a 39-year-old man with a large multinodular goitre. The patient was euthyroid with moderate to severe compression symptoms of difficulty in breathing and swallowing. We performed a TOaST procedure using intraoperative neuromonitoring and indocyanin green fluorescence imaging with an uneventful recovery. This is a first case report from the middle east region that will pave the way to large clinical trials to determine the efficacy and safety of TOaST.
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Affiliation(s)
| | - Salman Yousuf Guraya
- Clinical Sciences Department, College of Medicine, University of Sharjah, Sharjah, UAE
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