Robotic and endoscopic transoral thyroidectomy: feasibility and description of the technique in the cadaveric model

Transoral Endoscopic Thyroidectomy Vestibular Approach: A Single-institution Experience of the First 50 Cases

Background. Transoral endoscopic thyroidectomy vestibular approach (TOETVA) has evolved from a novel procedure to a cosmetically appealing alternative to the traditional open thyroidectomy. TOETVA is limited to only high-volume centers with the hope to expand and demonstrate the safety, reproducibility, and application for the correct patient with thyroid disease. We present our experience with the first 50 TOETVA procedures performed at our institution. Methods. From September 2016 to June 2018, we performed 50 transoral endoscopic thyroidectomies via the vestibular approach for a variety of thyroid pathologies. Outcomes were analyzed from a prospectively maintained database. Patients were treated for a different range of thyroid pathologies. Results. A total of 12 (24%) patients underwent total thyroidectomy, whereas 38 (76%) patients underwent a subtotal thyroidectomy or thyroid lobectomy. The mean surgical time was 149 ± 40.0 (90-256) minutes for lobectomy and 217.6 ± 33.3 (175-276) minutes for total thyroidectomy. Of our 50 patients, 16 (32%) had postoperative transient lower lip numbness with an average time to recovery of 23.8 (.43-48) weeks, with 1 (2%) patient having persistent, but improving, lower lip numbness beyond the 6-month follow-up. There were 13 (26%) patients with transient chin numbness with an average time to recovery of 15.7 (2-48) weeks. Two (4%) patients had transient recurrent laryngeal nerve (RLN) injury with hoarseness, whereas 1 (2%) patient had permanent injury. Conclusion. The TOETVA is a safe and reproducible procedure. For selected patients, this technique is a viable alternative to conventional thyroidectomy.

Transoral Endoscopic Thyroidectomy Vestibular Approach

BACKGROUND

Remote-access thyroid surgery has gained popularity and has advanced significantly over the past two decades, given the patient desire to avoid cosmetically displeasing scarring. It has only been recently that natural-orifice transluminal endoscopic surgery (NOTES) techniques have been geared for thyroidectomies. The transoral endoscopic thyroidectomy vestibular approach has been categorized as a NOTES procedure-given the approach to the thyroid gland via incisions in the oral cavity. Our aim is to provide a review of the current literature on the transoral endoscopic thyroidectomy vestibular approach (TOETVA), to present the worldwide experience of this novel procedure, and to outline whether individual patients have characteristics that would make the procedure feasible for this technique.

METHODS

A literature review was done to compile articles detailing the international experience with TOETVA. Our experience combined with what has been published in the literature was used to establish which pathological and patient characteristics make this particular technique feasible for a thyroidectomy.

RESULTS

We detail in the provided tables both feasibility for this surgical technique and the international experience.

CONCLUSION

TOETVA represents the latest remote-access endoscopic technique for the excision of the thyroid gland. TOETVA is being performed at various international institutions and multiple hospitals in the United States.

Extracervical Approaches to Thyroid Surgery: Evolution and Review

Over the last two decades, advances and adaptation of technology have led to a variety of endoscopic thyroidectomy procedures being performed. The drive for extracervical procedures has been predominantly influenced by the desire for improved cosmesis via avoidance of visible scars. Extracervical techniques have shown considerable evolution with approaches that have included transaxillary, breast, postauricular, and transoral routes. There has been a varied evidence base for each of these approaches with regard to technical feasibility, safety, patient satisfaction, and cost-effectiveness. In recent years, robotic-assisted thyroid surgery has gained increased popularity worldwide with the introduction of the da Vinci Robot. Reports of improved postoperative outcomes and patient satisfaction have been in contrast to the financial burden, longer operative time, and increased training required which, to date, have limited widespread application. The aim of this review is to describe the evolution of extracervical procedures including surgical approaches, outcomes, advantages, and disadvantages. Consideration is also given to the future direction of extracervical thyroid surgery with regard to the safety, feasibility, and application of robotic systems.

Standardization of simple auxiliary method beneficial to total endoscopic thyroidectomy on patients with PTC, based on retrospective study of 356 cases

OBJECTIVE

Total endoscopic thyroidectomy (TET) is paid increasing attention to by patients, especially those with thyroid carcinoma. The aim of this study is to evaluate the clinic feasibility of standardization of simple auxiliary method (SOSAM) involved in operating bed adjustment, location of skin traction points and thyroid retractor points for the TET via bilateral breast approach.

METHODS

A retrospective study was performed on 356 patients with thyroid carcinoma, who had undergone the TET. Patients were divided into Group A (with the SOSAM) and Group B (without the SOSAM). This study compares the surgical outcome parameters between the two groups, including the total operative time, hemorrhage volume during operation, postoperative hospitalization days, numbers of dissecting and metastatic lymph nodes, and postoperative complication.

RESULT

The total operative time, hemorrhage volume and postoperative hospitalization days in Group A were significantly lower than those in Group B (P < 0.05). Nevertheless no statistically significant differences were found in both groups in terms of other observation indexes (P > 0.05), including numbers of dissecting and metastatic lymph nodes, and postoperative complication. Meanwhile, there were no patients with incision and surgical site infection, air embolism, and flap injury occurred in both groups.

CONCLUSION

The clinical application of the SOSAM can effectively decrease the total operative time and hemorrhage during operation. Moreover, it can be used in a wider range of popularization to improve the operative effect for total endoscopic thyroidectomy.