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Xu X, Pan C, Gao X, Zhang L, Lin S. Perioperative outcomes of bilateral axillo-breast approach robotic thyroidectomy (BABART) versus minimally invasive thyroidectomy (MIT): a systematic review and meta-analysis. J Robot Surg 2024; 18:136. [PMID: 38520624 DOI: 10.1007/s11701-024-01891-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 02/28/2024] [Indexed: 03/25/2024]
Abstract
Minimally invasive thyroidectomy (MIT) is increasingly being used for the thyroid tumors. The comparison of bilateral axillo-breast approach robotic thyroidectomy (BABART) with other MIT has not yet led to a unified conclusion with regard to surgical outcomes. To conduct a systematic review and meta-analysis of the literature on the surgical outcomes of BABART compared with MIT. We performed a systematic search in PubMed, Web of Science, Embase and Cochrane Library database for randomized control trials (RCTs) and non-RCTs that compare BABART to MIT. The primary outcomes included perioperative, postoperative complications. The odds ratio (OR) and mean difference (MD) were applied for the comparison of dichotomous and continuous variables with 95% confidence intervals (CIs). Nine studies, comprising 3645 patients, were included in the meta-analysis. Our findings indicated that there were no significant differences in hospital stay, number of retrieved lymph nodes, recurrent laryngeal nerve (RLN) injury, and vocal cord dysfunction between BABRT and MIT. However, BABART was associated with a shorter operation time (MD = - 21.45 min, 95% CI [- 47.27, 4.38], p = 0.1) and lower rate of permanent hypoparathyroidism (OR = 0.42, 95% CI [0.20, 0.88], p = 0.02). Additionally, the MIT group had reduced postoperative pain score (MD = 0.45, 95% CI [0.02, 0.88], p = 0.04) and lower rate of hypocalcemia (OR = 2.31, 95% CI [1.04, 5.13], p = 0.04) than the BABART group. In comparison with MIT, BABART exhibits better results in terms of operative time and the rate of permanent hypoparathyroidism, with no significant difference in hospital stay, number of retrieved lymph nodes, RLN injury, and vocal cord dysfunction. However, the postoperative pain score and the rate of hypocalcemia of MIT are slightly better that of BABART.
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Affiliation(s)
- Xia Xu
- Department of Thyroid and Breast Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - ChaoYing Pan
- Department of Thyroid and Breast Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Xiang Gao
- Department of Thyroid and Breast Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - LinXing Zhang
- Department of Thyroid and Breast Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Shuai Lin
- Department of Thyroid and Breast Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, China.
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Katoh H, Ikeda Y, Saito Y, Yokota M, Kikuchi M, Sengoku N, Fujisaki K, Sangai T. The Usefulness of AirSeal™ Intelligent Flow System in Gas Insufflation Total Endoscopic Thyroidectomy. Indian J Otolaryngol Head Neck Surg 2023; 75:115-120. [PMID: 37007898 PMCID: PMC10050613 DOI: 10.1007/s12070-022-03257-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 10/23/2022] [Indexed: 11/07/2022] Open
Abstract
Total endoscopic thyroidectomy (TET) using low CO2 insufflation provides cosmetic advantage, excellent working space and visibility. On the contrary, suctioning blood or mist/smoke produced by energy device application causes narrowing of working space especially in neck surgery. In this regard, AirSeal intelligent flow system would be particularly suitable in TET. However, the benefit of AirSeal is unknown in TET unlike abdominal surgery. Therefore, the impact of AirSeal was evaluated in TET in this study. Twenty patients who underwent total endoscopic hemithyroidectomy were retrospectively analyzed. Insufflation was conducted by either conventional or AirSeal system according to the surgeon's preference. Short-term surgical outcomes including operation time, bleeding, frequency of scope cleaning, and disappearance of subcutaneous emphysema were compared as well as actual visibility. AirSeal application dramatically reduced obstacle smoke/mist and prevented narrowing working space by suctioning. Frequency of scope cleaning was significantly less in AirSeal group than that in conventional group (p = 0.016). In patients with nodule < 5 cm, intraoperative hemorrhage was less in AirSeal group than that in the counterpart (p = 0.077) regardless of larger nodule size in AirSeal group (p = 0.058). Notably, subcutaneous emphysema around surgical cavity disappeared significantly earlier in AirSeal group than in the counter parts (p = 0.019). On the contrary, AirSeal application did not shorten operation time in the current study. AirSeal provided excellent visibility and seamless operation. AirSeal has great potential to decrease not only surgeon's stress but surgical invasion on patients. The results in this study give rational to AirSeal application to TET. Supplementary Information The online version contains supplementary material available at 10.1007/s12070-022-03257-0.
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Affiliation(s)
- Hiroshi Katoh
- Department of Breast and Endocrine Surgery, Kitasato University Hospital, 1-15-1 Kitasato, Minami-Ku, Sagamihara, Kanagawa 252-0374 Japan
| | - Yoshifumi Ikeda
- Department of Surgery, International University of Health and Welfare, Atami Hospital, Atami, Japan
| | - Yoshiyuki Saito
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Mitsuo Yokota
- Department of Breast and Endocrine Surgery, Kitasato University Hospital, 1-15-1 Kitasato, Minami-Ku, Sagamihara, Kanagawa 252-0374 Japan
| | - Mariko Kikuchi
- Department of Breast and Endocrine Surgery, Kitasato University Hospital, 1-15-1 Kitasato, Minami-Ku, Sagamihara, Kanagawa 252-0374 Japan
| | - Norihiko Sengoku
- Department of Breast and Endocrine Surgery, Kitasato University Hospital, 1-15-1 Kitasato, Minami-Ku, Sagamihara, Kanagawa 252-0374 Japan
| | - Kaoru Fujisaki
- Department of Breast and Endocrine Surgery, Kitasato University Hospital, 1-15-1 Kitasato, Minami-Ku, Sagamihara, Kanagawa 252-0374 Japan
| | - Takafumi Sangai
- Department of Breast and Endocrine Surgery, Kitasato University Hospital, 1-15-1 Kitasato, Minami-Ku, Sagamihara, Kanagawa 252-0374 Japan
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Saavedra-Pérez D, Manyalich M, Domínguez P, Farguell J, Rull R, López-Boado MÁ, Vilaça J, Vidal Ó. Unilateral axilo-breast approach (UABA) with gas insufflation versus open conventional hemithyroidectomy: A prospective comparative study. Cir Esp 2023; 101:107-115. [PMID: 36100055 DOI: 10.1016/j.cireng.2022.09.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 02/17/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND The objective of this study was to compare with the conventional open approach, the surgical and aesthetic results of endoscopic thyroidectomy via unilateral axillo-breast approach (UABA) with gas insufflation in patients with a unilateral thyroid nodule. METHODS Between August 2017 and August 2020, a prospective comparative cohort study was carried out in patients proposed for hemithyroidectomy. The patients were assigned to one type of approach (Open or Endoscopic) in a successive manner. Surgical results and aesthetic satisfaction at hospital discharge and during the 12-month follow-up were evaluated and compared between both groups. RESULTS A total of 200 patients were included in the study: 100 for the Open approach and 100 for the Endoscopic. The baseline patient characteristics were similar between both groups. Total operative time was longer in the Endoscopic approach, due to the time required for subcutaneous dissection (the hemithyroidectomy time was similar in both groups). There was no significant difference in the frequency of major complications. The length of hospital stay was longer (for 1 day) in the Endoscopic group. The aesthetic satisfaction of the patients was significantly higher in the Endoscopic than in the Open group (p < 0.001), at hospital discharge and at 12-month follow-up. CONCLUSION UABA with gas insufflation for hemithyroidectomy represents a safe and effective therapeutic option for the treatment of unilateral benign thyroid pathologies.
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Affiliation(s)
- David Saavedra-Pérez
- Unidad de Endocrinología Médico-Quirúrgica, Cirugía Endocrina, Servicio de Cirugía General y del Aparato Digestivo, Instituto Clínic de Enfermedades Digestivas y Metabólicas (ICMDiM), Hospital Clínic de Barcelona, Universidad de Barcelona, IDIBAPS, Barcelona, Spain.
| | - Marti Manyalich
- Unidad de Endocrinología Médico-Quirúrgica, Cirugía Endocrina, Servicio de Cirugía General y del Aparato Digestivo, Instituto Clínic de Enfermedades Digestivas y Metabólicas (ICMDiM), Hospital Clínic de Barcelona, Universidad de Barcelona, IDIBAPS, Barcelona, Spain
| | - Paula Domínguez
- Unidad de Endocrinología Médico-Quirúrgica, Cirugía Endocrina, Servicio de Cirugía General y del Aparato Digestivo, Instituto Clínic de Enfermedades Digestivas y Metabólicas (ICMDiM), Hospital Clínic de Barcelona, Universidad de Barcelona, IDIBAPS, Barcelona, Spain
| | - Jordi Farguell
- Unidad de Endocrinología Médico-Quirúrgica, Cirugía Endocrina, Servicio de Cirugía General y del Aparato Digestivo, Instituto Clínic de Enfermedades Digestivas y Metabólicas (ICMDiM), Hospital Clínic de Barcelona, Universidad de Barcelona, IDIBAPS, Barcelona, Spain
| | - Ramón Rull
- Unidad de Endocrinología Médico-Quirúrgica, Cirugía Endocrina, Servicio de Cirugía General y del Aparato Digestivo, Instituto Clínic de Enfermedades Digestivas y Metabólicas (ICMDiM), Hospital Clínic de Barcelona, Universidad de Barcelona, IDIBAPS, Barcelona, Spain
| | - Miguel Ángel López-Boado
- Unidad de Endocrinología Médico-Quirúrgica, Cirugía Endocrina, Servicio de Cirugía General y del Aparato Digestivo, Instituto Clínic de Enfermedades Digestivas y Metabólicas (ICMDiM), Hospital Clínic de Barcelona, Universidad de Barcelona, IDIBAPS, Barcelona, Spain
| | - Jaime Vilaça
- Departamento de Cirugía General y del Aparato Digestivo, Hospital da Luz Arrábida, Escola de Medicina, Universidade do Minho, Braga, Porto, Portugal
| | - Óscar Vidal
- Unidad de Endocrinología Médico-Quirúrgica, Cirugía Endocrina, Servicio de Cirugía General y del Aparato Digestivo, Instituto Clínic de Enfermedades Digestivas y Metabólicas (ICMDiM), Hospital Clínic de Barcelona, Universidad de Barcelona, IDIBAPS, Barcelona, Spain
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Lage Fernández FJ, Paulos Novoa M, Parente Arias P. Minimally Invasive Video-Assisted Thyroidectomy (MIVAT): How to do it (with video). Eur Ann Otorhinolaryngol Head Neck Dis 2021; 138 Suppl 2:41-42. [PMID: 34334340 DOI: 10.1016/j.anorl.2021.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 06/14/2021] [Accepted: 07/03/2021] [Indexed: 11/28/2022]
Affiliation(s)
- F J Lage Fernández
- Servicio de ORL, Hospital HM Rosaleda, Rúa de Santiago León de Caracas, 1, 15701 Santiago de Compostela, Spain.
| | - M Paulos Novoa
- Servicio de ORL, Hospital HM Rosaleda, Rúa de Santiago León de Caracas, 1, 15701 Santiago de Compostela, Spain.
| | - P Parente Arias
- Servicio de ORL, Hospital HM Rosaleda, Rúa de Santiago León de Caracas, 1, 15701 Santiago de Compostela, Spain.
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Alesina PF, Wahabie W, Meier B, Hinrichs J, Mohmand W, Kapakoglou A, Kniazeva P, Walz MK. Long-term cosmetic results of video-assisted thyroidectomy: a comparison with conventional surgery. Langenbecks Arch Surg 2021; 406:1625-1633. [PMID: 33987765 DOI: 10.1007/s00423-021-02196-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Accepted: 05/10/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE We present the long-term cosmetic results of the video-assisted thyroidectomy (MIVAT) in comparison to the conventional operation. METHODS Forty-eight patients (four males, 44 females; mean age 47.4 ± 12.5 years) constituted the video-assisted group (VA-Group). These were compared with 48 patients (10 males, 38 females; mean age 47.4 ± 12.5 years) operated by conventional surgery (C-Group). The patients were selected from all thyroid operations performed between January 2016 and June 2017. Patient Scar Assessment Scale (PSAS) and Observer Scar Assessment Scale (OSAS) were used for the evaluation performed by an independent surgeon. Both scales contained six items scored numerically on a ten-step scale ranging from 1 (normal skin) to 10 (worst result). Moreover, photos of all scars were taken and analyzed by six team surgeons using modified OSAS. RESULTS The mean follow-up time was 31.7 ± 6.4 months for the MIVAT group and 32.9 ± 4.6 months for the conventional group (p = 0.39). The mean scar length in the VA-Group was 2.6 cm vs. 3.8 cm in the C-Group (p < 0.0001). The total score of PSAS was 9.93 (6-35) for MIVAT and 9.72 (6-29) for conventional thyroidectomy (p = 0.22). The total OSAS score by the independent surgeon showed a better cosmetic outcome for conventional surgery (13.19 vs. 12.33; p = 0.01). The total OSAS score by the six team surgeons did not differ between both groups in five of six ratings; one surgeon favored MIVAT (12.2 vs. 13.6; p = 0.04). CONCLUSIONS This study does not find cosmetic advantages of minimally invasive video-assisted thyroidectomy compared to conventional thyroidectomy.
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Affiliation(s)
- P F Alesina
- Klinik für Chirurgie und Zentrum für Minimal Invasive Chirurgie, Evang. Kliniken Essen-Mitte, Henricistrasse 92, 45136, Essen, Germany.
| | - W Wahabie
- Evangelisches Krankenhaus Oldenburg, Steinweg 13-17, 26122, Oldenburg, Germany
| | - B Meier
- Klinik für Chirurgie und Zentrum für Minimal Invasive Chirurgie, Evang. Kliniken Essen-Mitte, Henricistrasse 92, 45136, Essen, Germany
| | - J Hinrichs
- Klinik für Chirurgie und Zentrum für Minimal Invasive Chirurgie, Evang. Kliniken Essen-Mitte, Henricistrasse 92, 45136, Essen, Germany
| | - W Mohmand
- Klinik für Chirurgie und Zentrum für Minimal Invasive Chirurgie, Evang. Kliniken Essen-Mitte, Henricistrasse 92, 45136, Essen, Germany
| | - A Kapakoglou
- Klinik für Chirurgie und Zentrum für Minimal Invasive Chirurgie, Evang. Kliniken Essen-Mitte, Henricistrasse 92, 45136, Essen, Germany
| | - P Kniazeva
- Klinik für Chirurgie und Zentrum für Minimal Invasive Chirurgie, Evang. Kliniken Essen-Mitte, Henricistrasse 92, 45136, Essen, Germany
| | - M K Walz
- Klinik für Chirurgie und Zentrum für Minimal Invasive Chirurgie, Evang. Kliniken Essen-Mitte, Henricistrasse 92, 45136, Essen, Germany
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Kim SY, Kim HJ, Chang H, Kim SM, Lee YS, Chang HS, Park CS. Modified version of minimally invasive open thyroidectomy using an unilateral incision. Asian J Surg 2021; 44:1166-1171. [PMID: 33814255 DOI: 10.1016/j.asjsur.2021.02.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 01/10/2021] [Accepted: 02/07/2021] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND/OBJECTIVE Open thyroidectomy has been the standard approach for patients undergoing thyroidectomy. However, this approach leads to prominent scars, hypesthesia, paresthesia, and uncomfortable sensations. We aimed to describe our modified technique of minimally invasive open thyroidectomy (MIT) and to compare the results with those of conventional thyroidectomy. METHODS This study included 880 patients who underwent surgery between January 2016 and December 2016. Modified MIT was performed in 249 patients (28.3%), and conventional thyroidectomy was performed in the remaining 631 patients. RESULTS Lobectomy was performed in the majority of cases (MIT 204 [81.9%] vs. conventional 429 [67.9%]). There were no significant differences in complications between the two approaches (6 [2.4%] vs. 8 [1.3%]). Patients who underwent surgery using the minimally invasive approach had a shorter operative time (77.99 ± 34.5 vs. 91.23 ± 36.58 min) and were discharged earlier (2.4 ± 0.8 vs. 3.2 ± 0.8) than those who underwent conventional thyroidectomy. CONCLUSION Modified MIT is a safe alternative to standard open thyroidectomy and allows the performance of bilateral total thyroidectomy with proper central compartment neck dissection. LEVEL OF EVIDENCE 2b.
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Affiliation(s)
- Soo Young Kim
- Department of Surgery, Ajou University of Medicine, Suwon, Republic of Korea
| | - Hee Jun Kim
- Department of Surgery, CHA Ilsan Medical Center, Goyang-si, Republic of Korea
| | - Hojin Chang
- Department of Surgery, Thyroid Cancer Center, Gangnam Severance Hospital, Institute of Refractory Thyroid Cancer, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seok-Mo Kim
- Department of Surgery, Thyroid Cancer Center, Gangnam Severance Hospital, Institute of Refractory Thyroid Cancer, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yong Sang Lee
- Department of Surgery, Thyroid Cancer Center, Gangnam Severance Hospital, Institute of Refractory Thyroid Cancer, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hang-Seok Chang
- Department of Surgery, Thyroid Cancer Center, Gangnam Severance Hospital, Institute of Refractory Thyroid Cancer, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Cheong Soo Park
- Department of Surgery, CHA Ilsan Medical Center, Goyang-si, Republic of Korea.
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Choi JB, Lee BC, Park YM, Jung HJ, Kim DI. Application of minimal invasive technique for thyroidectomy without remote access in locally advanced thyroid carcinoma with gross extra-thyroidal extension. Int J Surg Case Rep 2020; 75:143-146. [PMID: 32949912 PMCID: PMC7502781 DOI: 10.1016/j.ijscr.2020.09.047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 09/05/2020] [Accepted: 09/05/2020] [Indexed: 11/25/2022] Open
Abstract
Minimally invasive thyroidectomy (MIT) is useful and famous technique that is being applied to thyroid carcinoma. MIT without remote access is useful and applicable in thyroid disease and carcinoma in terms of cost effect and cosmetic outcome. MIT without remote access can be feasible method for thyroid carcinoma with gross extra-thyroidal extension, especially, upper pole carcinoma.
Introduction Minimally invasive thyroidectomy (MIT) is technically less damaging tissue and is better cosmetic results with small neck scar, decreasing postoperative pain and neck discomfort. We present the experience of MIT without remote access with case of grossly extra-thyroidal extension positive papillary thyroid carcinoma. Presentation of case A 44-year-old, female presented 1.6 cm irregular hypoechoic nodule at upper pole in Right thyroid gland and diagnosed to papillary thyroid carcinoma. The tumor was suspicious to have extra-thyroidal extension. We performed MIT without remote access for this patient with 2 cm cervical incision. Postoperative course was uneventful and patient was discharged on the 3th postoperative day. At present, she is taking 100mcg levothyroxine and is free of disease 3 years post-surgery. Conclusion If experienced surgeons can get sufficient resection margin and control bleeding of superior thyroid artery, MIT without remote access can be feasible method for thyroid carcinoma with gross extra-thyroidal extension, especially, upper pole carcinoma.
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Affiliation(s)
- Jung Bum Choi
- Department of Surgery, Pusan National University Hospital, Republic of Korea
| | - Byoung Chul Lee
- Department of Surgery, Pusan National University Hospital, Republic of Korea
| | - Young Mok Park
- Department of Surgery, Pusan National University Hospital, Republic of Korea
| | - Hyuk Jae Jung
- Department of Surgery, Pusan National University Hospital, Republic of Korea
| | - Dong-Il Kim
- Department of Surgery, Pusan National University Yangsan Hospital, 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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Abstract
Transoral endoscopic thyroidectomy vestibular approach (TOETVA) is a feasible novel surgical procedure that does not need visible incisions. We describe our initial experience with TOETVA. We recruited 15 patients who were willing to undergo TOETVA. Inclusion criteria were (a) patients who had a neck ultrasound (US) with a estimated thyroid diameter not larger than 10 cm; (b) US estimated gland volume ≤45 mL; (c) nodule size ≤50 mm; (d) a benign tumor, such as a thyroid cyst, single-nodular goiter, or multinodular goiter; (e) follicular neoplasm; (f) papillary microcarcinoma without evidence of metastasis. The procedure is carried out through a three-port technique placed at the oral vestibule, one 10-mm port for 30° endoscope and two additional 5-mm ports for dissecting and coagulating instruments. CO2 insufflation pressure is set at 6 mmHg. An anterior cervical subplatysmal space is created from the oral vestibule down to the sternal notch, laterally to the sternocleidomastoid muscle. Thyroidectomy is done fully endoscopically using conventional endoscopic instruments and intraoperative neuromonitoring. There were 34% total thyroidectomies and 66% hemithyroidectomies. All TOETVA procedures were performed successfully with no conversions. The mean operative time was 87.6 (59-118) min for lobectomy and 107.6 (99-135) min for bilateral procedure. We observed one case of transient postoperative hypocalcemia. There was no recurrent laryngeal nerve palsy. The cosmetic result was excellent in all patients. This is the first case series of TOETVA in Italy. TOETVA may provide a method for ideal cosmetic results. The results are encouraging, and we are optimistic about the future expansion of its applicability.
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Affiliation(s)
- Gianlorenzo Dionigi
- 1st Division of Surgery, Department of Medicine and Surgery, Endocrine Surgery Research Center, University of Insubria, Varese, Italy.
| | - Alessandro Bacuzzi
- Division of Anesthesia, Ospedale di Circolo, Fondazione Macchi, Varese, Italy
| | - Matteo Lavazza
- 1st Division of Surgery, Department of Medicine and Surgery, Endocrine Surgery Research Center, University of Insubria, Varese, Italy
| | - Davide Inversini
- 1st Division of Surgery, Department of Medicine and Surgery, Endocrine Surgery Research Center, University of Insubria, Varese, Italy
| | - Luigi Boni
- Department of General and Emergency Surgery at the IRCCS - Ca Granda, Policlinico Hospital in Milan, University of Milan, Milano, Italy
| | - Stefano Rausei
- 1st Division of Surgery, Department of Medicine and Surgery, Endocrine Surgery Research Center, University of Insubria, Varese, Italy
| | - Hoon Yub Kim
- Department of Surgery, Korea University College of Medicine, Seoul, Republic of Korea
| | - Angkoon Anuwong
- Minimally Invasive and Endocrine Surgery Division, Department of Surgery Police General Hospital, Bangkok, Thailand
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Dionigi G, Bacuzzi A, Lavazza M, Inversini D, Boni L, Rausei S, Kim HY, Anuwong A. Transoral endoscopic thyroidectomy: preliminary experience in Italy. Updates Surg 2017; 69:225-234. [PMID: 28405949 DOI: 10.1007/s13304-017-0436-x] [Citation(s) in RCA: 79] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Accepted: 04/01/2017] [Indexed: 12/17/2022]
Abstract
Transoral endoscopic thyroidectomy vestibular approach (TOETVA) is a feasible novel surgical procedure that does not need visible incisions. We describe our initial experience with TOETVA. We recruited 15 patients who were willing to undergo TOETVA. Inclusion criteria were (a) patients who had a neck ultrasound (US) with a estimated thyroid diameter not larger than 10 cm; (b) US estimated gland volume ≤45 mL; (c) nodule size ≤50 mm; (d) a benign tumor, such as a thyroid cyst, single-nodular goiter, or multinodular goiter; (e) follicular neoplasm; (f) papillary microcarcinoma without evidence of metastasis. The procedure is carried out through a three-port technique placed at the oral vestibule, one 10-mm port for 30° endoscope and two additional 5-mm ports for dissecting and coagulating instruments. CO2 insufflation pressure is set at 6 mmHg. An anterior cervical subplatysmal space is created from the oral vestibule down to the sternal notch, laterally to the sternocleidomastoid muscle. Thyroidectomy is done fully endoscopically using conventional endoscopic instruments and intraoperative neuromonitoring. There were 34% total thyroidectomies and 66% hemithyroidectomies. All TOETVA procedures were performed successfully with no conversions. The mean operative time was 87.6 (59-118) min for lobectomy and 107.6 (99-135) min for bilateral procedure. We observed one case of transient postoperative hypocalcemia. There was no recurrent laryngeal nerve palsy. The cosmetic result was excellent in all patients. This is the first case series of TOETVA in Italy. TOETVA may provide a method for ideal cosmetic results. The results are encouraging, and we are optimistic about the future expansion of its applicability.
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Affiliation(s)
- Gianlorenzo Dionigi
- 1st Division of Surgery, Department of Medicine and Surgery, Endocrine Surgery Research Center, University of Insubria, Varese, Italy.
| | - Alessandro Bacuzzi
- Division of Anesthesia, Ospedale di Circolo, Fondazione Macchi, Varese, Italy
| | - Matteo Lavazza
- 1st Division of Surgery, Department of Medicine and Surgery, Endocrine Surgery Research Center, University of Insubria, Varese, Italy
| | - Davide Inversini
- 1st Division of Surgery, Department of Medicine and Surgery, Endocrine Surgery Research Center, University of Insubria, Varese, Italy
| | - Luigi Boni
- Department of General and Emergency Surgery at the IRCCS - Ca Granda, Policlinico Hospital in Milan, University of Milan, Milano, Italy
| | - Stefano Rausei
- 1st Division of Surgery, Department of Medicine and Surgery, Endocrine Surgery Research Center, University of Insubria, Varese, Italy
| | - Hoon Yub Kim
- Department of Surgery, Korea University College of Medicine, Seoul, Republic of Korea
| | - Angkoon Anuwong
- Minimally Invasive and Endocrine Surgery Division, Department of Surgery Police General Hospital, Bangkok, Thailand
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Lombardi CP, Raffaelli M, De Crea C, D'Amore A, Bellantone R. Video-assisted thyroidectomy: lessons learned after more than one decade. Acta Otorhinolaryngol Ital 2009; 29:317-320. [PMID: 20463836 PMCID: PMC2868209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/02/2009] [Accepted: 11/20/2009] [Indexed: 05/29/2023]
Abstract
In selected patients, video-assisted thyroidectomy can be considered a safe and validated procedure offering significant advantages over conventional surgery, with no additional morbidity. Aim of this study was to evaluate the results obtained in a series of patients selected for video-assisted thyroidectomy over a 10-years period. All patients who underwent video-assisted thyroidectomy from June 1998 to June 2009 were considered. The eligibility criteria for video-assisted thyroidectomy are: thyroid nodules < or = 35 mm; estimated thyroid volume < 30 ml; no previous conventional neck surgery and/or radiation therapy; small, low-risk papillary thyroid carcinoma. A total of 1363 video-assisted thyroidectomies were attempted in the time period considered. Conversion to the conventional procedure was necessary in 7 cases. Thyroid lobectomy was successfully performed in 157 cases, total thyroidectomy in 1175, and completion thyroidectomy in 24. In 126 patients, the central neck nodes were removed through the same access. Simultaneous video-assisted parathyroidectomy, for a parathyroid adenoma, was performed in 42 patients. Pathological studies showed benign disease in 986 cases, papillary thyroid carcinoma in 368 cases, C-cells hyperplasia in 1 case, and medullary microcarcinoma in 1 patients with RET germline mutation. Post-operative complications included 27 transient and 1 definitive recurrent laryngeal nerve palsy, 230 transient hypocalcemia, 10 definitive hypoparathyroidism, 4 postoperative hematoma and 5 wound infection.
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Affiliation(s)
- C P Lombardi
- Endocrine Surgery Unit, Department of Surgical Sciences, Pol. A. Gemelli, Rome, Italy
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