No abstract

No abstract

The achieved results show feasibility of introducing the described modification of transoral thyroidectomy into clinical practice.

Voice alterations after thyroidectomy with mobile vocal folds are common. Ultrasonography has been used to assess the mobility of the vocal folds after thyroidectomy. Fifty-four patients underwent thyroidectomy. Indirect laryngoscopy, ultrasonography, and GRBAS (grade, roughness, breathiness, asthenia, strain) scoring were performed preoperatively, 3 days, 2 and 6 months, postoperatively. On the third postoperative day, the mobility of the vocal folds was preserved in 52 patients and pareses were recorded in 2 patients. All patients after thyroidectomy noted the presence of voice alteration in the absence of the postoperative paresis of the vocal folds. On the third postoperative day, the voice was impaired by all criteria of the GRBAS scale, but mainly due to roughness (85%). Sixth month postoperatively, 62% of the subjects considered the voice to be altered. Asthenia was observed in 39%. On the third postoperative day indirect laryngoscopy revealed the unchanged vocal folds, the edema and the shortening of one of the vocal folds in 56%, 42%, and 1.9%. Six months postoperatively, the vocal folds returned to their original form. Indirect laryngoscopy and ultrasonography had 100% concordance in assessing the mobility of the vocal folds. Patients with edema of the vocal folds had a significantly higher mean GRBAS grade than patients without edema. The mean GRBAS score decreased from 3.36 to 0.90, 3 days and 6 months, postoperatively. Voice alteration after thyroidectomy is always present. Postoperative edema represents a likely main cause of voice alteration and resolves within 6 months. Ultrasonography is recommended as alternative to indirect laryngoscopy in assessing of the vocal folds after thyroidectomy.

Objective. To present the results of the author’s own series of transoral operations in patients with pathology of the thyroid and parathyroid glands. Methods. Transoral surgery was performed in women (n=20) and (n=1) man. All patients were operated on for the primary disease and met the selection criteria based on ultrasound and cytological examinations, hormonal levels, and somatic status. Indications for surgery were: nodular goiter in 17 cases, diffuse toxic goiter - in 2 cases, parathyroid adenoma - in 2 cases. The surgical technique included a three-port approach in the lower fornix of the vestibule of the mouth and a gas technique for maintaining the working cavity. Standard laparoscopic instruments and an energy based ultrasonic device were used for the operation. In the postoperative period, patients underwent a test for subjective assessment of the aesthetic result of the operation using the survey of thedermatology life quality index. Results. Thyroidectomy was performed in 4 patients, hemithyroidectomy - in 15 patients and parathyroidectomy - in 2 patients. In one patient, transoralparathyroidectomy was performed as a part of a simultaneous operation for multiple endocrine neoplasia type 1 syndrome. Papillary cancer T1N0M0 was verified in two patients after surgery. The mean operation time was 196.1 min (range 110 - 300 min). Average blood loss - 3 9.5 ml (range 10 - 300 ml). The nineth operation required the conversion due to severebleeding. In one case, the temporary recurrent laryngeal nerve(RLN)injury was reported, in one case - hematoma. After surgery, the median and average values of thedermatology life quality index were 1 (IQR 0-4) and 2.05, respectively, which indicates an insignificant effect on the quality of life. Conclusion. Transoral endoscopic surgery on the thyroid and parathyroid glands would be thepromising optimal choice in patients to avoid scarring on the neck.