Adoption of the transoral endoscopic vestibular approach by head and neck surgeons without prior laparoscopic/robotic experience

Abstract

Background: Transoral endoscopic vestibular approach (TOEVA) for thyroidectomy (TOETVA) and parathyroidectomy (TOEPVA) is gaining popularity, yet knowledge is based on a limited number of studies, mostly performed by surgeons experienced in laparoscopicnrobotic surgery. Methods: All patients who underwent TOEVA at our institution between February 2018 and October 2019 were followed prospectively. Main outcomes were ability to accomplish surgery endoscopically (failure defined as conversion to open approach) and complications. Results: Seventy-one patients (52 TOETVA and 19 TOEPVA) were included. 98% (51/52) and 100% (19/19) of TOETVA and TOEPVA surgeries were accomplished endoscopically, respectively. Transient vocal cord and mental nerve injuries rates were 8.4% (6/71) and 2.8% (2/71), respectively. Thyroid carcinoma was diagnosed in 27 patients (51.9%), all completely excised with clean margins. Conclusions: Adoption of the TOEVA suggested framework by head and neck surgeons without prior experience in laparoscopic/robotic techniques is feasible resulting in nearly 100% of surgeries accomplished endoscopically. K E Y W O R D S endoscopic, parathyroidectomy, thyroidectomy, transoral, vestibular approach 1 | BACKGROUND The use of the transoral endoscopic thyroidectomy vestibular approach (TOETVA) is increasing, as both surgeons and patients are becoming more and more familiar with this technique and its advantages. Unlike other approaches for scarless thyroidectomies, TOETVA does not require a surgical robot, 1 and can be relatively quickly adopted in different centers worldwide.

Transoral thyroidectomy implemented by a novice surgeon: Efforts for safe implementation

“…In transoral thyroidectomy, Khafif et al described the outcomes of 71 patients with transoral endoscopic vestibular approach for thyroidectomy (TOETVA) and parathyroidectomy (TOEPVA) by surgeons with no previous laparoscopic or robotic experience. All but one case of conversion demonstrated successful surgical outcomes with no permanent RLN injury or hypoparathyroidism 14 …”

“…All but one case of conversion demonstrated successful surgical outcomes with no permanent RLN injury or hypoparathyroidism. 14 …”

“…We also aimed to evaluate the feasibility, safety, and RLN injury or hypoparathyroidism. 14 In this study, the transoral thyroidectomy was performed by a novice surgeon who had experienced 12 cases of transcervical thyroidectomy but had not independently performed endoscopic or robotic thyroidectomy. In addition, the surgeon initiated robotic transoral thyroidectomy immediately following only six cases of endoscopic transoral thyroidectomy.…”

Primary hyperparathyroidism: Disease of diverse genetic, symptomatic, and biochemical phenotypes

“…The feasibility and safety of this approach to the thyroid and parathyroids have been shown by Khafif et al and others. 19,20…”

Scarless Neck Feminization by Transoral Endoscopic Vestibular Approach Chondrolaryngoplasty: A Prospective Cohort

“…17 Since TOETVA utilizes conventional endoscopic equipment, it was quickly adopted by medical centers worldwide gaining further popularity and clinical evidence. 18 TOEVA has been practiced by our group since 2018, for patients undergoing either thyroid (TOETVA) or parathyroid (transoral endoscopic parathyroidectomy vestibular approach, TOEPVA) surgery, with over 200 surgeries performed, 19,20 with an extremely high safety profile. Shortly after gaining experience with TOEVA, we noticed that the thyroid cartilage can be easily accessed by TOEVA and assumed that patients in need of chondrolaryngoplasty would benefit from the scarless advantage of this approach.…”