Bi‐institutional experience of transoral endoscopic thyroidectomy: Challenges and outcomes

Abstract

BackgroundTransoral endoscopic thyroidectomy vestibular approach (TOETVA) is a novel remote‐access endoscopic approach. In this study, we compared the surgical outcomes of TOETVA with those of conventional transcervical approach (TCA) in two tertiary hospitals.MethodsA total of 82 patients were done by TOETVA and 233 patients received TCA between January 2018 and April 2019. Propensity score matching was used to reduce selection bias.ResultsOperation time of the TOETVA group was longer than that of the TCA group. The mean number or retrieved lymph nodes were significantly higher in the TOETVA group. No significant difference was observed in the overall perioperative complications.ConclusionTOETVA is technically acceptable when compared to TCA in terms of equal baseline characteristics of patients. Although future large‐scale multicenter studies with longer follow‐up periods are needed, we expect this novel technique can be performed not only for cosmetic purposes but also for patients with papillary thyroid carcinoma.

Initial Experience With Robotic Modified Radical Neck Dissection Using the da Vinci Xi System Through the Bilateral Axillo-Breast Approach

“…The hospital stay for thyroid surgery is usually longer in South Korea than in western countries because the medical insurance system in South Korea generally covers the cost of longer admissions for cancer patients [18]. Our study found, however, that the mean hospital stay was shorter in the robotic group than in the open group (3.92±0.90 vs. 4.71±1.63 days, respectively; P=0.056).…”

“…The shorter hospital stay may be linked to the lower postoperative pain score and the significantly lower incidence of transient hypoparathyroidism in the robotic group. The use of BABA alone for remote access thyroidectomy, without neck dissection, has been regarded as not being "minimally invasive" as it requires a wider area of subcutaneous dissection than open surgery [18,19]. However, robotic MRND using BABA showed better performance, with excellent cosmetic and clinical outcomes, suggesting that robotic MRND is minimally invasive compared with open MRND.…”

Transient asystole related to carbon dioxide embolism during transoral endoscopic parathyroidectomy vestibular approach

“…They also recommend minimizing the blunt dissection and controlling the injured veins under endoscopic view. 8 In two cases who underwent ABBA endoscopic thyroidectomy, bradycardia recovered without intervention before asystole occurred, and in two cases with TOETVA, cardiac arrest developed and returned with intervention. Cardiac arrest developed in both of our cases.…”

“…The patient was followed by cardiopulmonary resuscitation and taken to the intensive care unit. 8 CO 2 embolism in laparoscopic or endoscopic surgery can be explained by two possible mechanisms. The first may occur by injection of CO 2 into the intravascular area via placing the Veress needle or trocar directly into the intravascular space.…”

Assessing National Utilization Trends and Outcomes of Robotic and Endoscopic Thyroidectomy in the United States

“…23 Endoscopic surgeries, compared to open thyroidectomies, may also offer patients less pain and improved cosmesis, without differences in complications. 24,25 While technique specific, many endoscopic approaches have broadly been associated with longer operation times, longer hospital length of stay, and increased cost, [24][25][26][27][28][29][30] although 1 recent large study found equal length of stay and operation times between open and the chest-breast approach. 31 Unique complications from endoscopic thyroidectomy, aside from the aforementioned axillary complications, include mental nerve injury, CO 2 embolism, and deep neck infections in the transoral approach.…”