Bilateral transaxillary endoscopic total thyroidectomy

Miyano, Go; Lobe, Thom E.; Wright, Simon K.

doi:10.1016/j.jpedsurg.2007.10.018

Cited by 107 publications

(90 citation statements)

References 29 publications

(42 reference statements)

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“…However, small scars remain on the anterior region of the neck via video-assisted thyroidectomy (16), on the chest wall and nipples for the breast approach, and on the axilla via bilateral transaxillary approach (25) as well as the BABA (7,26,27). Interestingly, the average pain scores from the first to third operative day were lower in TOETVA patients than in OT patients (2.72±0.94 vs. 1.08±1.01, P<0.05).…”

Section: Discussionmentioning

confidence: 99%

Transoral endoscopic thyroidectomy vestibular approach (TOETVA) for Graves’ disease: a comparison of surgical results with open thyroidectomy

et al. 2016

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Background: Transoral endoscopic thyroidectomy vestibular approach (TOETVA) provides excellent cosmetic results from its potential for scar-free operation. The procedure has been applied successfully for Graves' disease by the authors of this work and compared with the standard open cervical approach to evaluate its safety and outcomes.Methods: From January 2014 to November 2016, a total of 97 patients with Graves' disease were reviewed retrospectively. Open thyroidectomy (OT) and TOETVA were performed in 49 patients and 46 patients, respectively. For TOETVA, a three-port technique through the oral vestibule was utilized. The thyroidectomy was done endoscopically using conventional laparoscopic instruments and an ultrasonic device. Patient demographics and surgical variables, including operative time, blood loss, and complications, were investigated and compared.Results: TOETVA was performed successfully in all 45 patients, although conversion to open surgery was deemed necessary in one patient. All patient characteristics for both groups were similar. Operative time was shorter for the OT group compared to the TOETVA group, which totaled 101.97±24.618 and 134.11±31.48 minutes, respectively (P<<0.5). Blood loss was comparable for both groups. The visual analog scale (VAS) pain score for the TOETVA group was significantly lower than for the OT group on day 1 (2.08±1.53 vs. 4.57±1.35), day 2 (0.84±1.12 vs. 2.57±1.08) and day 3 (0.33±0.71 vs. 1.08±1.01) (P<<0.05).Transient recurrent laryngeal nerve (RLN) palsy was found in four and two cases of TOETVA and OT group, respectively. Transient hypocalcemia was found in ten and seven cases of TOETVA and OT group, respectively. No other complications were observed.Conclusions: TOETVA is a feasible and safe treatment for Graves' disease in comparison to the standard open cervical approach. It is considered a viable alternative for patients who have been indicated for surgery with excellent cosmetic results.

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Section: Discussionmentioning

confidence: 99%

Transoral endoscopic thyroidectomy vestibular approach (TOETVA) for Graves’ disease: a comparison of surgical results with open thyroidectomy

et al. 2016

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“…A further review by Miccoli et al [10] found that MIVAT is indicated for papillary cancers and has the same oncologic outcome as conventional surgery, but should not be used for locally invasive disease or medullary or anaplastic carcinomas. Additionally, total thyroidectomy for Grave's disease may be less easily dealt with by minimally invasive approaches, and in particular, by extra-cervical approaches due to the need for bilateral access, though it has been attempted [11]. Minimally invasive and extra-cervical thyroid surgery fuelled by emerging technology such as robotics has led to the evolution of a myriad of acronyms for various surgical approaches.…”

Section: Discussionmentioning

confidence: 99%

Scars and satisfaction: do smaller scars improve patient-reported outcome?

Toll

Loizou

Davis

et al. 2011

Eur Arch Otorhinolaryngol

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Thyroidectomy has few complications, as a result, many patients are concerned about the prominence of their scar. Performing thyroid surgery through excessively small incisions in order to maximise cosmesis may increase the likelihood of complications. This study investigates the relationship between conventional approach thyroidectomy scar length and patient satisfaction. A validation of self-measurement of neck circumference and thyroidectomy scar was carried out with the measurements taken by patients compared with those taken by an investigator. One hundred consecutive patients who had undergone conventional thyroidectomy and total thyroidectomy within 24 months were invited to measure their scars and neck circumference, and to score their satisfaction on a Likert scale of 1-10. Spearman's correlation was calculated for the relationship between absolute and relative scar length, and patient satisfaction. Thirty-four patients entered the preliminary study and 80 patients entered the main study (80% response rate). Measurements by patients and investigators were closely associated: Spearman's Rank correlation coefficient for neck circumference and for scar length were ρ = 0.9, p < 0.0001 and ρ = 0.93, p < 0.0001 respectively. No significant correlation was evident between scar length and patient satisfaction (ρ = 0.068, p = 0.55), or between relative scar length ratio and patient satisfaction (ρ = -0.045, p = 0.69). Mean scar length was 6.96 cm [standard deviation (SD) 2.70], and mean satisfaction score 8.62 (SD 2.04). Thyroidectomy scar length appears to have no association with patient satisfaction. Thyroid surgery should, therefore, not be performed through unnecessarily small incisions for purely aesthetic reasons.

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“…Although endoscopic thyroidectomy has benefits for patients, it is more difficult than open surgery for surgeons. The limitations of endoscopic techniques include limited visualization of the surgical field due to the use of two-dimensional (2-D) representation and limited manipulation due to use of nonflexible endoscopic instruments [6][7][8][9][10]. The da Vinci surgical robot system (Intuitive Surgical, Sunnyvale, CA, USA) was developed to overcome these limitations.…”

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confidence: 99%

Perioperative clinical outcomes after robotic thyroidectomy for thyroid carcinoma: a multicenter study

et al. 2010

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Objectives Robotic thyroidectomy and lymph node dissection is rapidly emerging as an alternative to conventional endoscopic thyroidectomy for thyroid carcinoma. Robot techniques incorporate the advantages of endoscopic procedures while overcoming some of the problems. We present the largest multi-institution clinical study of robotic thyroidectomy for thyroid carcinomas. The robotic thyroidectomy involved gasless transaxillary approach using the da Vinci surgical robot system. Methods We reviewed a database of 1,043 consecutive patients with low-risk differentiated thyroid carcinoma who underwent robotic thyroidectomy between October 2007 and August 2009. Operations were performed by five surgeons at four academic centers. We analyzed perioperative, clinical, and pathological data. Results The study involved 71 men and 972 women, with a mean age of 39 (range, 15-70) years. All operations were performed successfully without any need for conventional open or endoscopic conversion. There were 366 total thyroidectomies and 677 subtotal thyroidectomies with cervical lymph node dissection. The mean overall operation time and console time were 132.4 and 63.9 min, respectively. There were ten (1%) major postoperative morbidities. The mean tumor size was 0.8 (range, 0.1-6.0) cm, and the mean number of retrieved central lymph nodes was 5.1 ± 3.8 (range, 0-26). The mean postoperative hospital stay was 2.9 (range, 1-8) days. Conclusions Robotic thyroidectomy using gasless transaxillary method was feasible, safe, and provided good outcomes for patients with differentiated thyroid carcinoma. Robotic technology overcame some technical limitations associated with conventional endoscopy.

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Bilateral transaxillary endoscopic total thyroidectomy

Cited by 107 publications

References 29 publications

Transoral endoscopic thyroidectomy vestibular approach (TOETVA) for Graves’ disease: a comparison of surgical results with open thyroidectomy

Transoral endoscopic thyroidectomy vestibular approach (TOETVA) for Graves’ disease: a comparison of surgical results with open thyroidectomy

Scars and satisfaction: do smaller scars improve patient-reported outcome?

Perioperative clinical outcomes after robotic thyroidectomy for thyroid carcinoma: a multicenter study

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