Can Voice Pitch Be Preserved in Patients after Transoral Endoscopic Thyroidectomy Vestibular Approach?

Abstract

Introduction: Transoral endoscopic thyroidectomy vestibular approach (TOETVA) has become increasingly popular. Several reports have emphasized the safety and efficacy of this new approach. However, there is no report on functional voice outcomes, including voice pitch change after TOETVA. Methods: The functional voice outcomes of patients undergoing TOETVA were compared with those of patients undergoing conventional thyroidectomy. A total of 82 consecutive patients were included in the study: 44 underwent thyroid lobectomy via TOETVA (transoral group) and 38 underwent thyroid lobectomy via the classic cervical approach (open group). Thyroidectomy-related voice questionnaire (TVQ), perceptual voice analysis, fiberoptic laryngoscopic and videolaryngostroboscopic examinations, and acoustic analysis were carried out before and one month after surgery. The changes in these values after surgery and the differences between the transoral and open groups were analyzed. Results: We found no significant postoperative change in voice workups in either group. The mean high pitch decreased (from 367.91 ± 120.98 to 325.80 ± 100.86 Hz, p = 0.069) in the transoral group, but statistical significance was not attained. Clinically significant changes in pitch (postoperative change in speaking fundamental frequency, ΔSFF ≥ 12) after surgery were evident in seven (15.91%) patients in the transoral group and eight (21.05%) patients in the open group without significant difference (p = 0.579). Conclusions: This is the first study to assess functional voice outcomes (including pitch) after TOETVA compared with conventional open surgery. TOETVA was associated with good voice outcomes without any significant drop in pitch.

Robotic versus endoscopic transoral thyroidectomy in papillary thyroid cancer: A comparative analysis of surgical outcomes in 240 consecutive patients

“…14,30,31 Regarding postoperative voice function, previous studies reported that the transoral vestibular approach preserved the highest frequency and pitch range better than the conventional transcervical approach. [32][33][34] The feasibility of transoral thyroidectomy using the da Vinci Si surgical system (Intuitive Surgical, Sunnyvale, CA) in humans was also reported by Kim et al 9 They utilized the three oral vestibular ports and an additional axillary port to insert the third robotic instrument. Recently, TOETVA is widely performed worldwide owing to its advantages, including short surgical time, convenience and familiarity with the surgeon's endoscopic surgery, and absence of costly robotic systems.…”

“…Moreover, it has a midline approach that facilitates the performance of bilateral total thyroidectomy more conveniently and with complete central LN dissection, including at levels VI and VII 14,30,31 . Regarding postoperative voice function, previous studies reported that the transoral vestibular approach preserved the highest frequency and pitch range better than the conventional transcervical approach 32–34 …”

Transoral endoscopic thyroidectomy vestibular approach (TOETVA): first twelve case series in Erbil, Iraq

“…A total of 82 patients were included in a study published by Mi Ra Kim et al, in which 44 cases underwent TOETVA and 38 classic open methods. No significant drop in pitch was noted in TOETVA cases [ 37 ].…”

“…The most challenging and difficult part of the surgery for an inexperienced surgeon is the dissection of the superior pole because it is poorly visible, as, during the procedure, we see the thyroid gland craniocaudal [ 37 ]. Apart from this, in our initial experience, we noticed that insertion of the first lateral port was somewhat difficult.…”

Letter to the Editor: Functional Voice and Swallowing Outcome Analysis After Thyroid Lobectomy: Transoral Endoscopic Vestibular Versus Open Approach

“…When TOETVA was introduced in 2016, many surgeons were concerned that injury to the external branch of the superior laryngeal nerve (EBSLN) may occur more frequently following TOETVA compared to OT because the cranio-caudal surgical view in this approach means that the sternothyroid muscle obscures visualization of the EBSLN. Recent studies have reported that using various strategies for a safe approach to the superior thyroid gland pole structures can preserve EBSLN during TOETVA [2][3][4]. However, there are still concerns that voice outcomes following TOETVA may be inferior to those of OT.…”