Endoscopic thyroidectomy: the transoral approach

Abstract

Transoral endoscopic thyroid surgery seems to be the logical consequence in the evolution of thyroid surgery. Animal and cadaver studies have shown that different endoscopic techniques can be performed in a safe and successful way. Presently, the minimally invasive aspect and cosmetic advantage seem to be the most important factor for the patients. However, even if these procedures are feasible in patients, the transoral access must still be considered as experimental. In this study then we aim at comparing the available literature on transoral thyroid surgery with our own experience in this field. The access itself needs to be further refined, and even more suitable and better adapted instruments need to be developed so that optimal and safe results that meet all requirements on endocrine surgery can be achieved and all requirements for endocrine surgery are met. The transoral thyroidectomy should only be performed in highly specialized centres for endocrine and endoscopic surgery. As an alternative, a combination with endoscopic non-transoral techniques-so called hybrid techniques-might be useful for our patients.

Monitored transoral endoscopic thyroidectomy via long monopolar stimulation probe

“…Indications for TOETVA are as follows: a predicted gland width on diagnostic imaging ≤10 cm; a thyroid volume outline of <45 mL or dominant nodule dimension of ≤50 mm; Bethesda category 3 or 4 lesions; primary papillary microcarcinoma without local or distant metastasis; patient request for optimal aesthetic results (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16). Exclusion criteria are as follows: patients unfit for Brief Report on Thyroid Surgery Monitored transoral endoscopic thyroidectomy via long monopolar stimulation probe general anesthesia; precedent radiation in the head, neck, or upper mediastinum; antecedent neck surgery; recurrent goiter; a gland volume of >45 mL or main nodule diameter of >50 mm; documentation of lymph node or distant metastases, tracheal/esophageal infiltration, preoperative laryngeal nerve palsy, hyperthyroidism, mediastinal goiter, or oral abscesses.…”

“…Exclusion criteria are as follows: patients unfit for Brief Report on Thyroid Surgery Monitored transoral endoscopic thyroidectomy via long monopolar stimulation probe general anesthesia; precedent radiation in the head, neck, or upper mediastinum; antecedent neck surgery; recurrent goiter; a gland volume of >45 mL or main nodule diameter of >50 mm; documentation of lymph node or distant metastases, tracheal/esophageal infiltration, preoperative laryngeal nerve palsy, hyperthyroidism, mediastinal goiter, or oral abscesses. Moreover, patients with poorly-or undifferentiated cancer, dorsal extrathyroidal radius, and/or lateral neck metastasis (N1b) are not favored for TOETVA (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16).…”

Transoral endoscopic thyroidectomy via vestibular approach: operative steps and video

“…Hydrodissection is first performed with a 30 mL solution of 1 mg adrenaline diluted with 500 mL normal saline injected sub-platysma into the oral vestibular area of the lower lip down to the anterior neck and central working space (1)(2)(3)(4)(5)(6)(7)(8)(9).…”

“…A blunt-tipped 10-mm trocar is inserted for a 10 mm 30° laparoscope (8). The CO 2 insufflation pressure is set at 6 mmHg.…”

“…Contralateral thyroidectomy is accomplished only if the RLN EMG signal of first side is preserved (1)(2)(3)(4)(5)(6)(7)(8)(9). If surgical drain is required, this is placed by adding a 5-mm incision into the axilla and tunnelled up to neck; correct placement of drain is guarantee by endoscopic view.…”