Foley Balloon Facilitates Creation of Working Space in Transoral Thyroidectomy

Abstract

Background Transoral thyroidectomy via the vestibular approach retains no scars in the body surface and is a good option for patients indicated for thyroidectomy but with cosmetic concerns. However, the working space of this procedure is relatively small and is also difficult to create compared with that of other remote‐access thyroidectomy procedures. Methods In this study, we first created a tract from the chin to the sternal notch, after which a Foley catheter with stylet was inserted through the middle oral incision. Sequential balloon insufflations were performed to dilate the entire subplatysmal tunnel. Results After Foley catheter dilatation, the subplatysmal space was larger, and subsequent trocar insertion became much easier. With the help of a balloon compressing the surrounding tissue, hemostasis was secured and a clearer tissue plane could be identified for subsequent sharp dissection. Conclusions Foley balloon dilatation is a simple, effective, and low‐cost technique that overcomes the difficulty in creation of working space during the initial stage and can be applied to all transoral thyroidectomy procedures.

Balloon Dilators for Fast and Safe Flap Dissection in Transoral Endoscopic Vestibular Approach Thyroidectomy Vestibular Approach (TOETVA)

“…Although TOETVA has many advantages compared to other thyroidectomy approaches, there are some initial difficulties faced by inexperienced surgeons including unfamiliarity with the cranio-caudal view and the use of laparoscopic instruments (21). Working space formation in TOETVA is an especially difficult procedure with a steep learning curve for inexperienced surgeons (10). Due to the limited field-of-view and small space, bleeding is difficult to control once it occurs.…”

“…Balloon dilators are especially popular for laparoscopic totally extra-peritoneal inguinal hernia repair because they enable easy dissection of the correct plane, resulting in better exposure and bloodless surgery with reduced operation time, conversion rates, and complications (7,24). Liang et al (10) reported the use of the Foley catheter balloon to create a working space in TOETVA, and concluded that Foley balloon dilatation helps overcome the difficulties of initial working space formation. Bertelli et al (9) later reported the use of the same Spacemaker balloon dilator for working space formation in TOETVA as we used in the present study.…”

“…Our center has recently been using a balloon dilator device (Spacemaker Plus Dissector System; Medtronic, Jacksonville, FL, USA) to create the working space during TOETVA, with satisfying results. The use of balloon dilators in TOETVA has been reported by two previous study, but these studies did not assess the outcomes or advantages of the use of balloon dilators for flap dissection (9,10).…”

Indocyanine Green Angiography for Parathyroid Gland Evaluation during Transoral Endoscopic Thyroidectomy

“…Transoral endoscopic thyroidectomy was performed as described by Anuwong et al with a modification in the step of working space creation [ 13 ]. We applied the Foley balloon to dilate the subplatysmal space so as to minimize the use of blunt dissection and its associated injury [ 14 ]. The details of the perioperative management have been delineated in our previous publication [ 15 ].…”

Working Space Creation in Transoral Thyroidectomy: Pearls and Pitfalls

“…Balloon dilatation with a balloon in the Foley catheter [ 50 ], cuff in the endotracheal tube [ 51 ], and commercialized balloon dilator device [ 47 , 52 ] are also alternative options used by some surgeons. With the balloon inflation pressure, it is easier to create a homogenous space with a clear tissue plane and achieve good hemostasis [ 50 ].…”