How I Do It: New Dissector Device Allows for Effective Operative Field in Transoral Endoscopic Thyroid Surgery Using Vestibular Approach

Müller, Verena; Mogl, Martina T.; Seika, Philippa; Jöns, Thomas; Sauer, Igor M.; Pratschke, Johann; Anuwong, Angkoon; Zorrón, Ricardo

doi:10.1177/1553350618785281

Cited by 7 publications

(6 citation statements)

References 21 publications

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“…Third, transoral endoscopic thyroidectomy (TOET) has received attention in recent years, but no reports have compared OT with TOET in total thyroid cancer. Most patients who undergo TOET have benign lesions,44 and many reports are on initial experiences45,46 or robot-assisted surgery 47,48. In addition, cosmetic results and quality of life are difficult to assess because of the few well-accepted tools available to study such outcomes 40…”

Section: Discussionmentioning

confidence: 99%

Total endoscopic thyroidectomy versus conventional open thyroidectomy in thyroid cancer: a systematic review and meta-analysis

Chen¹,

Huang²,

Jia³

et al. 2018

TCRM

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BackgroundDespite the considerable experience gained thus far using endoscopic technologies, the role of total endoscopic thyroidectomy (ET) for papillary thyroid cancer (PTC) remains controversial. We conducted a systematic review and meta-analysis to investigate the safety and effectiveness of total ET compared with conventional open thyroidectomy (OT) in PTC.MethodsA systematic search was conducted using the PubMed, Embase and Cochrane Library electronic databases up to March 2018. The quality of included studies was evaluated using the Newcastle–Ottawa Scale. Review Manager software version 5.3 was used for the meta-analysis.ResultsTwelve studies including 2,672 patients were ultimately included in the systematic review and meta-analysis. ET was associated with longer operative time (P<0.00001), drainage time (P<0.00001) and hospital stay (P=0.03), higher transient recurrent laryngeal nerve (RLN) palsy rate (P=0.004) and a greater amount of drainage fluid (P<0.0001) compared with OT. Furthermore, no significant differences were detected between ET and OT in terms of retrieved lymph nodes (P=0.17), blood loss (P=0.22), transient hypocalcemia (P=0.84), permanent hypocalcemia (P=0.58), permanent RLN palsy (P=0.14), hematoma or bleeding (P=0.15) and seroma (P=0.54). In addition, the rates of tumor recurrence were comparable (P=0.18), whereas the proportions of stimulated thyroglobulin levels <1 ng/mL measured after completion of thyroidectomy and radioactive iodine therapy were less (P=0.02) in the ET than in the OT group.ConclusionET is not superior to OT in terms of operation and drainage time, amount of drainage fluid, hospital stay or transient RLN palsy, but is comparable to OT in terms of retrieved lymph nodes and permanent complications. Despite the similar tumor recurrence rates between the two approaches, the level of surgical completeness in ET may not be as good as that for OT.

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Section: Discussionmentioning

confidence: 99%

Total endoscopic thyroidectomy versus conventional open thyroidectomy in thyroid cancer: a systematic review and meta-analysis

Chen¹,

Huang²,

Jia³

et al. 2018

TCRM

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“…Incisions were made sublingually in order to obscure obvious scarring. Now, POET or trans-oral-vestibule endoscopic thyroidectomy has been increasingly recognised and accepted as various international centres have published their results [33][34][35][36][37][38][39][40][41][42][43][44]. A. Angkoon has the largest existing series to date with 465 cases reported.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of Per-oral Endoscopic Thyroidectomy (POET) – A New Trend for Scarfree Thyroidectomy

2018

JAPM

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Objectives: This paper discusses the surgical outcomes of POET compared to open thyroidectomy (OT) and other approaches of video thyroidectomy (VT) such as chest or axillary approach to investigate the feasibility of POET as a safe alternative. Background: Per-Oral Endoscopic Thyroidectomy (POET) is a developing novel technique based on the principles of minimally invasive surgery offering “scar-free” thyroidectomy. To date, results from various individual centers have been published internationally but none from UK, Malaysia or Singapore. Methods: This is a single tertiary hospital, single surgeon based retrospective analysis of 98 selected patients (mean age: 43.5 years old) undergoing POET in 12 months (July 2017 to July 2018). It records the complication rates post-operatively until day of discharge. Results: The average length of stay is 2 days and average time of operation is 69 minutes. There was no blood loss >100ml and no wound infection recorded among the 98 patients. Only 1 out of 98 patients (1%) had permanent recurrent laryngeal nerve (RLN) palsy. Clinical hypocalcemia described as cramp and lip paresthesia was experienced by 6 patients (6%). 5% had transient mental nerve injury described as mental paresthesia. Conclusion: POET is a promising safe alternative technique to thyroidectomy with comparable surgical outcome yet significantly better cosmetic outcome. This technique has a strong potential to be useful when lowering the rate of developing keloidal scar and hypertrophic scaring. POET can be an option to offer patients who are especially driven to achieve perfect cosmesis.

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“…Next, an olive‐tip dissector was inserted and pushed down gradually to further extend the subcutaneous tract to the level of the sternal notch (Figs. 1 and 2) [2]. One stroke of the blunt dissection is sufficient to create a tract that can accommodate the Foley catheter.…”

Section: Methodsmentioning

confidence: 99%

Foley Balloon Facilitates Creation of Working Space in Transoral Thyroidectomy

2020

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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.

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How I Do It: New Dissector Device Allows for Effective Operative Field in Transoral Endoscopic Thyroid Surgery Using Vestibular Approach

Abstract: The new device is a promising feature to allow safe transoral thyroid surgery in a cadaver model. Further studies in clinical series are needed to evaluate the broad application of the device.

Cited by 7 publications

References 21 publications

Total endoscopic thyroidectomy versus conventional open thyroidectomy in thyroid cancer: a systematic review and meta-analysis

Total endoscopic thyroidectomy versus conventional open thyroidectomy in thyroid cancer: a systematic review and meta-analysis

Outcomes of Per-oral Endoscopic Thyroidectomy (POET) – A New Trend for Scarfree Thyroidectomy

Foley Balloon Facilitates Creation of Working Space in Transoral Thyroidectomy

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