Minimally invasive and remote‐access thyroid surgery in the era of the 2015 <scp>A</scp>merican <scp>T</scp>hyroid <scp>A</scp>ssociation guidelines

Russell, Jonathon O.; Noureldine, Salem I.; Khadem, Mai G. Al; Tufano, Ralph P.

doi:10.1002/lio2.36

Cited by 35 publications

(21 citation statements)

References 54 publications

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“…The main advantages of this technique are that the scars are completely invisible as they are situated intraorally, and midline access ensures that there is excellent access to bilateral thyroid lobes and central compartment lymph nodes . In addition, the use of wristed instruments, elimination of hand tremor, use of additional arms, and the superior visualization of the da Vinci camera gives TORT further precision during thyroid surgery …”

Section: Discussionmentioning

confidence: 99%

Obesity May Not Affect Outcomes of Transoral Robotic Thyroidectomy: Subset Analysis of 304 Patients

et al. 2019

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Objectives/Hypothesis: Obesity is an increasing health concern worldwide. It has been associated with perioperative complications that could affect patient outcomes. Our aim was to compare surgical outcomes in obese and nonobese patients after transoral robotic thyroid (TORT) surgery.Study Design: Retrospective cohort study.Methods: A total of 304 consecutive patients who underwent TORT between January 2012 to December 2017 were included in the study. Patients were divided into two groups according to their body mass index (BMI): BMI < 30 kg/m 2 and BMI ≥ 30 kg/m 2 . Patient demographics, operative extent, pathological data, surgical outcomes, and postoperative complications were included and analyzed. A χ 2 test was used to compare categorical variables, and a Student t test was used to compare changes of continuous variables between groups. Statistical significance was conferred by a two-tailed P value of ≤.05.Results: There were 290 patients in the non-obese group and 14 patients in the obese group. There was no statistically significant difference between the two groups in terms of patient demographics, operative procedure, or pathological characteristics. The only statistically significant difference was for lymph node dissection (P = .012); however, for both groups, unilateral central node dissection was the most common procedure. There was also no statistically significant difference found for operative time, length of stay, pain score, or postoperative complications including TORT-specific complications such as oral commissure tear and general complications such as recurrent nerve injury.Conclusions: This initial experience shows that TORT appears to be a safe and feasible option for obese patients pursuing scarless thyroid surgery.

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Section: Discussionmentioning

confidence: 99%

Obesity May Not Affect Outcomes of Transoral Robotic Thyroidectomy: Subset Analysis of 304 Patients

et al. 2019

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“…18 These innovations have taken various endoscopic and robotic forms, including axillary, facelift, breast, and transoral methods. 19 Of the various transoral approaches to the thyroid, the transoral vestibular approach is the most cited in the literature and has been shown to have good surgical outcomes with the least complications in Western populations. 20 First described by Richmon and colleagues, 21 the transoral vestibular approach offers several technical advantages over other remote-access neck surgeries.…”

Section: Discussionmentioning

confidence: 99%

Transoral neck surgery prevents attentional bias towards the neck compared to open neck surgery

et al. 2019

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Objective: Measure attentional distraction of neck scars after open neck surgery compared to transoral endoscopic thyroidectomy via a vestibular approach (TOETVA) or transoral endoscopic parathyroidectomy via a vestibular approach (TOEPVA) using eye-tracking technology.Methods: Casual observers viewed facial images of patients who underwent open neck surgery, TOETVA/TOEPVA, or no surgery (controls). An eye-tracking monitor recorded eye fixations in real time. Multivariate Hotelling's analysis followed by post-hypothesis testing compared fixation durations for predefined regions of interest, including the eyes, nose, mouth, neck, and remaining face between open neck surgery patients, transoral neck surgery patients, and controls.Results: One hundred forty observers completed the experiment. The majority of their attention was directed towards the central triangle (eyes, nose, mouth). On multivariate analysis, distribution of attention was significantly different on the faces of those who underwent open neck surgery versus TOETVA/TOEPVA (T 2 = 43.66; F[32,131] = 14.5389, P < .0001). Observers attended significantly more to the neck (0.20 seconds, P < .0001; 95% CI, 0.13, 0.26 s) and less to the peripheral face (−0.24 seconds, P = .0031; 95% CI, −0.39, −0.08 s) of open neck surgery patients. In patients who followed up months after surgery, significant differences persisted (T 2 = 13.97; F[3451] = 4.6377, P = .0033). By contrast, fixation patterns for TOETVA/TOEPVA patients were not significantly different from controls (T 2 = 5.59, F[31,186] = 1.8602, P = .1345). Observer race and gender did not significantly affect attention to neck scars.Conclusion: Scars following open neck surgery draw attention in casual observers. This attentional distraction is prevented in TOETVA/TOEPVA patients due to the absence of a scar, even months after surgery. Moreover, visual processing of TOETVA/TOEPVA patients' faces is similar to that of controls. These data support the effectiveness of transoral neck surgery in giving patients a cosmetic result that does not distract the attention of observers.

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“…These techniques include endoscopic or robotic breast, bilateral axillobreast, and axillary incisions, as well as the retroauricular approach . More recently, transoral thyroidectomy has become a favored approach as it provides midline access to the thyroid with minimal extracervical tissue dissection and no cutaneous scar …”

Section: Introductionmentioning

confidence: 99%

“…5 More recently, transoral thyroidectomy has become a favored approach as it provides midline access to the thyroid with minimal extracervical tissue dissection and no cutaneous scar. 2,[6][7][8][9][10][11][12] Despite this experience, the North American experience has been decidedly different. 5 Early excitement for remote access thyroidectomy was tempered when novel complications were reported via the transaxillary approach.…”

Section: Introductionmentioning

confidence: 99%

Anterior cervical incision‐sparing thyroidectomy: Comparing retroauricular and transoral approaches

Russell

Razavi

Khadem

et al. 2018

Laryngoscope Investig Oto

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ObjectivesThe robotic retroauricular approach and transoral endoscopic thyroidectomy vestibular approach (TOETVA) have been employed to avoid anterior neck scarring in thyroidectomy with good success. However, outcomes have yet to be compared between techniques. We compare our initial clinical experience with these approaches for thyroid lobectomy at our institution.MethodsA review of initial consecutive patients who underwent robotic facelift thyroidectomy (RFT) (August 2011–August 2016) at our institution was conducted. This was compared with the same number of initial consecutive patients who underwent TOETVA (September 2016–September 2017) at our institution. Demographics, operative time, pathology, complications, and learning curve were compared between cohorts. Learning curve was defined based on the slope of linear regression models of operative time versus case number.ResultsThere were 20 patients in each cohort. There was no statistically significant difference in demographic data between cohorts. One hundred percent of RFT cases versus 95% TOETVA cases (P = .999) were completed without conversion to standard open technique with median operative times of 201 (124–293) minutes versus 188 (89–343) minutes with RFT and TOETVA, respectively (P = .36). There was no incidence of permanent recurrent laryngeal nerve injury in either cohort. The slopes of the regression models were 0.29 versus −8.32 (P = .005) for RFT and TOETVA, respectively.ConclusionRFT and TOETVA are safe and feasible options for patients motivated to avoid an anterior neck scar. However, the quicker learning curve without the need for a costly robotic system may make TOETVA the preferred technique for institutions wishing to perform anterior cervical incision‐sparing thyroidectomy.Level of Evidence4

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Minimally invasive and remote‐access thyroid surgery in the era of the 2015 American Thyroid Association guidelines

Cited by 35 publications

References 54 publications

Obesity May Not Affect Outcomes of Transoral Robotic Thyroidectomy: Subset Analysis of 304 Patients

Obesity May Not Affect Outcomes of Transoral Robotic Thyroidectomy: Subset Analysis of 304 Patients

Transoral neck surgery prevents attentional bias towards the neck compared to open neck surgery

Anterior cervical incision‐sparing thyroidectomy: Comparing retroauricular and transoral approaches

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