Robotic and endoscopic transoral thyroidectomy: feasibility and description of the technique in the cadaveric model

Abstract

Background: Numerous new approaches have been described over the years to improve the cosmetic outcomes of thyroid surgery. Transoral approach is a new technique that aims to achieve superior cosmetic outcomes by concealing the incision in the oral cavity.Methods: Transoral thyroidectomy through vestibular approach was performed in two institutions on cadaveric models. Procedure was performed endoscopically in one institution, while the robotic technique was utilized at the other.Results: Transoral thyroidectomy was successfully performed at both institutions with robotic and endoscopic techniques. All vital structures were identified and preserved.Conclusions: Transoral thyroidectomy has been performed in animal and cadaveric models, as well as in some clinical studies. Our initial experience indicates the feasibility of this approach. More clinical studies are required to elucidate its full utility.

Extracervical Approaches to Thyroid Surgery: Evolution and Review

“…Whilst several different approaches have been tried, the transoral vestibular approach proves to be the most popular. Another benefit is the shorter dissection tunnel and minimally invasive approach to the more established extracervical approaches; techniques such as the axillary approach require extensive tissue dissection to expose the thyroid gland and therefore some authors argue they are not truly minimally invasive [83]. Complete endoscopic radical lymphadenectomy for papillary thyroid cancer has also been reported using the transoral technique [74], giving the potential for wider indications of this technique.…”

“…It therefore requires a comprehensive knowledge of anatomical structures and may prove to be technically challenging. Kahramangil et al [83] state that, despite the direct access to the neck, the dissection of the lateral borders of the thyroid lobes was more difficult in the transoral approach compared to the axillary approach.…”

Transoral Endoscopic Thyroidectomy Vestibular Approach

“…Evolution of TOETVA over the past decade. 6–9,14,15,18,19 *Combined sublingual and vestibular approach.…”

“…1,12,13 Then, in 2014, after conducting several cadaver dissections, Dr. Anuwong started performing a modified version of the vestibular technique on humans. 3,5,14,15 The problem was addressed by adjusting the placement of the lateral 5-mm ports. The two vertical incisions for the 5-mm ports were repositioned to the vestibular mucosa lateral to the level of the canines and just in the inner aspect of the inferior lip, to avoid contact or at least injury to the mental nerve.…”

“…A Maryland dissector and bipolar energy or ultrasonic energy device is used on either side of the camera. 14 Dissection is carried out in the caudal direction toward the sternal notch, always staying beneath the platysma muscle. Laterally, dissecting to bilateral sternocleidomastoid muscles further enhances exposure.…”