Scarless Completion Thyroidectomy After Initial Transoral Approach for Differentiated Thyroid Cancer: How and When to Start?

Abstract

Background: With growing literature, the feasibility of transoral endoscopic thyroidectomy vestibular approach (TOETVA) has been confirmed as a valid method for managing differentiated thyroid cancer. Completion thyroidectomy (CT) is recommended in patients who have been diagnosed with differentiated thyroid cancer after unilateral lobectomy by TOETVA. In this retrospective study, the authors addressed the critical questions of how and when to do the second operation of CT to avoid a neck scar. Materials and Methods:The authors retrospectively reviewed our patients who had received TOETVA in our hospital from August 2016 to December 2019. Those who received CT after initial TOETVA as cTOETVA were further separated according to the approaching methods. Demographic data, operative variables, and postoperative variables were collected and analyzed.Results: A total of 97 patients were enrolled using TOETVA. Malignancies were present in 42 patients (43.3%) using TOETVA. There were 3 approaching methods of cTOETVA and separated into reopen transcervical approach (re-TCA), retransoral TOETVA (re-TOETVA), and transaxillary approach (TAA) groups. There were no significant complications among patients for cTOETVA. Of the 8 patients for the cTOETVA, 3 received re-TCA, 3 re-TOETVA, and 2 TAA. Conclusions:The outcomes are encouraging and demonstrate the feasibility of scarless completion thyroidectomy after initial TOETVA. The re-TOETVA procedure should be completed within 14 days after the initial TOETVA procedure, TAA beyond 14 days, and re-TCA may be completed at any time. The cTOETVA techniques using re-TOETVA or TAA have better cosmetic results than re-TCA in oncological equivalency.

Outcomes of Minimally Invasive Thyroid Surgery – A Systematic Review and Meta-Analysis

“…Of the studies included in this article, completion thyroidectomy was described by eight studies, using all mentioned techniques except the RA-ET and RA-RT (31,34,41,43,46,57,65,89). Moreover, several other studies described the safety and feasibility of minimally invasive techniques for the completion thyroidectomy, showing the vast range of application of these techniques (65,(120)(121)(122). It is advised to either perform re-operation within two weeks after initial surgery or after two to three months to minimize complications due to adhesions (57,65,120).…”

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

“…TOETVA has become an attractive minimally invasive thyroidectomy approach for both surgeons and patients worldwide because it provides excellent cosmetic outcomes (14). TOETVA leaves no visible scars because the intraoral scars are unnoticeable and heal completely within 2 two 3 weeks, compared to other remote-access approaches which merely transfer scars to other parts of the body (15,16).…”

Working Space Creation in Transoral Thyroidectomy: Pearls and Pitfalls

“…After 2 weeks, tight adhesion may pose difficulty in opening the space again. Wu et al [ 65 ] proposed creating a working space through a different approach if completion thyroidectomy was performed beyond 2 weeks. Anuwong et al [ 18 ] suggested postponing the surgery 6 months later if a repeated transoral approach is desired.…”