Transoral access for endoscopic thyroid resection

Witzel, Kai; Rahden, Æ B. H. A. von; Kaminski, Cornelia; Stein, Hubert J.

doi:10.1007/s00464-007-9734-6

Cited by 258 publications

(184 citation statements)

References 20 publications

(25 reference statements)

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“…However, with those techniques, the scars are still seen at the incision area. Recently, natural orifice transluminal endoscopic surgery (NOTES) of the thyroid has been developed (7,8). A benefit of this innovative thyroid technique is its excellent cosmetic outcome due to scarless surgery.…”

Section: Introductionmentioning

confidence: 99%

Transoral endoscopic thyroidectomy using vestibular approach: updates and evidences

2017

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Recently, natural orifice transluminal endoscopic surgery (NOTES) has been applied in thyroid surgery with transoral access. The benefit of transoral endoscopic thyroidectomy is the potential for scar-free surgery. However, there are many concerns over some aspects, such as infection, recurrent laryngeal nerve injury, and oncological outcome. In this paper, we have reviewed the development history and the current clinical evidence of this innovative surgery. We conclude that the transoral endoscopic thyroidectomy vestibular approach (TOETVA) is feasible and can be considered no longer an experimental operation.

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Section: Introductionmentioning

confidence: 99%

Transoral endoscopic thyroidectomy using vestibular approach: updates and evidences

2017

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“…The rapid development of endoscopic techniques and instruments has allowed surgeons to perform a thyroidectomy from a remote site, providing a scar-free outcome in the neck. Recently, natural orifice thyroid surgery has been developed due to its potential for surgery with scar-free results (10)(11)(12)(13). The enhanced refinement of this transoral thyroidectomy technique was well-established and described by Anuwong as the transoral endoscopic thyroidectomy vestibular approach (TOETVA) with excellent clinical results (14).…”

Section: Introductionmentioning

confidence: 99%

Transoral endoscopic thyroidectomy vestibular approach (TOETVA) for Graves’ disease: a comparison of surgical results with open thyroidectomy

et al. 2016

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Background: Transoral endoscopic thyroidectomy vestibular approach (TOETVA) provides excellent cosmetic results from its potential for scar-free operation. The procedure has been applied successfully for Graves' disease by the authors of this work and compared with the standard open cervical approach to evaluate its safety and outcomes.Methods: From January 2014 to November 2016, a total of 97 patients with Graves' disease were reviewed retrospectively. Open thyroidectomy (OT) and TOETVA were performed in 49 patients and 46 patients, respectively. For TOETVA, a three-port technique through the oral vestibule was utilized. The thyroidectomy was done endoscopically using conventional laparoscopic instruments and an ultrasonic device. Patient demographics and surgical variables, including operative time, blood loss, and complications, were investigated and compared.Results: TOETVA was performed successfully in all 45 patients, although conversion to open surgery was deemed necessary in one patient. All patient characteristics for both groups were similar. Operative time was shorter for the OT group compared to the TOETVA group, which totaled 101.97±24.618 and 134.11±31.48 minutes, respectively (P<<0.5). Blood loss was comparable for both groups. The visual analog scale (VAS) pain score for the TOETVA group was significantly lower than for the OT group on day 1 (2.08±1.53 vs. 4.57±1.35), day 2 (0.84±1.12 vs. 2.57±1.08) and day 3 (0.33±0.71 vs. 1.08±1.01) (P<<0.05).Transient recurrent laryngeal nerve (RLN) palsy was found in four and two cases of TOETVA and OT group, respectively. Transient hypocalcemia was found in ten and seven cases of TOETVA and OT group, respectively. No other complications were observed.Conclusions: TOETVA is a feasible and safe treatment for Graves' disease in comparison to the standard open cervical approach. It is considered a viable alternative for patients who have been indicated for surgery with excellent cosmetic results.

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“…Indications for TOETVA are as follows: a predicted gland width on diagnostic imaging ≤10 cm; a thyroid volume outline of <45 mL or dominant nodule dimension of ≤50 mm; Bethesda category 3 or 4 lesions; primary papillary microcarcinoma without local or distant metastasis; patient request for optimal aesthetic results (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16). Exclusion criteria are as follows: patients unfit for Brief Report on Thyroid Surgery Monitored transoral endoscopic thyroidectomy via long monopolar stimulation probe general anesthesia; precedent radiation in the head, neck, or upper mediastinum; antecedent neck surgery; recurrent goiter; a gland volume of >45 mL or main nodule diameter of >50 mm; documentation of lymph node or distant metastases, tracheal/esophageal infiltration, preoperative laryngeal nerve palsy, hyperthyroidism, mediastinal goiter, or oral abscesses.…”

Section: Patient Selection and Workupmentioning

confidence: 99%

Monitored transoral endoscopic thyroidectomy via long monopolar stimulation probe

Dionigi¹,

Wu²,

Tufano³

et al. 2018

J. Vis. Surg.

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This video aimed to describe the role of intraoperative neuromonitoring (IONM) during transoral endoscopic thyroidectomy vestibular approach (TOETVA) with emphasis given to IONM technical and technological notes, the identification of recurrent laryngeal nerve (RLN). Standardized technique of IONM consist in identifying and monitoring both the vagus nerve and the RLNs before and after resection (V1, V2, R1, R2). According to this report, IONM during TOETVA is feasible and safe in providing identification and function of laryngeal nerves. IONM enable surgeons to feel more comfortable with their initial approach to TOETVA or extended indications. Larger series are needed for appropriated evaluation of IONM in reduction of the rates for RLN complications. general anesthesia; precedent radiation in the head, neck, or upper mediastinum; antecedent neck surgery; recurrent goiter; a gland volume of >45 mL or main nodule diameter of >50 mm; documentation of lymph node or distant metastases, tracheal/esophageal infiltration, preoperative laryngeal nerve palsy, hyperthyroidism, mediastinal goiter, or oral abscesses. Moreover, patients with poorly-or undifferentiated cancer, dorsal extrathyroidal radius, and/or lateral neck metastasis (N1b) are not favored for TOETVA (1-16).Candidates for TOETVA undergo same preoperative workup will offer a conventional open approach. Preoperative preparationThe 3 vestibular incisions determine a new communication between the oral cavity and neck and a poor oral heath may contribute the ability of the oral microbiota to invade the body. Good oral and dental hygiene can prevent possible postoperative infective complications. Therefore, it is suggested a preoperative oral/dental assessment by specialist. Patients undergo dental care about 1 month before TOETVA (1-9). This is recommended especially in high risk subjects as diabetic and cardiovascular patients.Moreover, pre-and post-operatively, patients are asked to gargle with Chlorhexidine mouth wash. Amoxicillin/ clavulanic acid is used for preoperative prophylactic antibiotic (1-9). Some authors suggest extending the antibiotic for 5 days postoperatively orally (1-9). Equipment preference cardMonitored TOETVA is performed according to standards of equipment set up, induction and maintenance anesthesia, correct tube positioning verification tests, EMG definitions described by the INMSG Guidelines (23).Nerve-monitoring formats as laryngeal palpation, glottic observation, glottic pressure monitoring, endoscopically placed intramuscular vocal cord electrodes, intramuscular electrodes placed through the cricothyroid membrane, and postcricoid surface electrodes are difficult to use in any endoscopic thyroid procedure (21,23,24). Thus, for safety, utility, simplicity, systems that rely on endotracheal tube-based surface electrodes were preferred monitoring equipment format for TOETVA.Pre-fashioned with integrated paired left and right stainless steel electrodes embedded within the endotracheal tube surface were used (NIM TriVantage ® E...

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Transoral access for endoscopic thyroid resection

Cited by 258 publications

References 20 publications

Transoral endoscopic thyroidectomy using vestibular approach: updates and evidences

Transoral endoscopic thyroidectomy using vestibular approach: updates and evidences

Transoral endoscopic thyroidectomy vestibular approach (TOETVA) for Graves’ disease: a comparison of surgical results with open thyroidectomy

Monitored transoral endoscopic thyroidectomy via long monopolar stimulation probe

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