Transoral endoscopic thyroidectomy: preliminary experience in Italy

Dionigi, Gianlorenzo; Bacuzzi, Alessandro; Lavazza, Matteo; Inversini, Davide; Boni, Luigi; Rausei, Stefano; Kim, Hoon Yub; Anuwong, Angkoon

doi:10.1007/s13304-017-0436-x

Cited by 101 publications

(97 citation statements)

References 28 publications

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“…[2][3][4] Remote access thyroidectomies employing a gasless transaxillary approach, bilateral axillo-breast approach (BABA), postauricular facelift approach, or transoral approach are commonly used. However, the efficacy and feasibility of transoral robotic and endoscopic thyroidectomy has not been fully assessed although some institutes have reported its feasibility and safety, [17][18][19][20][21][22][23][24] and one study obtained comparable surgical outcomes to conventional transcervical thyroidectomy. The transoral approach is considered a form of true, natural orifice transluminal endoscopic surgery, and is less invasive in terms of working space than other types of remote access thyroidectomy.…”

Section: Introductionmentioning

confidence: 99%

“…[9][10][11][12][13][14][15][16] Of these, the oral vestibular approach has been most popular recently. However, the efficacy and feasibility of transoral robotic and endoscopic thyroidectomy has not been fully assessed although some institutes have reported its feasibility and safety, [17][18][19][20][21][22][23][24] and one study obtained comparable surgical outcomes to conventional transcervical thyroidectomy. 25 We have been performing robotic and endoscopic thyroidectomy by a gasless unilateral axillary or gasless unilateral Kyung Tae and Dong Won Lee contributed equally to this study.…”

Section: Introductionmentioning

confidence: 99%

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Early experience of transoral thyroidectomy: Comparison of robotic and endoscopic procedures

et al. 2018

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Background The aim of this study was to evaluate the feasibility, safety, and early surgical outcomes of transoral thyroidectomy and to compare robotic and endoscopic procedures. Methods A total of 37 patients underwent robotic (23 cases) or endoscopic (14 cases) transoral thyroidectomy. We compared the outcomes of the two procedures. Results Of the 37 patients, 2 were converted to the robotic facelift approach as a result of an intraoperative CO2 embolism and inability to remove the tumor. The mean operative time was 172.8 ± 37.5 minutes. Transient recurrent laryngeal nerve palsy occurred in one case, and transient hypoparathyroidism in two cases. Most of patients were satisfied with the postoperative cosmesis. There were no significant differences between the robotic and endoscopic procedures, except for operative time, which was significantly longer in the robotic group. Conclusion Robotic and endoscopic transoral thyroidectomies are both feasible and safe in appropriate patients.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Early experience of transoral thyroidectomy: Comparison of robotic and endoscopic procedures

et al. 2018

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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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“…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.…”

Section: Equipment Preference Cardmentioning

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 endoscopic thyroidectomy: preliminary experience in Italy

Cited by 101 publications

References 28 publications

Early experience of transoral thyroidectomy: Comparison of robotic and endoscopic procedures

Early experience of transoral thyroidectomy: Comparison of robotic and endoscopic procedures

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

Monitored transoral endoscopic thyroidectomy via long monopolar stimulation probe

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