Transoral endoscopic thyroidectomy vestibular approach (TOETVA): Our outcomes from Turkey

Abstract

Objective: The Transoral Endoscopic Thyroidectomy Vestibular Approach (TOETVA) was described in 2016 and had its case series published. This study aimed to present the largest TOETVA case series performed in Turkey.Material and Methods: Data from 52 patients who underwent TOETVA procedure between February 2018 and October 2019 were analyzed retrospectively. Demographic data, duration of operation, blood loss, rate of conversion to open surgery, radiological findings, pathological outcomes, and complications were analyzed.Results: All patients were female. Mean duration of the operation was 192 ± 45 minutes, mean blood loss was 39 ± 47 mL, and the ratio of surgical site infection was 6% (3/50). In two (4%) patients, TOETVA was converted to open surgery. Temporary and permanent recurrent laryngeal nerve (RLN) paralysis was observed in 2 (4%) and 0 patients, respectively. Temporary and permanent hypoparathyroidism was observed in 10 (20%) and 0 patients, respectively. Conclusion:TOETVA procedure is the most recently defined NOTES technique for endocrine surgery. In experienced healthcare centers, TOETVA can achieve outcomes similar and even better than the ones obtained with open surgery. The complication rates, durations of operation, surgical site infection, and blood loss parameters that we observed in our experience are similar to the ones reported in the literature.

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

“…Moreover, unlike other remote-access surgeries that require extensive flap dissection, TOETVA only requires minimal dissection (similar to conventional open thyroidectomy) and provides an exceptional magnified view of the surgical field (17). Many studies have also reported the promising safety and outcomes of TOETVA, by showing comparable complication rates to that of traditional open thyroidectomies (18)(19)(20).…”

Tiroidectomía endoscópica transoral por vía vestibular: resultados de los 53 primeros casos

“…Para la colocacio ´n de tro ´cares se empleo ´una mediana de 14 min (12-15), con una duracio ´n mediana de 80 min (65-100) las lobectomı ´as y 140 min (125-173) la tiroidectomı ´a total. La mediana de tiempo empleado en el VGCCI fue de 30 min (20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30). Para la extraccio ´n de la pieza se emplearon 10 min (6)(7)(8)(9)(10)(11)(12)(13)(14)(15).…”

“…De todos los anteriores, solo la TOETVA evita la cicatriz visible, al realizarse por un orificio natural. La casuı ´stica de la cirugı ´a transoral en la literatura es muy variable (desde 5 a 260 casos) 13,[19][20][21][22][23][24][25][26][27] debido, probablemente, a la dificultad de encontrar pacientes adecuados por los estrictos criterios de inclusio ´n y por la baja demanda de este abordaje en Occidente, al no considerarse un estigma las cicatrices cervicales.…”

Trans-oral endoscopic endocrine surgery vestibular approach: Pioneering the technique in the Gulf Cooperation Council Countries – A case series

“…Furthermore, the use of carbon dioxide (CO2) for insufflation has led to the introduction of new scope of complications. Subcutaneous surgical emphysema, hypercarbia and CO2 embolism has been reported in the literature [ 8 , 22 ]. The first two complications are due to high intra-cavity pressure.…”

“…At a later date, the natural orifice transluminal endoscopic surgery (NOTES) was introduced in thyroid surgery in 2008 [ [5] , [6] , [7] ]. Initially the access was via a sublingual or trans-tracheal approach [ 8 ]. These techniques resulted in severe tissue damage and were associated with high complication rates [ 5 , 6 ].…”