Transoral endoscopic thyroidectomy vestibular approach with intraoperative nerve monitoring

Inabnet, William B.; Suh, Hyun Suk; Fernández-Ranvier, Gustavo

doi:10.1007/s00464-016-5322-y

Cited by 49 publications

(47 citation statements)

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“…Despite the rate being very low in the present day due to a better operative technique (40,41), it is better to avoid this problem. Inabnet et al (34), Dionigi et al (36), and Wang et al (33) demonstrated intraoperative neuromonitoring in TOETVA operations with good results. However, the numbers of patients in those papers were too small; larger studies should be conducted to confirm that neuromonitoring can reduce the rate of RLN injury.…”

Section: Discussionmentioning

confidence: 97%

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: Discussionmentioning

confidence: 97%

Transoral endoscopic thyroidectomy using vestibular approach: updates and evidences

2017

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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%

“…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. Moreover, patients with poorly-or undifferentiated cancer, dorsal extrathyroidal radius, and/or lateral neck metastasis (N1b) are not favored for TOETVA (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16).…”

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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“…Hydrodissection is first performed with a 30 mL solution of 1 mg adrenaline diluted with 500 mL normal saline injected sub-platysma into the oral vestibular area of the lower lip down to the anterior neck and central working space (1)(2)(3)(4)(5)(6)(7)(8)(9).…”

Section: Operative Techniquementioning

confidence: 99%

“…Contralateral thyroidectomy is accomplished only if the RLN EMG signal of first side is preserved (1)(2)(3)(4)(5)(6)(7)(8)(9). If surgical drain is required, this is placed by adding a 5-mm incision into the axilla and tunnelled up to neck; correct placement of drain is guarantee by endoscopic view.…”

Section: Operative Techniquementioning

confidence: 99%

Transoral endoscopic thyroidectomy via vestibular approach: operative steps and video

Dionigi¹,

Bacuzzi²,

Lavazza³

et al. 2016

Gland Surg.

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Transoral endoscopic thyroidectomy vestibular approach with intraoperative nerve monitoring

Abstract: TOETVA is safe and feasible and provides an excellent cosmetic outcome with the most confidentially compared to the other remote access endoscopic approaches.

Cited by 49 publications

References 0 publications

Transoral endoscopic thyroidectomy using vestibular approach: updates and evidences

Transoral endoscopic thyroidectomy using vestibular approach: updates and evidences

Monitored transoral endoscopic thyroidectomy via long monopolar stimulation probe

Transoral endoscopic thyroidectomy via vestibular approach: operative steps and video

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