Transoral robotic thyroidectomy: lessons learned from an initial consecutive series of 24 patients

Kim, Hoon Yub; Chai, Young Jun; Dionigi, Gianlorenzo; Anuwong, Angkoon; Richmon, Jeremy D.

doi:10.1007/s00464-017-5724-5

Cited by 128 publications

(171 citation statements)

References 20 publications

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“…Conversely, Kim et al . utilized a 4-cm nodule maximum, regardless of suspected pathology in their robotic series (24,25). …”

Section: Indications and Inclusion Criteriamentioning

confidence: 99%

“…Of note, all patients in this series were euthyroid at the time of the procedure (38). Each group’s inclusion criteria have been summarized in Table 1 (22–25,27,36,38–40). …”

Section: Indications and Inclusion Criteriamentioning

confidence: 99%

“…Patients whom were deemed unfit for surgery or could not tolerate general anesthesia were also excluded (22–24,27,30,38). Most high-volume authors additionally note that lymph node metastasis and evidence of extrathyroidal extension such as tracheal or esophageal invasion should be contraindications (24,25,27,36,39,40). Dionigi et al .…”

Section: Contraindications and Exclusion Criteriamentioning

confidence: 99%

“…(21) and modifications of this technique have gained favor with refinement of incision placement via both robotic and endoscopic approaches (22–25). Transoral robotic or endoscopic thyroidectomy vestibular approach (TOR/ ETVA) offers access to the bilateral thyroid beds via a gingivobuccal incision without a permanent cutaneous scar (22–28).…”

Section: Introductionmentioning

confidence: 99%

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Indications and contraindications to transoral thyroidectomy

Razavi

Russell

2017

Ann. Thyroid

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Patient motivation to avoid neck scarring has been a strong impetus in the development of remote access approaches to the thyroid, including transoral robotic or endoscopic thyroidectomy vestibular approach (TOR/ETVA). TOR/ETVA continues to become more prevalent given its early success in North America and the demonstration of its safety and efficacy in Asia. As more surgeons perform this procedure, it is important that specific and uniform indications and contraindications exist to prevent surgical complications due to poor patient selection. In this article, we review the existing English literature regarding TOR/ETVA and compile the inclusion and exclusion criteria of individual authors for both robotic and endoscopic techniques to date. We then resolve differences in the existing literature to provide recommended indications and contraindications to TOR/ETVA based on both our review and our own experience with TOR/ETVA to date. The following are our resultant recommended indications for TOR/ETVA: patient history of hypertrophic scarring or motivation to avoid a cervical neck incision with a maximal thyroid diameter ≤ 10 cm and dominant nodule ≤6 cm, with one of the following pathologic criteria; benign lesion, multinodular goiter, indeterminate nodule, or suspicious lesions/well-differentiated thyroid carcinomas ≤ 2 cm. Recommended contraindications to TOR/ETVA are as follows: history of head & neck surgery, history of head, neck, or upper mediastinal irradiation, inability to tolerate general anesthesia, evidence of clinical hyperthyroidism, preoperative recurrent laryngeal nerve palsy, lymph node metastasis, extrathyroidal extension including tracheal or esophageal invasion, oral abscesses, substernal thyroidal extension, or failure to meet inclusion criteria as above. Relative contraindications include smoking and other oral pathology, and surgeons should be aware that morbid obesity may make it difficult to raise skin flaps.

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“…Conversely, Kim et al . utilized a 4-cm nodule maximum, regardless of suspected pathology in their robotic series (24,25). …”

Section: Indications and Inclusion Criteriamentioning

confidence: 99%

“…Of note, all patients in this series were euthyroid at the time of the procedure (38). Each group’s inclusion criteria have been summarized in Table 1 (22–25,27,36,38–40). …”

Section: Indications and Inclusion Criteriamentioning

confidence: 99%

Section: Contraindications and Exclusion Criteriamentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Indications and contraindications to transoral thyroidectomy

Razavi

Russell

2017

Ann. Thyroid

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“…” However, these authors further state that the utility for any individual patient must be based upon the importance placed in staging information CND may provide the multidisciplinary treatment team. Given that we do not recommended TONS for T3 and T4 disease (22,32), a prophylactic CND may be considered if preoperative workup is consistent with a 2-cm or smaller well differentiated thyroid cancer and the treatment team believes that staging information gained from CND outweigh the operative risks of recurrent laryngeal nerve (RLN) injury or hypoparathyroidism (19,30,31)…”

Section: Indicationsmentioning

confidence: 99%

Central neck dissection via the transoral approach

et al. 2017

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There has been a strong impetus for the development of remote access approaches to the central neck. The primary motivation for this has been to alleviate the negative impact that some patients may perceive from a central neck scar. Numerous approaches have been described; however the only approach that provides midline access and equivalent visualization of the bilateral thyroid lobes and paratracheal basins is transoral neck surgery (TONS). TONS has been shown to be safe and effective in performing thyroidectomy, parathyroidectomy, and central neck dissection (CND) via both the endoscopic and robotic techniques. In contrast with other remote access techniques, it provides the surgeon with familiar views of the bilateral recurrent laryngeal nerves (RLN) at their insertion site in concert with equivalent access to both paratracheal basins, thus uniquely facilitating safe and comprehensive CND. Though feasible and safe, CND via TONS is not appropriate in all cases. CND via TONS should only be performed with concomitant transoral total thyroidectomy, either prophylactically if the surgeon routinely performs prophylactic CND, or therapeutically if there is newly found evidence of nodal metastasis in the central compartment at the time of surgery. We base these recommendations on both the recent American Head and Neck Society (AHNS) consensus statement for indications for transcervical CND and the baseline indications for TONS.

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