Transoral thyroidectomy and parathyroidectomy – A North American series of robotic and endoscopic transoral approaches to the central neck

Russell, Jonathon O.; Clark, James H.; Noureldine, Salem I.; Anuwong, Angkoon; Khadem, Mai G. Al; Kim, Hoon Yub; Dhillon, Vaninder K.; Dionigi, Gianlorenzo; Tufano, Ralph P.

doi:10.1016/j.oraloncology.2017.06.001

Cited by 139 publications

(170 citation statements)

References 33 publications

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“…8,21,22,25 In our procedure, blunt dissection with a tunneler is done only in the submental area so as to minimize blunt dissection and avoid tearing the anterior jugular vein. 8,21,22,25 In our procedure, blunt dissection with a tunneler is done only in the submental area so as to minimize blunt dissection and avoid tearing the anterior jugular vein.…”

Section: Discussionmentioning

confidence: 99%

“…[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%

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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: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

et al. 2018

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“…TONS via both the robotic and endoscopic techniques provides excellent midline visualization of the central neck and associated subcompartments, facilitating safe and effective completion of comprehensive CND (17,20). Specifically, the ability to equally access both paratracheal basins and distally identify the RLN at its insertion facilitating an in-plane dissection are significant advantages when compared to other remote access approaches to the central neck.…”

Section: Discussionmentioning

confidence: 99%

“…If not, the procedure continues via endoscopic visualization and instrumentation. At this point, total thyroidectomy is completed via TONS in the usual fashion, utilizing the trachea as a landmark for the identification of the RLN, which is most often identified 2 o’clock and 3 o’clock from the anterior trachea (17,18,20,30). After the respective lobe(s) of the thyroid has been extracted utilizing an endocatch bag, attention may be turned to completion of CND.…”

Section: Operative Approachmentioning

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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“…and Wang et al . have used a 6-cm maximum nodule size in their respective series (23,36,40). Richmon et al .…”

Section: Indications and Inclusion Criteriamentioning

confidence: 99%

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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Transoral thyroidectomy and parathyroidectomy – A North American series of robotic and endoscopic transoral approaches to the central neck

Cited by 139 publications

References 33 publications

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

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

Central neck dissection via the transoral approach

Indications and contraindications to transoral thyroidectomy

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