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Transoral endoscopic thyroidectomy: preliminary experience in Italy

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Abstract

Transoral endoscopic thyroidectomy vestibular approach (TOETVA) is a feasible novel surgical procedure that does not need visible incisions. We describe our initial experience with TOETVA. We recruited 15 patients who were willing to undergo TOETVA. Inclusion criteria were (a) patients who had a neck ultrasound (US) with a estimated thyroid diameter not larger than 10 cm; (b) US estimated gland volume ≤45 mL; (c) nodule size ≤50 mm; (d) a benign tumor, such as a thyroid cyst, single-nodular goiter, or multinodular goiter; (e) follicular neoplasm; (f) papillary microcarcinoma without evidence of metastasis. The procedure is carried out through a three-port technique placed at the oral vestibule, one 10-mm port for 30° endoscope and two additional 5-mm ports for dissecting and coagulating instruments. CO2 insufflation pressure is set at 6 mmHg. An anterior cervical subplatysmal space is created from the oral vestibule down to the sternal notch, laterally to the sternocleidomastoid muscle. Thyroidectomy is done fully endoscopically using conventional endoscopic instruments and intraoperative neuromonitoring. There were 34% total thyroidectomies and 66% hemithyroidectomies. All TOETVA procedures were performed successfully with no conversions. The mean operative time was 87.6 (59–118) min for lobectomy and 107.6 (99–135) min for bilateral procedure. We observed one case of transient postoperative hypocalcemia. There was no recurrent laryngeal nerve palsy. The cosmetic result was excellent in all patients. This is the first case series of TOETVA in Italy. TOETVA may provide a method for ideal cosmetic results. The results are encouraging, and we are optimistic about the future expansion of its applicability.

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References

  1. Witzel K, von Rahden BH, Kaminski C et al (2008) Transoral access for endoscopic thyroid resection. Surg Endosc 22:1871–1875

    Article  CAS  PubMed  Google Scholar 

  2. Benhidjeb T, Wilhelm T, Harlaar J et al (2009) Natural orifice surgery on thyroid gland: totally transoral video-assisted thyroidectomy (TOVAT): report of first experimental results of a new surgical method. Surg Endosc 23:1119–1120

    Article  CAS  PubMed  Google Scholar 

  3. Wilhelm T, Metzig A (2010) Endoscopic minimally invasive thyroidectomy: first clinical experience. Surg Endosc 24:1757–1758

    Article  PubMed  Google Scholar 

  4. Wilhelm T, Metzig A (2011) Endoscopic minimally invasive thyroidectomy (eMIT): a prospective proof-of-concept study in humans. World J Surg 35:543–551

    Article  PubMed  Google Scholar 

  5. Liu E, Qadir Khan A, Niu J, Xu Z, Peng C (2015) Natural orifice total transtracheal endoscopic thyroidectomy surgery: first reported experiment. J Laparoendosc Adv Surg Tech A 25(7):586–591

    Article  PubMed  Google Scholar 

  6. Woo SH (2014) Endoscope-assisted transoral thyroidectomy using a frenotomy incision. J Laparoendosc Adv Surg Tech A 24(5):345–349

    Article  PubMed  Google Scholar 

  7. Benhidjeb T, Stark M (2011) Endoscopic minimally invasive thyroidectomy (eMIT): safety first! World J Surg 35:1936–1937

    Article  PubMed  Google Scholar 

  8. Anuwong A (2016) Transoral endoscopic thyroidectomy vestibular approach: a series of the first 60 human cases. World J Surg 40(3):491–497

    Article  PubMed  Google Scholar 

  9. Clark JH, Kim HY, Richmon JD (2015) Transoral robotic thyroid surgery. Gland Surg. 4(5):429–434

    PubMed  PubMed Central  Google Scholar 

  10. Lee HY, Richmon JD, Walvekar RR, Holsinger C, Kim HY (2015) Robotic transoral periosteal thyroidectomy (TOPOT): experience in two cadavers. J Laparoendosc Adv Surg Tech A 25(2):139–142

    Article  PubMed  Google Scholar 

  11. Lee HY, You JY, Woo SU, Son GS, Lee JB, Bae JW, Kim HY (2015) Transoral periosteal thyroidectomy: cadaver to human. Surg Endosc 29(4):898–904

    Article  PubMed  Google Scholar 

  12. Lee HY, Hwang SB, Ahn KM, Lee JB, Bae JW, Kim HY (2014) The safety of transoral periosteal thyroidectomy: results of Swine models. J Laparoendosc Adv Surg Tech A 24(5):312–317

    Article  PubMed  Google Scholar 

  13. Randolph GW, Dralle H, Abdullah H et al (2011) Electrophysiologic recurrent laryngeal nerve monitoring during thyroid and parathyroid surgery: international standards guideline statement. Laryngoscope 121(Suppl 1):S1–S16

    Article  PubMed  Google Scholar 

  14. Chiang FY, Lee KW, Chen HC, Chen HY, Lu IC, Kuo WR, Hsieh MC, Wu CW (2010) Standardization of intraoperative neuromonitoring of recurrent laryngeal nerve in thyroid operation. World J Surg 34(2):223–229

    Article  PubMed  Google Scholar 

  15. Wu CW, Lu IC, Randolph GW, Kuo WR, Lee KW, Chen CL, Chiang FY (2010) Investigation of optimal intensity and safety of electrical nerve stimulation during intraoperative neuromonitoring of the recurrent laryngeal nerve: a prospective porcine model. Head Neck 32(10):1295–1301

    Article  PubMed  Google Scholar 

  16. Wu CW, Dionigi G, Chen HC, Chen HY, Lee KW, Lu IC, Chang PY, Hsiao PJ, Ho KY, Chiang FY (2013) Vagal nerve stimulation without dissecting the carotid sheath during intraoperative neuromonitoring of the recurrent laryngeal nerve in thyroid surgery. Head Neck 35(10):1443–1447

    PubMed  Google Scholar 

  17. Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, Pacini F, Randolph GW, Sawka AM, Schlumberger M, Schuff KG, Sherman SI, Sosa JA, Steward DL, Tuttle RM, Wartofsky L (2016) 2015 American Thyroid Association Management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: the American Thyroid Association guidelines task force on thyroid nodules and differentiated thyroid cancer. Thyroid 26(1):1–133

    Article  PubMed  PubMed Central  Google Scholar 

  18. Finlay AY, Khan GK (1994) Dermatology Life Quality Index (DLQI)–a simple practical measure for routine clinical use. Clin Exp Dermatol 19(3):210–216

    Article  CAS  PubMed  Google Scholar 

  19. Dralle H (2006) Impact of modern technologies on quality of thyroid surgery. Langenbecks Arch Surg 391:1–3

    Article  PubMed  Google Scholar 

  20. Miccoli P, Berti P, Materazzi G, Minuto M, Barellini L (2004) Minimally invasive video-assisted thyroidectomy: five years of experience. J Am Coll Surg 199(2):243–248

    Article  PubMed  Google Scholar 

  21. Tan CT, Cheah WK, Delbridge L (2008) “Scarless” (in the Neck) endoscopic thyroidectomy (SET): an evidence-based review of published techniques. World J Surg 32(7):1349–1357

    Article  PubMed  Google Scholar 

  22. Yeung GH (2002) Endoscopic thyroid surgery today: a diversity of surgical strategies. Thyroid 12(8):703–706

    Article  PubMed  Google Scholar 

  23. Duh QY (2003) Presidential Address: minimally invasive endocrine surgery–standard of treatment or hype? Surgery 134(6):849–857

    Article  PubMed  Google Scholar 

  24. Henry JF (2008) Minimally invasive thyroid and parathyroid surgery is not a question of length of the incision. Langenbecks Arch Surg 393(5):621–626. doi:10.1007/s00423-008-0406-3

    Article  PubMed  Google Scholar 

  25. Ng JW (2004) Minimally invasive surgery or minimal-incision thyroidectomy? Arch Surg 139(7):802

    Article  PubMed  Google Scholar 

  26. Cunningham SC (2006) Minimally accurate nomenclature. Surg Endosc 20(6):998

    Article  CAS  PubMed  Google Scholar 

  27. Cuschieri A (1992) “A rose by any other name…” Minimal access or minimally invasive surgery? Surg Endosc 6(5):214

    Article  CAS  PubMed  Google Scholar 

  28. Dionigi G, Rovera F, Boni L, Castano P, Dionigi R (2006) Surgical site infections after thyroidectomy. Surg Infect (Larchmt) 7(Suppl 2):S117–S120

    Google Scholar 

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Authors and Affiliations

  1. 1st Division of Surgery, Department of Medicine and Surgery, Endocrine Surgery Research Center, University of Insubria, Varese, Italy

    Gianlorenzo Dionigi, Matteo Lavazza, Davide Inversini & Stefano Rausei

  2. Division of Anesthesia, Ospedale di Circolo, Fondazione Macchi, Varese, Italy

    Alessandro Bacuzzi

  3. Department of General and Emergency Surgery at the IRCCS – Ca Granda, Policlinico Hospital in Milan, University of Milan, Milano, Italy

    Luigi Boni

  4. Department of Surgery, Korea University College of Medicine, Seoul, Republic of Korea

    Hoon Yub Kim

  5. Minimally Invasive and Endocrine Surgery Division, Department of Surgery Police General Hospital, Bangkok, Thailand

    Angkoon Anuwong

Authors
  1. Gianlorenzo Dionigi
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  2. Alessandro Bacuzzi
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  3. Matteo Lavazza
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  4. Davide Inversini
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  5. Luigi Boni
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  6. Stefano Rausei
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  7. Hoon Yub Kim
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  8. Angkoon Anuwong
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Correspondence to Gianlorenzo Dionigi.

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The authors have no conflict of interest to disclosure, and no other funding or financial relationship with the surgical industry.

Research involving human participants and/or animals

The study was approved by the institutional ethics committee of Department of Medicine and Surgery, University of Insubria.

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All participants were provided the particular details for their surgeries and informed consent obtained from each patient.

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Dionigi, G., Bacuzzi, A., Lavazza, M. et al. Transoral endoscopic thyroidectomy: preliminary experience in Italy. Updates Surg 69, 225–234 (2017). https://doi.org/10.1007/s13304-017-0436-x

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  • DOI: https://doi.org/10.1007/s13304-017-0436-x

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