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Printing a Three-Dimensional Patient-Specific Safety Device for Reducing the Potential Risk of Mental Nerve Injury During Transoral Thyroidectomy

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Abstract

Background

Thyroidectomy transoral endoscopic thyroidectomy vestibular approach (TOETVA) is a safe and cosmetically appealing alternative for well-selected patients undergoing thyroidectomy. However, during TOETVA, placement of the two lateral trocars and/or manipulation of the surgical instruments through the trocars may potentially injure and/or compress the mental nerve (MN) because the actual location of the nerve foramen may vary among individuals. The MN injury rate was reported to be as high as 75% in the initial period of robotic-assisted TOETVA. To reduce the potential risk of MN injury, we implemented a three-dimensional printing technology to develop a safety device for TOETVA.

Methods

The patient-specific safety device (PSSD) was a brace with an exact fit to the lower teeth and two safety markers on each side to indicate the location of the mental foramen. For patient in whom the brace would not be applicable, a 3D mandibular model was printed as a PSSD instead. We analyzed 66 patients undergoing TOETVA at our institution from March 2017 to March 2019. The preoperative details and complication profiles were also analyzed.

Results

With incorporation of the PSSD into our TOETVA procedure, there have been no cases of MN injury.

Conclusions

Our own TOETVA series has demonstrated that the implementation of the PSSD has been successful in preoperatively identifying and preventing the potential risk of MN injury. Although the additional requirements of preoperative CT and time for fabricating the device impose limitations, the influence of the PSSD in TOETVA is positive.

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Acknowledgements

This work was supported in part by a Taipei Veterans General Hospital Research (V106 E-003-1, V107 D39-001-MY2-1, V107C-198, V108C-180) and the Ministry of Science and Technology (MOST 107-2410-H-075-001), Taiwan.

Funding

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Author information

Author notes

  1. Yi-Ting Yeh, Jui-Yu Chen contributed equally to the work as joint first authors.

Authors and Affiliations

  1. Division of Pediatric Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan

    Yi-Ting Yeh

  2. Division of General Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan

    Jui-Yu Chen, Po-Chung Kuo, Chen-Hsen Lee & Yi-Ming Shyr

  3. Division of Plastic Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan

    Tien-Hsiang Wang

  4. Institute of Pharmacology, School of Medicine, National Yang-Ming University, Taipei, Taiwan

    Jui-Yu Chen, Hsin-Chen Lee & Chin-Wen Chi

  5. Division of Experimental Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan

    Shyh-Jen Wang

  6. Department of Orthopedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan

    Wei-Ming Chen

  7. School of Medicine, National Yang-Ming University, Taipei, Taiwan

    Yi-Ting Yeh, Jui-Yu Chen, Po-Chung Kuo, Tien-Hsiang Wang, Chen-Hsen Lee, Yi-Ming Shyr & Wei-Ming Chen

  8. Rehabilitation and Technical Aids Center, Taipei Veterans General Hospital, Taipei, Taiwan

    Shyh-Jen Wang

  9. Department of Mechanical Engineering, National Central University, Taoyuan, Taiwan

    Tien-Hsiang Wang

  10. Institute of Hospital and Health Care Administration, National Yang-Ming University, Taipei, Taiwan

    Shyh-Jen Wang

Authors
  1. Yi-Ting Yeh
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  2. Jui-Yu Chen
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  3. Po-Chung Kuo
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  4. Tien-Hsiang Wang
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  5. Hsin-Chen Lee
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  6. Chin-Wen Chi
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  7. Chen-Hsen Lee
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  8. Yi-Ming Shyr
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  9. Shyh-Jen Wang
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  10. Wei-Ming Chen
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Corresponding authors

Correspondence to Shyh-Jen Wang or Wei-Ming Chen.

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Conflict of interest

The authors certify that they have no affiliations with or involvement in any organization or entity with any financial interests (such as honoraria, educational grants, participation in speakers’ bureaus, memberships, employment, consultancies, stock ownership, or other equity interests, and expert testimony or patent-licensing arrangements) or nonfinancial interests (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Ethical standards

The study was approved by the Institutional Review Board of the Taipei Veterans General Hospital (VGHIRB No: 2016–08-023CC).

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Cite this article

Yeh, YT., Chen, JY., Kuo, PC. et al. Printing a Three-Dimensional Patient-Specific Safety Device for Reducing the Potential Risk of Mental Nerve Injury During Transoral Thyroidectomy. World J Surg 44, 371–377 (2020). https://doi.org/10.1007/s00268-019-05155-z

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  • DOI: https://doi.org/10.1007/s00268-019-05155-z

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