Surgical Endoscopy

, Volume 22, Issue 8, pp 1871–1875 | Cite as

Transoral access for endoscopic thyroid resection

  • K. WitzelEmail author
  • B. H. A. von Rahden
  • C. Kaminski
  • H. J. Stein



Endoscopic neck surgery is requested by an increasing number of patients. The access trauma of the axillary, breast, and chest approaches is greater than with open or video-assisted surgery. The authors tested the feasibility of the sublingual transoral access, which they believe is the most promising minimally invasive endoscopic access to the thyroid gland from outside the neck region.


The sublingual transoral access was first evaluated in two fresh human cadavers. An experimental investigation then was performed using a porcine model. A total of 10 endoscopic transoral thyroidectomies were performed in 10 pigs using a modified axilloscope with an obturator, ultrasonic scissors, and a neuromonitoring system to identify the recurrent laryngeal nerve.


A complete transoral thyroid resection was achieved with both the human cadavers and all the living pigs. Despite the complexity of the anatomic region, the transoral procedure was astonishingly easy to perform. In the animal study, the time from the introduction of the obturator just above the larynx to its removal was 59 s. The average overall operation time was 50 min. The neuromonitoring system permitted the regular function of the recurrent laryngeal nerves on both sides to be proved after removal of the thyroid gland. The pigs were observed for another 2 h after the operation. No complications occurred during the operation or afterward.


Endoscopic transoral thyroid resection is possible. It proved to be a safe procedure in living pigs and astonishingly easy to perform. The results may be helpful for thyroid resections in humans using a similar access, as suggested by the thyroidectomies in human cadavers preceding this study.


Goiter Minimally invasive Thyroid surgery Transoral 


  1. 1.
    Shimizu K, Tanaka S (2003) Asian perspective on endoscopic thyroidectomy: a review of 193 cases. Asian J Surg 26:92–100PubMedCrossRefGoogle Scholar
  2. 2.
    Ikeda Y, Takami H, Sasaki Y, Takayama J, Niimi M, Kan S (2002) Comparative study of thyroidectomies: endoscopic surgery versus conventional open surgery. Surg Endosc 16:1741–1745PubMedCrossRefGoogle Scholar
  3. 3.
    Duh QY (2003) Recent advances in minimally invasive endocrine surgery. Asian J Surg 26:62–63PubMedCrossRefGoogle Scholar
  4. 4.
    Miccoli P (2002) Minimally invasive surgery for thyroid and parathyroid diseases. Surg Endosc 16:3–6PubMedCrossRefGoogle Scholar
  5. 5.
    Gagner M (1996) Endoscopic subtotal parathyroidectomy in patients with primary hyperparathyroidism. Br J Surg 83:875PubMedCrossRefGoogle Scholar
  6. 6.
    Yeung GH (1998) Endoscopic surgery of the neck: a new frontier. Surg Laparosc Endosc 8:227–232PubMedCrossRefGoogle Scholar
  7. 7.
    Sebag F, Palazzo FF, Harding J, Sierra M, Ippolito G, Henry JF (2006) Endoscopic lateral approach thyroid lobectomy: safe evolution from endoscopic parathyoidectomy. World J Surg 30:802–805PubMedCrossRefGoogle Scholar
  8. 8.
    Shimizu K (2001) Minimally invasive thyroid surgery. Best Pract Res Clin Endocrinol Metab 15:123–137PubMedCrossRefGoogle Scholar
  9. 9.
    Takami H, Ikeda Y (2003) Total endoscopic thyroidectomy. Asian J Surg 26:82–85PubMedCrossRefGoogle Scholar
  10. 10.
    Kitano H, Fujimura M, Kinoshita T, Kataoka H, Hirano M, Kitajima K (2002) Endoscopic thyroid resection using cutaneous elevation in lieu of insufflation. Surg Endosc 16:88–91PubMedCrossRefGoogle Scholar
  11. 11.
    Ikeda Y, Takami H, Niimi M, Kan S, Sasaki Y, Takayama J (2002) Endoscopic thyroidectomy and parathyroidectomy by the axillary approach: a preliminary report. Surg Endosc 16:92–95PubMedCrossRefGoogle Scholar
  12. 12.
    Witzel K (2007) The axillary access in unilateral thyroid resection. Langenbecks Arch Surg 392:617–621PubMedCrossRefGoogle Scholar
  13. 13.
    Shimazu K, Shiba E, Tamaki Y, Takiguchi S, Taniguchi E, Ohashi S, Noguchi S (2003) Endoscopic thyroid surgery through the axillobilateral breast approach. Surg Laparosc Endosc Percutan Tech 13:196–201PubMedCrossRefGoogle Scholar
  14. 14.
    Park YL, Han WK, Bae WG (2003) 100 cases of endoscopic thyroidectomy: breast approach. Surg Laparosc Endosc Percutan 13:20–25CrossRefGoogle Scholar
  15. 15.
    Ikeda Y, Takami H, Sasaki Y, Takayama J, Niimi M, Kan S (2003) Clinical benefits in endoscopic thyroidectomy by the axillary approach. J Am Coll Surg 196:189–195PubMedCrossRefGoogle Scholar
  16. 16.
    Cougard P, Osmak L, Esquis P, Ognois P (2005) Endoscopic thyroidectomy: a preliminary report including 40 patients. Ann Chir 130:81–85PubMedCrossRefGoogle Scholar
  17. 17.
    Duh QY (2003) Minimally invasive endocrine surgery: standard of treatment or hype? Surgery 134:849–857PubMedCrossRefGoogle Scholar
  18. 18.
    Terris DJ, Haus BM, Nettar K, Ciecko S, Gourin CG (2004) Prospective evaluation of endoscopic approaches to the thyroid compartment. Laryngoscope 114:1377–1382PubMedCrossRefGoogle Scholar
  19. 19.
    Inabnet WB, Gagner M (2001) Endoscopic thyroidectomy. Otolaryngology 30:41–42CrossRefGoogle Scholar
  20. 20.
    Morioka M, Hamada J, Yano S, Kai Y, Ogata N, Yumoto E, Ushio Y, Kuratsu J (2005) Frontal skull base surgery combined with endonasal endoscopic sinus surgery. Surg Neurol 64:44–49PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  • K. Witzel
    • 1
    Email author
  • B. H. A. von Rahden
    • 1
  • C. Kaminski
    • 1
  • H. J. Stein
    • 1
  1. 1.Department of SurgeryParacelsus Medical Private UniversitySalzburgAustria

Personalised recommendations