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Surgical Endoscopy

, Volume 24, Issue 6, pp 1261–1267 | Cite as

Transoral thyroid and parathyroid surgery

  • Elias Karakas
  • Thorsten Steinfeldt
  • Andreas Gockel
  • Reiner Westermann
  • Anja Kiefer
  • Detlef K. Bartsch
Article

Abstract

Background

Translumenal endoscopic interventions via so-called natural orifices are gaining increasing interest because they allow surgical treatment without any incision of the skin. Moreover, minimally invasive procedures have found their way into thyroid and parathyroid surgery. Our goal was to develop a new access for thyroid and parathyroid resection via an entirely transoral approach.

Methods

We managed to find an entirely transoral sublingual access to the thyroid region in pigs and human cadavers. Using a modified rigid rectoscope (oraloscope) hemithyroidectomies as well as resection of parathyroid glands were performed via this new approach. Preparation and resection was performed using conventional laparoscopic instruments. In living pigs, integrity of the recurrent laryngeal nerve after resection could be documented by neuromonitoring. An absorbable suture was used to seal the mucosal incision.

Results

First, hemithyroidectomy was performed via the transoral access in 10 porcine cadavers, then in 10 living and orally intubated pigs, and finally in five human corpses. In humans, resection of parathyroid glands also was performed. We gained access to the thyroid region by blunt dissection of the layer behind the hyoid bone and the strap muscles of the neck. We did not observe any complication during the insertion, resection, and removal part of the new procedure.

Conclusions

Entirely transoral thyroid and parathyroid surgery via sublingual access seems to be feasible. However, further investigations are needed to evaluate the safety of the new technique, especially potential and clinically relevant contamination of the access route has to be excluded.

Keywords

NOTES Surgical approach Thyroid and parathyroid gland 

Notes

Disclosures

Drs. Elias Karakas, Thorsten Steinfeldt, Anja Kiefer, Thorsten Schlosshauer, Andreas Gockel, Reiner Westermann, and Detlef K. Bartsch have no conflicts of interest or financial ties to disclose.

References

  1. 1.
    Rattner D, Kalloo A (2006) ASGE/SAGES Working Group on natural orifice translumenal endoscopic surgery 2005. Surg Endosc 20:329–333CrossRefPubMedGoogle Scholar
  2. 2.
    Gagner M (1996) Endoscopic subtotal parathyroidectomy in patients with primary hyperparathyroidism. Br J Surg 83:875CrossRefPubMedGoogle Scholar
  3. 3.
    Yeung GH (1998) Endoscopic surgery of the neck: a new frontier. Surg Laparosc Endosc 8:227–232CrossRefPubMedGoogle Scholar
  4. 4.
    Sebag F, Palazzo FF, Harding J, Sierra M, Ippolito G, Henry JF (2006) Endoscopic lateral approach thyroid lobectomy: safe evolution from endoscopic parathyroidectomy. World J Surg 30:802–805CrossRefPubMedGoogle Scholar
  5. 5.
    Shimizu K (2001) Minimally invasive thyroid surgery. Best Pract Res Clin Endocrinol Metab 15:123–137CrossRefPubMedGoogle Scholar
  6. 6.
    Takami H, Ikeda Y (2003) Total endoscopic thyroidectomy. Asian J Surg 26:82–85Google Scholar
  7. 7.
    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 16:88–91CrossRefPubMedGoogle Scholar
  8. 8.
    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 16:92–95CrossRefPubMedGoogle Scholar
  9. 9.
    Witzel K (2007) The axillary access in unilateral thyroid resection. Langenbecks Arch Surg 392:617–621CrossRefPubMedGoogle Scholar
  10. 10.
    Shimizu K, Shiba E, Tamaki Y, Takiguchi S, Tanigushi E, Ohashi S, Noguchi S (2003) Endoscopic thyroid surgery through the axillobilateral breast approach. Surg Laparosc Endosc Percutan Tech 13:196–201CrossRefGoogle Scholar
  11. 11.
    Park YL, Han WK, Bae WG (2003) 100 cases of endoscopic thyroidectomy: breast approach. Surg Laparosc Endosc Percutan Tech 13:20–25Google Scholar
  12. 12.
    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 196:189–195CrossRefPubMedGoogle Scholar
  13. 13.
    Cougard P, Osmak L, Esquis P, Ognois P (2005) Endoscopic thyroidectomy; a preliminary report including 40 patients. Ann Chir 130:81–85Google Scholar
  14. 14.
    Duh QY (2003) Minimally invasive endocrine surgery: standard of treatment or hype? Surgery 134:849–857CrossRefPubMedGoogle Scholar
  15. 15.
    Witzel K, Rahden BHA, Kaminski C, Stein HJ (2008) Transoral access for endoscopic thyroid resection. Surg Endsoc 22:1871–1875CrossRefGoogle Scholar
  16. 16.
    Akerström G, Malmaeus J, Bergström R (1984) Surgical anatomy of human parathyroid glands. Surgery 95:14–21PubMedGoogle Scholar
  17. 17.
    Langman J (1981) Medical embryology, 4th edn. Williams & Wilkins, BaltimoreGoogle Scholar
  18. 18.
    Schiel R, Olthoff A, Kruse E (2005) Comparative anatomic conditions of the recurrent laryngeal nerve in humans and pigs; Vergleichende Anatomie des N. recurrens bei Mensch und Schwein. http://www.egms.de/en/meetings/dgpp2005/05dgpp098.shtml (German)
  19. 19.
    Salomon, Franz-Viktor, Geyer, Hans; Gilles, Uwe [Hrsg.] (2008) Anatomy in veterinary medicine (Anatomie für die Tiermedizin), Enkeverlag (German)Google Scholar
  20. 20.
  21. 21.
    Wagh MS, Merrifield BF, Thompson CC (2006) Survival studies after endoscopic transgastric oophorectomy and tubectomy in a porcine model. Gastrointest Endosc 63:473–478CrossRefPubMedGoogle Scholar
  22. 22.
    Kanstevoy SV, Jagannath SB, Niiyama H, Chung SS, Cotton PB, Gostout CJ, Hawes RH, Pasricha PJ, Magee CA, Vaughn CA, Barlow D, Shimonaka H, Kalloo AN (2005) Endoscopic gastrojejunostomy with survival in a porcine model. Gastrointest Endosc 62:287–292CrossRefGoogle Scholar
  23. 23.
    Merrifield BF, Wagh MS, Thompson CC (2006) Peroral transgastric organ resection; a feasibility study in pigs. Gastrointest Endosc 63:693–697CrossRefPubMedGoogle Scholar
  24. 24.
    Della Flora E, Wilson TG, Martin IJ, O’Rourke NA, Maddern GJ (2008) A review of natural orifice translumenal endoscopic surgery (NOTES) for intra-abdominal surgery experimental models, techniques, and applicability to the clinical setting. Ann Surg 247:583–602CrossRefGoogle Scholar
  25. 25.
    Bergenfelz A, Kanngiesser V, Zielke A, Nies C, Rothmund M (2005) Conventional bilateral cervical exploration versus open minimally invasive parathyroidectomy under local anaesthesia for primary hyperparathyroidism. Br J Surg 92:190–197CrossRefPubMedGoogle Scholar
  26. 26.
    Miccoli P (2002) Minimally invasive surgery for thyroid and parathyroid diseases. Surg Endosc 16:3–6CrossRefPubMedGoogle Scholar
  27. 27.
    Lorenz K, Miccoli P, Monchik JM, Düren M, Dralle H (2001) Minimally invasive video-assisted parathyroidectomy: multi-institutional study. World J Surg 25:704–707CrossRefPubMedGoogle Scholar
  28. 28.
    Barczyński M, Cichoń S, Konturek A, Cichoń W (2006) Minimally invasive video-assisted parathyroidectomy versus open minimally invasive parathyroidectomy for a solitary parathyroid adenoma: a prospective, randomized, blinded trial. World J Surg 30:721–731CrossRefPubMedGoogle Scholar
  29. 29.
    Rubello D, Mariani G, Pelizzo MR (2007) Italian Study Group of Radioguided Surgery and ImmunoScintigraphy. Minimally invasive radio-guided parathyroidectomy on a group of 452 primary hyperparathyroid patients: refinement of preoperative imaging and intraoperative procedure. Nuklearmedizin 46:85–92PubMedGoogle Scholar
  30. 30.
    Grant CS, Thompson G, Farley D, van Heerden J (2005) Primary hyperparathyroidism surgical management since the introduction of minimally invasive parathyroidectomy: Mayo Clinic experience. Arch Surg 140:472–478CrossRefPubMedGoogle Scholar
  31. 31.
    Berti P, Materazzi G, Picone A, Miccoli P (2003) Limits and drawbacks of video-assisted parathyroidectomy. Br J Surg 90:743–747CrossRefPubMedGoogle Scholar
  32. 32.
    Irvin GL III, Solorzano CC, Carneiro DM (2004) Quick intraoperative parathyroid hormone assay: surgical adjunct to allow limited parathyroidectomy, improve success rate, and predict outcome. World J Surg 28:1287–1292CrossRefPubMedGoogle Scholar
  33. 33.
    Udelsman R, Donovan PI (2004) Open minimally invasive parathyroid surgery. World J Surg 28:1224–1226CrossRefPubMedGoogle Scholar
  34. 34.
    Udelsman R, Donovan PI, Sokoll LJ (2000) One hundred consecutive minimally invasive parathyroid explorations. Ann Surg 232:331–339CrossRefPubMedGoogle Scholar
  35. 35.
    Henry JF, Sebag F, Cherenko M, Ippolito G, Taieb D, Vaillant J (2008) Endoscopic parathyroidectomy: why and when? World J Surg 32:2509–2515CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  • Elias Karakas
    • 1
  • Thorsten Steinfeldt
    • 2
  • Andreas Gockel
    • 2
  • Reiner Westermann
    • 3
  • Anja Kiefer
    • 1
  • Detlef K. Bartsch
    • 1
  1. 1.Department of Visceral, Thoracic, and Vascular SurgeryUniversity Hospital MarburgMarburgGermany
  2. 2.Department of Anaesthesiology and Critical CareUniversity Hospital MarburgMarburgGermany
  3. 3.Department of Anatomy and Cell BiologyPhilipps-University MarburgMarburgGermany

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