Transoral periosteal thyroidectomy: cadaver to human
- 742 Downloads
Although endoscopic thyroid surgery is gaining wide acceptance, existing endoscopic methods for thyroidectomy are blamed for the increased frequency of flap dissections and longer surgical times. More recently, transoral endoscopic thyroidectomy has overcome the limitations of previous approaches. Herein, we present our initial experience with transoral periosteal thyroidectomy (TOPOT) in cadaver and porcine models. Using these models, the surgical view was improved and had greater freedom of motion; the technique was then performed in human subjects using robotic TOPOT, which has not previously been reported.
TOPOTs were performed in seven fresh human cadavers and ten live pigs. Total thyroidectomies were performed in all cadavers and pigs. After the cadaver and animal trials, four human patients underwent robotic TOPOT performed using the da Vinci® surgical system at Korea University Anam Hospital. Recurrent laryngeal nerve function, intra- and postoperative complications, and postoperative outcomes were assessed in all patients.
One left lobectomy for follicular adenoma, two right lobectomies for nodular hyperplasia, and one left lobectomy with a central neck dissection for papillary thyroid microcarcinoma were performed in the human subjects using a robotic transoral periosteal approach. In three cases, paresthesia occurred in the mental nerve, but this improved within 4 weeks in all cases. No local infections occurred at the incision site or anterior neck, and no recurrent laryngeal nerve cord palsies occurred postoperatively.
TOPOT may be an effective and safe approach for robotic thyroid surgery.
KeywordsThyroidectomy Transoral Periosteal Minimally invasive
Hye Yoon Lee, Ji Young You, Sang Uk Woo, Gil Soo Son, Jae Bok Lee, Jeoung Won Bae, and Hoon Yub Kim have no conflicts of interest or financial ties to disclose.
This research was supported by Basic Science Research Program through the National Research Foundation of Korea(NRF) funded by the Ministry of Education, Science and Technology (2012R1A1A1013413) and supported by a Korea University grant (K1421381).
Supplementary material 1 (MPG 10,630 kb)
Supplementary material 2 (MPG 22,644 kb)
Supplementary material 3 (MPG 19,278 kb)
- 2.Wilhelm T, Harlaar JJ, Kerver A, Kleinrensink GJ, Benhidjeb T (2010) Surgical anatomy of the floor of the oral cavity and the cervical spaces as a rationale for trans-oral, minimal-invasive endoscopic surgical procedures: results of anatomical studies. Eur Arch Otorhinolaryngol 267:1285–1290CrossRefPubMedGoogle Scholar
- 8.Nakajo A, Arima H, Hirata M, Mizoguchi T, Kijima Y, Mori S, Ishigami S, Ueno S, Yoshinaka H, Natsugoe S (2013) Trans-Oral Video-Assisted Neck Surgery (TOVANS). A new transoral technique of endoscopic thyroidectomy with gasless premandible approach. Surg Endosc 27:1105–1110CrossRefPubMedCentralPubMedGoogle Scholar