Transoral endoscopic thyroidectomy vestibular approach (TOETVA): indications, techniques and results
- 1.4k Downloads
The Transoral Neck Surgery (TONS) Study Group was established at the 1st International Thyroid NOTES Conference in February 2016 with the intention of standardizing and refining thyroid NOTES techniques, including both transoral endoscopic and robotic thyroidectomy approaches. Herein, the authors report the modification of indications, preparation, and step-by-step explanations for operative techniques, as well as results and postoperative care for transoral endoscopic thyroidectomy vestibular approach (TOETVA).
Between February 2015 and December 2015, a total of 200 patients comprising 8 males (4%) and 192 females (96%) underwent TOETVA using 3 laparoscopic ports inserted at the oral vestibule. Of these patients, 111 presented with single thyroid nodules (55.5%), while 66 patients had multinodular goiters (33%), 12 had Graves’ disease (6%) and 11 had papillary microcarcinoma (5.5%). The CO2 insufflation pressure was maintained at 6 mmHg. Each surgery was performed using laparoscopic instruments and ultrasonic devices.
TOETVA was performed on 200 consecutive patients. No conversion to conventional open surgery was necessary. Average tumor size was 4.1 ± 1.78 cm (1–10 cm). Median operative time was 97 ± 40.5 min (45–300 min). Median blood loss was 30 ± 46.25 mL (6–300 mL). Mean visual analog scale measurements were 2.41 ± 2.04 (2–7), 1.17 ± 1.4 (0–5), and 0.47 ± 0.83 (0–3) on the first, second, and third days, respectively. Temporary hoarseness and hypoparathyroidism occurred in 8 patients (4%) and 35 patients (17.5%), respectively. No permanent hoarseness or hypoparathyroidism occurred. Mental nerve injury occurred in 3 patients (1.5%). One patient (0.5%) developed a post-operative hematoma that required open surgery. No infection was identified.
TOETVA was shown to be safe and feasible with a reasonable surgical duration and minimal pain scores. This approach shows promise for those patients who are motivated to avoid a neck scar.
KeywordsTransoral endoscopic thyroidectomy Thyroidectomy TOETVA Transoral Endoscopic thyroidectomy Transoral neck surgery
No grant support was received for this study.
Compliance with ethical standards
Dr. Angkoon Anuwong, Dr. Thanyawat Sasanakietkul, Dr. Pornpeera Jitpratoom, Dr. Khwannara Kantha, Dr. Hoon Yub Kim, Dr. Gianlorenzo Dionigi and Dr. Jeremy Richmon have no conflicts of interest or financial ties to disclose related to the work herein.
- 13.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 27:1105–1110CrossRefPubMedGoogle Scholar
- 26.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 26:1–133CrossRefPubMedPubMedCentralGoogle Scholar
- 29.Calò PG, Pisano G, Medas F, Pittau MR, Gordini L, Demontis R, Nicolosi A (2014) Identification alone versus intraoperative neuromonitoring of the recurrent laryngeal nerve during thyroid surgery: experience of 2034 consecutive patients. J Otolaryngol Head Neck Surg 43:16. doi: 10.1186/1916-0216-43-16 CrossRefPubMedPubMedCentralGoogle Scholar