Skip to main content

Advertisement

SpringerLink
Log in

Anatomical study of gasless transoral thyroidectomy and clinical application

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Transoral thyroidectomy is becoming a preferred technique because it has the advantage of not leaving a scar after surgery. However, it is not yet standard because of the anatomic nerve complexity of this oral cavity and difficulty of approach. The aim of this study was to determine the safety zone of a gasless transoral thyroidectomy approach using an anatomical study and to evaluate the efficacy of this approach on clinical application.

Methods

Phase 1, twenty unilateral specimens from fresh cadavers underwent staining by the modified Sihler’s method to identify nerves around the oral vestibules. Then, the safety zone of the transoral thyroidectomy approach was proposed. Phase 2, a comparative analysis of the clinical outcomes of gasless transoral thyroidectomy through the safety zone versus transcutaneous thyroidectomy approach.

Results

In phase 1, numerous inferior labial branches diverged from the mental nerve and were distributed across the lower lip. In most cases, the most lateral branch reached almost to the corner of the mouth, whereas a nerve-free area was present at the medial region of the lower lip. The suggested safety zone was presented as a trapezoid shape. In phase 2, there were no significant differences in age, mass size, or complications between the two groups. However, the operation time in the transoral thyroidectomy group was longer than in the transcutaneous group (p = 0.001).

Conclusions

Based on the anatomical study, we suggested a safety zone for the gasless transoral thyroidectomy. On application of this safety zone, gasless transoral thyroidectomy is a safe and feasible procedure.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Anuwong A, Ketwong K, Jitpratoom P, Sasanakietkul T, Duh QY (2018) Safety and outcomes of the transoral endoscopic thyroidectomy vestibular approach. JAMA Surg 153:21–27

    Article  Google Scholar 

  2. Woo SH (2014) Endoscope-assisted transoral thyroidectomy using a frenotomy incision. J Laparoendosc Adv Surg Tech A 24:345–349

    Article  Google Scholar 

  3. Kim K, Gu MO, Jung JH, Hahm JR, Kim SK, Kim JH, Woo SH (2018) Efficacy of a home-based exercise program after thyroidectomy for thyroid cancer patients. Thyroid 28:236–245

    Article  CAS  Google Scholar 

  4. Lee JS, Kim JP, Ryu JS, Woo SH (2018) Effect of wound massage on neck discomfort and voice changes after thyroidectomy. Surgery 164:965–971

    Article  Google Scholar 

  5. Anuwong A (2016) Transoral endoscopic thyroidectomy vestibular approach: a series of the first 60 human cases. World J Surg 40:491–497

    Article  Google Scholar 

  6. Huscher CS, Chiodini S, Napolitano C, Recher A (1997) Endoscopic right thyroid lobectomy. Surg Endosc 11:877

    Article  CAS  Google Scholar 

  7. Kim HY, Chai YJ, Dionigi G, Anuwong A, Richmon JD (2017) Transoral robotic thyroidectomy: lessons learned from an initial consecutive series of 24 patients. Surg Endosc 32(2):688–694

    Article  Google Scholar 

  8. Clark MP, Qayed ES, Kooby DA, Maithel SK, Willingham FF (2012) Natural orifice translumenal endoscopic surgery in humans: a review. Minim Invasive Surg 2012:189296

    PubMed  PubMed Central  Google Scholar 

  9. Clark JH, Kim HY, Richmon JD (2015) Transoral robotic thyroid surgery. Gland Surg 4:429–434

    PubMed  PubMed Central  Google Scholar 

  10. Kim JP, Park JJ, Lee EJ, Woo SH (2011) Intraoral removal of a thyroglossal duct cyst using a frenotomy incision. Thyroid 21:1381–1384

    Article  Google Scholar 

  11. Woo SH, Jeong HS, Kim JP, Park JJ, Baek CH (2013) Endoscope-assisted intraoral removal of ectopic thyroid tissue using a frenotomy incision. Thyroid 23:605–608

    Article  Google Scholar 

  12. Yang CH, Chew KY, Solomkin JS, Lin PY, Chiang YC, Kuo YR (2013) Surgical site infections among high-risk patients in clean-contaminated head and neck reconstructive surgery: concordance with preoperative oral flora. Ann Plast Surg 71(Suppl 1):S55–S60

    CAS  PubMed  Google Scholar 

  13. Kim HS, Shin KJ, Jehoon O, Kwon HJ, Lee M, Yang HM (2018) Stereotactic topography of the greater and third occipital nerves and its clinical implication. Sci Rep 8:870

    Article  Google Scholar 

  14. Calo 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

    Article  Google Scholar 

  15. Cuschieri A (1992) “A rose by any other name…” minimal access or minimally invasive surgery? Surg Endosc 6:214

    Article  CAS  Google Scholar 

  16. Duh QY (2003) Presidential address: minimally invasive endocrine surgery–standard of treatment or hype? Surgery 134:849–857

    Article  Google Scholar 

  17. Henry JF (2008) Minimally invasive thyroid and parathyroid surgery is not a question of length of the incision. Langenbecks Arch Surg 393:621–626

    Article  Google Scholar 

  18. Miccoli P, Berti P, Materazzi G, Minuto M, Barellini L (2004) Minimally invasive video-assisted thyroidectomy: five years of experience. J Am Coll Surg 199:243–248

    Article  Google Scholar 

  19. Ng JW (2004) Minimally invasive surgery or minimal-incision thyroidectomy? Arch Surg 139:802

    Article  Google Scholar 

  20. Tan CT, Cheah WK, Delbridge L (2008) “Scarless” (in the neck) endoscopic thyroidectomy (SET): an evidence-based review of published techniques. World J Surg 32:1349–1357

    Article  Google Scholar 

  21. Yeung GH (2002) Endoscopic thyroid surgery today: a diversity of surgical strategies. Thyroid 12:703–706

    Article  Google Scholar 

  22. Kim JP, Park JJ, Jeon SY, Ahn SK, Hur DG, Kim DW, Park HW, Woo SH (2012) Endoscope-assisted intraoral resection of external dermoid cyst. Head Neck 34:907–910

    Article  Google Scholar 

  23. Woo SH, Jeong HS, Kim JP, Park JJ, Baek CH (2014) Endoscope-assisted frenotomy approach to median upper neck masses: clinical outcomes and safety (from a phase II clinical trial). Head Neck 36:985–991

    Article  Google Scholar 

  24. Woo SH, Park JJ, Hong JC, Wang SG, Park GC, Eun YG, Kim JP, Jeong HS (2015) Endoscope-assisted transoral removal of a thyroglossal duct cyst using a frenotomy incision: a prospective clinical trial. Laryngoscope 125:2730–2735

    Article  Google Scholar 

  25. Woo SH (2016) Endoscope-assisted transoral accessory parotid mass excision. Head Neck 38:E7–E12

    Article  Google Scholar 

  26. Kim JP, Lee DK, Moon JH, Park JJ, Woo SH (2018) Transoral dermoid cyst excision: a multicenter prospective observational study. Otolaryngol Head Neck Surg 159:981–986

    Article  Google Scholar 

  27. Kim JP, Park JJ, Woo SH (2018) No-scar transoral thyroglossal duct cyst excision in children. Thyroid 28:755–761

    Article  Google Scholar 

  28. Kim KN, Lee DW, Kim JY, Han KH, Tae K (2018) Carbon dioxide embolism during transoral robotic thyroidectomy: a case report. Head Neck 40:E25–E28

    Article  Google Scholar 

  29. Kim KN, Lee DW, Tae K (2019) Reply to letter to the editor regarding “carbon dioxide embolism during transoral robotic thyroidectomy: a case report”. Head Neck 41:832

    PubMed  Google Scholar 

  30. Hu KS, Yun HS, Hur MS, Kwon HJ, Abe S, Kim HJ (2007) Branching patterns and intraosseous course of the mental nerve. J Oral Maxillofac Surg 65:2288–2294

    Article  Google Scholar 

  31. Won SY, Yang HM, Woo HS, Chang KY, Youn KH, Kim HJ, Hu KS (2014) Neuroanastomosis and the innervation territory of the mental nerve. Clin Anat 27:598–602

    Article  Google Scholar 

  32. Lee HJ, Won SY, Jehoon O, Hu KS, Mun SY, Yang HM, Kim HJ (2017) The facial artery: a comprehensive anatomical review. Clin Anat 31(1):99–108

    Article  Google Scholar 

  33. Edizer M, Magden O, Tayfur V, Kiray A, Ergur I, Atabey A (2003) Arterial anatomy of the lower lip: a cadaveric study. Plast Reconstr Surg 111:2176–2181

    Article  Google Scholar 

  34. Han P, Liang F, Cai Q, Chen R, Yu S, Huang X (2017) Endoscope-assisted resection of thyroglossal duct cysts via a submaxillary vestibular approach. Head Neck 40(2):377–383

    Article  Google Scholar 

Download references

Acknowledgements

We are deeply grateful to Dae Won Kim and Jun Ho Kim, members of staff in the Surgical Anatomy Education Centre, Yonsei University College of Medicine, for technical support. All figures in this manuscript were drawn by Mr. Jehoon O in the Department of Anatomy, Yonsei University College of Medicine.

Funding

This research was supported by a grant of the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of health & Welfare, Republic of Korea (grant number: HI15C1524). The research was supported by the Leading Foreign Research Institute Recruitment Program through the National Research Foundation of Korea funded by the Ministry of Science and ICT (MSIT) (NRF-2018K1A4A3A02060572).

Author information

Authors and Affiliations

  1. Department of Anatomy, Yonsei University College of Medicine, Seoul, South Korea

    Hun-Mu Yang

  2. Department of Anatomy and Cell Biology, Dong-A University College of Medicine, Busan, South Korea

    Kang-Jae Shin

  3. Department of Surgery, Dankook University College of Medicine, Cheonan, South Korea

    Junwon Min

  4. Department of Otolaryngology-Head and Neck Surgery, Dankook University College of Medicine, 201 Manghyang-ro, Dongnam-gu, Cheonan, 31116, South Korea

    Seung Hoon Woo

Authors
  1. Hun-Mu Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kang-Jae Shin
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Junwon Min
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Seung Hoon Woo
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Seung Hoon Woo.

Ethics declarations

Disclosures

Hun-Mu Yang, Kang-Jae Shin, Junwon Min, and Seung Hoon Woo have no financial or material support has been received for this work; moreover, the authors declare no financial interests in companies or other entities that could have an interest in the information contained within this study. Hun-Mu Yang, Kang-Jae Shin, Junwon Min, and Seung Hoon Woo have no conflicts of interest or financial ties to disclose.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOCX 12 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Yang, HM., Shin, KJ., Min, J. et al. Anatomical study of gasless transoral thyroidectomy and clinical application. Surg Endosc 34, 3414–3423 (2020). https://doi.org/10.1007/s00464-019-07117-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-019-07117-x

Keywords

Search

Navigation