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Endocrine

, Volume 59, Issue 2, pp 275–279 | Cite as

Transoral endoscopic thyroidectomy via a vestibular approach: why and how?

  • Gianlorenzo Dionigi
  • Young Jun Chai
  • Ralph P. Tufano
  • Angkoon Anuwong
  • Hoon Yub KimEmail author
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Abstract

The transoral endoscopic thyroidectomy vestibular approach (TOETVA) is a novel, scar-free surgical procedure that does not require visible incisions. Indications for TOETVA are as follows: predicted gland width on diagnostic imaging ≤10 cm; a thyroid volume outline of <45 mL or dominant nodule dimension of ≤50 mm; three or four Bethesda lesions; a primary papillary microcarcinoma without local or distant metastasis; and patient request for optimal esthetic results. Contraindications are as follows: patients unfit for general anesthesia; precedent radiation in the head, neck, upper mediastinum; antecedent neck surgery; recurrent goiter; a gland volume of >45 mL or main nodule diameter of >50 mm; and documentation of lymph node or distant metastases, tracheal/esophageal infiltration, preoperative laryngeal nerve palsy, hyperthyroidism, mediastinal goiter, or an oral abscess. Patients with poorly differentiated or un-differentiated cancer, dorsal extrathyroidal radius, and/or lateral neck metastasis are not suitable for TOETVA. Following the introduction of a robotic surgical system, enabling a three-dimensional surgical view and the use of articulating instruments, TOETVA became suitable for most differentiated thyroid cancers without evidence of extensive extrathyroidal invasion or lateral neck metastasis. The procedure is performed using a vestibular approach and three-port technique; a 10-mm port is used for the 30° endoscope, two 5-mm ports are used for the dissecting and coagulating instruments, and an 8-mm port is placed in the axillary fold during the robotic procedure to enhance fine countertraction of tissue for radical oncological dissection. TOETVA follows surgical planes and is probably the best scar-free approach to the thyroid, given the short distance between the gland and intraoral incisions.

Keywords

Transoral thyroidectomy Endoscopic thyroidectomy Robotic thyroidectomy Natural orifice transluminal endoscopic surgery 

Notes

Author contributions

(I) Conception and design: G.D., H.Y.K., A.A.; (II) administrative support: G.D., R.P.T., A.A.; (III) collection and assembly of data: G.D., H.Y.K., R.P.T.; (IV) data analysis and interpretation: G.D., H.Y.K., Y.J.C., R.P.T., A.A.; (V) manuscript writing: all authors; (VI) final approval of manuscript: all authors.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no competing interests.

Informed consent

For this type of study formal informed consent is not required as the study does not involve participants.

References

  1. 1.
    Q.Y. Duh, Presidential address: minimally invasive endocrine surgery—standard of treatment or hype? Surgery 134, 849–857 (2003)CrossRefPubMedGoogle Scholar
  2. 2.
    J.F. Henry, Minimally invasive thyroid and parathyroid surgery is not a question of length of the incision. Langenbecks Arch. Surg. 393(5), 621–626 (2008).  https://doi.org/10.1007/s00423-008-0406-3 CrossRefPubMedGoogle Scholar
  3. 3.
    G. Dionigi, L. Boni, M. Duran-Poveda, Evolution of endoscopic thyroidectomy. Surg. Endosc. (2011).  https://doi.org/10.1007/s00464-011-1763-5
  4. 4.
    G. Dionigi, Evidence-based review series on endoscopic thyroidectomy: real progress and future trends. World J. Surg. 33(2), 365–366 (2009).  https://doi.org/10.1007/s00268-008-9834-z CrossRefPubMedGoogle Scholar
  5. 5.
    K. Witzel, B.H. von Rahden, C. Kaminski, H.J. Stein, Transoral access for endoscopic thyroid resection. Surg. Endosc. 22, 1871–1875 (2008)CrossRefPubMedGoogle Scholar
  6. 6.
    P. Miccoli, G. Materazzi, P. Berti, Natural orifice surgery on the thyroid gland using totally transoral video-assisted thyroidectomy: report of the first experimental results for a new surgical method: are we going in the right direction? Surg. Endosc. 24, 957–958 (2010)CrossRefPubMedGoogle Scholar
  7. 7.
    T. Benhidjeb, T. Wilhelm, J. Harlaar, G.J. Kleinrensink, T.A. Schneider, M. Stark, Natural orifice surgery on thyroid gland: totally transoral video-assisted thyroidectomy (TOVAT): report of first experimental results of a new surgical method. Surg. Endosc. 23, 1119–1120 (2009)CrossRefPubMedGoogle Scholar
  8. 8.
    T. Wilhelm, A. Metzig, Endoscopic minimally invasive thyroidectomy: first clinical experience. Surg. Endosc. 24, 1757–1758 (2010)CrossRefPubMedGoogle Scholar
  9. 9.
    T. Wilhelm, A. Metzig, Endoscopic minimally invasive thyroidectomy (eMIT): a prospective proof-of-concept study in humans. World J. Surg. 35, 543–551 (2011)CrossRefPubMedGoogle Scholar
  10. 10.
    E. Liu, A. Qadir Khan, J. Niu, Z. Xu, C. Peng, Natural orifice total transtracheal endoscopic thyroidectomy surgery: first reported experiment. J. Laparoendosc. Adv. Surg. Tech. A 25, 586–591 (2015)CrossRefPubMedGoogle Scholar
  11. 11.
    G. Dionigi, F. Rovera, L. Boni, Commentary on transoral access for endoscopic thyroid resection ‘Witzel, K., von Rahden, B.H., Kaminski, C., Stein, H.J.: Transoral access for endoscopic thyroid resection. Surg. Endosc. 22, 1871–1875 (2008).  https://doi.org/10.1007/s00464-008-0241-1. Surg. Endosc. (2009)CrossRefGoogle Scholar
  12. 12.
    A. Anuwong, Transoral endoscopic thyroidectomy vestibular approach: a series of the first 60 human cases. World J. Surg. 40, 491–497 (2016)CrossRefPubMedGoogle Scholar
  13. 13.
    R. Udelsman, A. Anuwong, A.D. Oprea, A. Rhodes, M. Prasad, M. Sansone, C. Brooks, P.I. Donovan, C. Jannitto, T. Carling, Trans-oral vestibular endocrine surgery: a new technique in the United States. Ann. Surg. 264, e13–e16 (2016)CrossRefPubMedGoogle Scholar
  14. 14.
    H.Y. Kim, Y.J. Chai, G. Dionigi, A. Anuwong, J. Richmon, Transoral robotic thyroidectomy: lessons learned from an initial consecutive series of 24 patients. Surg. Endosc. (2017).  https://doi.org/10.1007/s00464-017-5724-5
  15. 15.
    A. Anuwong, T. Sasanakietkul, P. Jitpratoom, K. Ketwong, H.Y. Kim, G. Dionigi, J.D. Richmon, Transoral endoscopic thyroidectomy vestibular approach (TOETVA): indications, techniques and results. Surg. Endosc. (2017)  https://doi.org/10.1007/s00464-017-5705-8
  16. 16.
    A. Anuwong, H.Y. Kim, G. Dionigi, Transoral endoscopic thyroidectomy using vestibular approach: updates and evidences. Gland Surg. 6(3), 277–284 (2017).  https://doi.org/10.21037/gs.2017.03.16 CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    G. Dionigi, M. Lavazza, C.W. Wu, H. Sun, X. Liu, R.P. Tufano, H.Y. Kim, J.D. Richmon, A. Anuwong, Transoral thyroidectomy: why is it needed? Gland Surg 6(3), 272–276 (2017).  https://doi.org/10.21037/gs.2017.03.21 CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    J.O. Russell, J. Clark, S.I. Noureldine, A. Anuwong, M.G. Al Khadem, H. Yub Kim, V.K. Dhillon, G. Dionigi, R.P. Tufano, J.D. Richmon, Transoral thyroidectomy and parathyroidectomy—a North American series of robotic and endoscopic transoral approaches to the central neck. Oral Oncol. 71, 75–80 (2017).  https://doi.org/10.1016/j.oraloncology.2017.06.001 CrossRefPubMedGoogle Scholar
  19. 19.
    G. Dionigi, R.P. Tufano, J. Russell, H.Y. Kim, E. Piantanida, A. Anuwong, Transoral thyroidectomy: advantages and limitations. J. Endocrinol. Invest. (2017)  https://doi.org/10.1007/s40618-017-0676-0
  20. 20.
    G. Dionigi, A. Bacuzzi, M. Lavazza, D. Inversini, L. Boni, S. Rausei, H.Y. Kim, A. Anuwong, Transoral endoscopic thyroidectomy: preliminary experience in Italy. Updates Surg. 69(2), 225–234 (2017).  https://doi.org/10.1007/s13304-017-0436-x CrossRefPubMedGoogle Scholar
  21. 21.
    G. Dionigi, M. Lavazza, A. Bacuzzi, D. Inversini, V. Pappalardo, R.P. Tufano, H.Y. Kim, A. Anuwong, Transoral endoscopic thyroidectomy vestibular approach (TOETVA): from A to Z. Surg. Technol. Int. 30, 103–112 (2017)PubMedGoogle Scholar
  22. 22.
    G. Dionigi, A. Bacuzzi, M. Lavazza, D. Inversini, V. Pappalardo, L. Boni, S. Rausei, M. Barczynski, R.P. Tufano, H.Y. Kim, A. Anuwong, Transoral endoscopic thyroidectomy via vestibular approach: operative steps and video. Gland Surg. 5(6), 625–627 (2016).  https://doi.org/10.21037/gs.2016.12.05 CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  1. 1.Division for Endocrine and Minimally Invasive Surgery, Department of Human Pathology in Adulthood and Childhood “G. Barresi”University Hospital G. Martino, University of MessinaMessinaItaly
  2. 2.Department of SurgerySeoul Metropolitan Government, Seoul National University Boramae Medical CenterSeoulSouth Korea
  3. 3.Division of Head and Neck Endocrine Surgery, Department of Otolaryngology-Head and Neck SurgeryJohns Hopkins University School of MedicineBaltimoreUSA
  4. 4.Minimally Invasive and Endocrine Division, Department of SurgeryPolice General HospitalBangkokThailand
  5. 5.Department of SurgeryKorea University College of Medicine, Seoul, KoreaSeoulKorea

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