Transoral endoscopic thyroidectomy: preliminary experience in Italy
- 509 Downloads
Transoral endoscopic thyroidectomy vestibular approach (TOETVA) is a feasible novel surgical procedure that does not need visible incisions. We describe our initial experience with TOETVA. We recruited 15 patients who were willing to undergo TOETVA. Inclusion criteria were (a) patients who had a neck ultrasound (US) with a estimated thyroid diameter not larger than 10 cm; (b) US estimated gland volume ≤45 mL; (c) nodule size ≤50 mm; (d) a benign tumor, such as a thyroid cyst, single-nodular goiter, or multinodular goiter; (e) follicular neoplasm; (f) papillary microcarcinoma without evidence of metastasis. The procedure is carried out through a three-port technique placed at the oral vestibule, one 10-mm port for 30° endoscope and two additional 5-mm ports for dissecting and coagulating instruments. CO2 insufflation pressure is set at 6 mmHg. An anterior cervical subplatysmal space is created from the oral vestibule down to the sternal notch, laterally to the sternocleidomastoid muscle. Thyroidectomy is done fully endoscopically using conventional endoscopic instruments and intraoperative neuromonitoring. There were 34% total thyroidectomies and 66% hemithyroidectomies. All TOETVA procedures were performed successfully with no conversions. The mean operative time was 87.6 (59–118) min for lobectomy and 107.6 (99–135) min for bilateral procedure. We observed one case of transient postoperative hypocalcemia. There was no recurrent laryngeal nerve palsy. The cosmetic result was excellent in all patients. This is the first case series of TOETVA in Italy. TOETVA may provide a method for ideal cosmetic results. The results are encouraging, and we are optimistic about the future expansion of its applicability.
KeywordsThyroid surgery Endoscopic thyroidectomy Minimally invasive thyroidectomy
Compliance with ethical standards
Conflict of interest
The authors have no conflict of interest to disclosure, and no other funding or financial relationship with the surgical industry.
Research involving human participants and/or animals
The study was approved by the institutional ethics committee of Department of Medicine and Surgery, University of Insubria.
All participants were provided the particular details for their surgeries and informed consent obtained from each patient.
- 15.Wu CW, Lu IC, Randolph GW, Kuo WR, Lee KW, Chen CL, Chiang FY (2010) Investigation of optimal intensity and safety of electrical nerve stimulation during intraoperative neuromonitoring of the recurrent laryngeal nerve: a prospective porcine model. Head Neck 32(10):1295–1301CrossRefPubMedGoogle Scholar
- 17.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):1–133CrossRefPubMedPubMedCentralGoogle Scholar
- 28.Dionigi G, Rovera F, Boni L, Castano P, Dionigi R (2006) Surgical site infections after thyroidectomy. Surg Infect (Larchmt) 7(Suppl 2):S117–S120Google Scholar