Transoral thyroidectomy: advantages and limitations
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In this opinion paper of the Journal of Endocrinological Investigation, leading experts in the field report on their current clinical experience with a novel approach for thyroid gland surgery, namely, “transoral thyroidectomy” (TOT). This feasible and novel surgical procedure does not require visible incisions and is, therefore, a truly scarless surgery. Patients meeting the following criteria can be considered as candidates for TOT: (a) an ultrasonographically (US) estimated thyroid diameter ≤10 cm; (b) US-estimated gland volume ≤45 mL; (c) nodule size ≤50 mm; (d) presence of a benign tumor such as a thyroid cyst or a single- or multi-nodular goiter; (e) Bethesda 3 and/or 4 category and (f) papillary microcarcinoma without the evidence of metastasis. The procedure is conducted via a three-port technique at the oral vestibule using a 10-mm port for the 30° endoscope and two additional 5-mm ports for the dissecting and coagulating instruments. TOT is performed using conventional endoscopic instruments and is probably the best scarless approach to the thyroid because of the short distance between the thyroid and the incisions placed intra-orally that do not result in any cutaneous scar and upon following the surgical planes. Experts in TOT organized a working group of general, endocrine, head and neck ENT surgeons and endocrinologist to develop the standards for practicing this emerging technique.
KeywordsThyroid Thyroidectomy Mini-invasive thyroidectomy Transoral thyroidectomy
(I) Conception and design: Gianlorenzo Dionigi, Hoon Yub Kim, Angkoon Anuwong; (II) Administrative support: Gianlorenzo Dionigi, Ralph P. Tufano, Angkoon Anuwong; (IV) Collection and assembly of data: Gianlorenzo Dionigi, Hoon Yub Kim, Ralph P. Tufano; (V) Data analysis and interpretation: Gianlorenzo Dionigi, Hoon Yub Kim, Ralph P. Tufano, Angkoon Anuwong; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors.
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.
The study was approved by the institutional ethics committee of Department of Medicine and Surgery, University of Insubria.
All patients were provided the particular details for their surgeries and informed consent obtained from each patient.
- 3.Souberbielle JC, Brazier F, Piketty ML, Cormier C, Minisola S, Cavalier E (2017) How the reference values for serum parathyroid hormone concentration are (or should be) established? J Endocrinol Invest. 40(3):241–256. doi: 10.1007/s40618-016-0553-2 [Epub 2016 Oct 1. Review. PubMed PMID: 27696297] CrossRefPubMedGoogle Scholar
- 6.Cassio A, Corbetta C, Antonozzi I, Calaciura F, Caruso U, Cesaretti G, Gastaldi R, Medda E, Mosca F, Pasquini E, Salerno MC, Stoppioni V, Tonacchera M, Weber G, Olivieri A, Italian Society for Pediatric Endocrinology and Diabetology, Italian Society for the Study of Metabolic Diseases and Neonatal Screening, Italian National Institute of Health, Italian National Coordinating Group for Congenital Hypothyroidism, Italian Thyroid Association, Italian Society of Pediatrics, Italian Society of Neonatology, Italian Society of Endocrinology, Associazione Medici Endocrinologi (2013) The Italian screening program for primary congenital hypothyroidism: actions to improve screening, diagnosis, follow-up, and surveillance. J Endocrinol Invest 36(3):195–203. doi: 10.3275/8849 PubMedGoogle Scholar
- 31.Inabnet WB 3rd, Suh H, Fernandez-Ranvier G (2016) Transoral endoscopic thyroidectomy vestibular approach with intraoperative nerve monitoring. Surg Endosc [Epub ahead of print] Google Scholar