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Pictorial essay of vestibular incision outcomes from transoral endoscopic thyroidectomy

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Abstract

Purpose

The transoral endoscopic thyroidectomy vestibular approach (TOETVA) has emerged as a new treatment option for patients with selected thyroid disease requiring surgery. The aim of this pictorial essay is to illustrate the healing outcomes of the vestibular incisions.

Methods

TOETVA patients were recruited at two Centers in China and Italy. TOETVA is initiated with one 10–20-mm median incision in the center of the oral vestibule 10 mm above the inferior labial frenulum, and two 5-mm lateral incisions, just below the lower lip near the labial commissure. Healing of the vestibular incision was monitored through serial photographs 1, 3, 7, 30, and 90 days after surgery. Outcomes were evaluated by Landry’s score, time to healing, issues affecting wound outcomes, scar, fibrin, granulation, necrotic tissue formation, and infections.

Results

Results of TOETVA were monitored in 52 patients. There were no postoperative infections. All lateral incisions demonstrated favorable surgical outcomes. Landry’s criteria scores indicated worse outcomes for the median incisions vs. the lateral ones (p<0.05). Median incisions healed well in 65.4% of patients, but 34.6% of patients had visible scars from the median incision 90 days after surgery. Eight (15.4%) had cicatricial diathesis, seven (13.5%) experienced displacement of the stitches, and three (5.8%) developed synechia with gingiva. When the central vestibular incision was <10mm from the gingiva, patients tended to form synechia (60%). There were no significant differences in wound healing between the Chinese and Italian patients.

Conclusions

Knowledge of vestibular incision healing is essential to provide practical TOETVA clinical guide and to define optimal outcomes evaluation for transoral surgeons. Vestibular wound problems were confined only to the central incision.

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Funding

This work was supported by the China Postdoctoral Science Foundation (no. 2017M611313), Department of Science and Technology of Jilin Province (no.20190201225JC) and Department of Finance of Jilin Province (no. SCZSY201714 and 2019SCZ028), China.

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Authors and Affiliations

  1. Division of thyroid Surgery, China-Japan Union Hospital Of Jilin University, Jilin Provincial Key Laboratory Of Surgical Translational Medicine, Jilin Provincial Precision Medicine Laboratory of Molecular Biology and Translational Medicine on Differentiated Thyroid Carcinoma, 126 Xiantai Blvd, Changchun City, Jilin Province, People’s Republic of China

    Daqi Zhang, Yantao Fu, Le Zhou, Tie Wang, Nan Liang, Jiao Zhang, Gaofeng Xue & Hui Sun

  2. Division for Endocrine and Minimally Invasive Surgery, Department of Human Pathology in Adulthood and Childhood “G. Barresi”, University Hospital G. Martino, University of Messina, Via C. Valeria 1, 98125, Messina, Italy

    Gianlorenzo Dionigi

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  1. Daqi Zhang
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  3. Le Zhou
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Contributions

(I) Conception and design: Hui Sun, Gianlorenzo Dionigi; (II) Administrative support: Hui Sun; (III) Collection and assembly of data: Hui Sun, Gianlorenzo Dionigi, Daqi Zhang; (IV) Data analysis and interpretation: Hui Sun, Gianlorenzo Dionigi, Daqi Zhang; (V) Manuscript writing: All authors; (VI) Final approval of manuscript: All authors

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Correspondence to Hui Sun.

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This report was approved by the Ethics Committee of the Institutional Review Board of Jilin Provincial Key Laboratory of Surgical Translational Medicine, China-Japan Union Hospital of Jilin University.

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Informed consent was obtained from all participants in this report.

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The authors declare no competing interests.

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Zhang, D., Fu, Y., Zhou, L. et al. Pictorial essay of vestibular incision outcomes from transoral endoscopic thyroidectomy. Langenbecks Arch Surg 406, 2869–2877 (2021). https://doi.org/10.1007/s00423-021-02124-w

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