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Trans-oral endoscopic thyroidectomy vestibular approach (TOETVA) for the pediatric population: a multicenter, large case series

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Abstract

Introduction

A cervical scar has been shown to have an impact on the quality of life of children undergoing thyroid surgery. Transoral endoscopic vestibular thyroidectomy via the vestibular approach (TOETVA) offers the absence of a cutaneous incision, and has not been described to date in the pediatric population.

Objective

To describe the first series of TOETVA in a pediatric population.

Patients and methods

A retrospective, multicenter study, including all patients > 18 years old who underwent TOETVA. Data was prospectively collected and included demographics, preoperative ultrasound, cytology and indications for surgery. Intraoperative parameters included length of surgery and complications, with final pathology and postoperative course also reviewed. TOETVA surgical success was defined as completion of surgery via this approach.

Results

Forty-eight children were included. Of these, 43 (89.5%) were girls. The median age was 16 years (range 10–17). The most common indication for surgery was a benign thyroid nodule (n = 26, 54.1%). Eleven patients (22.9%) had papillary thyroid carcinoma on final pathology, of which 90.9% (10/11) were diagnosed pre-operatively based on FNA cytology. Hemithyroidectomy was performed in 36 patients (75%). All surgeries were completed endoscopically. The mean malignant tumor size was 1.4 ± 0.4 cm and all tumors were completely excised with clean margins. No permanent complications were documented. A single patient (2.1%) had transient RLN injury (1.6%, 1/60 nerves at risk). Transient hypocalcemia was documented in 4 of the 12 patients undergoing total thyroidectomy (33.3%). Transient mental nerve injury/chin hypoesthesia was documented in 2 patients (4.2%).

Conclusions

TOETVA appears to be a feasible and safe approach for thyroidectomy in the pediatric population in carefully selected cases, and may be discussed with patients and parents as an alternative for the trans-cervical approach.

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Acknowledgements

Dr. Khalid Mohamed Ali is recognized for his assistance in the final preparation and assistance in submitting this manuscript.

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Authors and Affiliations

  1. ARM - Center for Head and Neck Surgery and Oncology, Assuta Medical Centers, Tel Aviv, Affiliated with Ben Gurion University, Beer Seva, Israel

    Oded Cohen, Niddal Assadi & Avi Khafif

  2. Division of Head and Neck Endocrine Surgery, Department of Otolaryngology—Head and Neck Surgery, Johns Hopkins, Baltimore, MD, USA

    Ralph P. Tufano & Jonathon O. Russell

  3. Department of Surgery, Minimally Invasive Endocrine and Surgery Division, Police General Hospital, Bangkok, Thailand

    Angkoon Anuwong

  4. Department of Human Pathology in Adulthood and Childhood “G. Barresi”, University of Messina, Messina, Italy

    Gianlorenzo Dionigi

  5. Department of Surgery, Korea University College of Medicine, Seoul, Korea

    Hoon Yub Kim

  6. Department of Surgery, Santa Casa de São Paulo Medical School, Sao Paulo, Brazil

    Antonio Bertelli

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  1. Oded Cohen
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Correspondence to Jonathon O. Russell.

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Author Ralph Tufano declares that he a consultant for Medtronic and Hemostatix. Authors Oded Cohen, Angkoon Anuwong, Jonathon Russell, Niddal Assadi, Gianlorenzo Dionigi, Hoon Yub Kim, Antonio Bertelliand Avi Khafif have no conflict of interest or financial ties to disclose.

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Cohen, O., Tufano, R.P., Anuwong, A. et al. Trans-oral endoscopic thyroidectomy vestibular approach (TOETVA) for the pediatric population: a multicenter, large case series. Surg Endosc 36, 2507–2513 (2022). https://doi.org/10.1007/s00464-021-08537-4

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