Abstract
Nodular goitre is the most common endocrine disease requiring surgical thyroidectomy for its cure. Though surgical exploration is routinely performed through conventional open-neck approach, a wide range of minimal access and minimally invasive endoscopic techniques (gasless and with gas) have been attempted in the past two decades. In this context, we report the feasibility and safety of an innovative transoral endoscopic thyroidectomy technique, which marks a paradigm shift in the endocrine surgery. This is a prospective study conducted at a tertiary care endocrine surgery department in Southern India from May 2016 to November 2018. We employed a novel transoral, lower vestibular route for endoscopic thyroidectomy. All the clinical, investigative, operative, pathological and post-operative data were collected from our prospectively filled proformas. Statistical analysis was performed with SPSS 20.0 version. Descriptive analysis was done. Out of the 604 goitre cases operated during the study period, 123 (20.4%) were operated by this technique. Hemithyroidectomy was performed in 104 and total thyroidectomy in 19 cases respectively. Mean operative time was 124 ± 18 min (100–220). There was extended subcutaneous emphysema on to upper chest in one case. Otherwise, the post-operative course was uneventful with no major morbidity, hypocalcemia, or recurrent laryngeal nerve palsy. All the cases had benign histopathology. We conclude that this novel transoral vestibular route thyroidectomy is a comparably optimal approach for nodular thyroid goitres, especially in benign cases.
Similar content being viewed by others
References
Dean DS, Gharib H (2008) Epidemiology of thyroid nodules. Best Pract Res Clin Endocrinol Metab 22:901–911
Tunbridge WM, Evered DC, Hall R, Appleton D, Brewis M, Clark F, Evans JG, Young E, Bird T, Smith PA (1977) The spectrum of thyroid disease in a community: the Whickham survey. Clin Endocrinol 7(6):481–489
Kochupillai N (2000) Clinical endocrinology in India. Curr Sci 79:1061–1067
Gagner M (1996) Endoscopic subtotal parathyroidectomy in patients with primary hyperparathyroidism. Br J Surg 83:875–875
Hüscher CS, Chiodini S, Napolitano C, Recher A (1997) Endoscopic right thyroid lobectomy. Surg Endosc 11(8):877
Miccoli P, Bellantone R, Mourad M, Walz M, Raffaelli M, Berti P (2002) Minimally invasive video-assisted thyroidectomy: multi-institutional experience. World J Surg 26:972–975
Shimazu K, Shiba E, Tamaki Y, Takiguchi S, Taniguchi E, Ohashi S et al (2003) Endoscopic thyroid surgery through the axillo-bilateral-breast approach. Surg Laparosc Endosc Percutan Tech 13:196–201
Bhargav PR, Bhagat SD, Kishan Rao B, Murthy SG, Amar V (2010) Combined cervical and video-assisted thoracoscopic thyroidectomy (CAVATT): a simplified and innovative approach for goiter with posterior mediastinal extension. Indian J Surg 72:336–338
Kang SW, Park JH, Jeong JS, Lee CR, Park S, Lee SH et al (2011) Prospects of robotic thyroidectomy using a gasless, transaxillary approach for the management of thyroid carcinoma. Surg Laparosc Endosc Percutan Tech 21:223–229
Ikeda Y, Takami H, Sasaki Y, Kan S, Niimi M (2000) Endoscopic neck surgery by the axillary approach. J Am Coll Surg 191:336–340
World Medical Organization (1996) Declaration of Helsinki. BM J 313:1448–1449
Rogers-Stevane J, Kauffman GL Jr (2008) A historical perspective on surgery of the thyroid and parathyroid glands. Otolaryngol Clin N Am 41:1059–1067
Witzel K, von Rahden BH, Kaminski C, Stein HJ (2008) Transoral access for endoscopic thyroid resection. Surg Endosc 22:1871–1875
Lee KE, Kim HY, Park WS, Choe JH, Kwon MR, Oh SK, Youn YK (2009) Postauricular and axillary approach endoscopic neck surgery: a new technique. World J Surg 33:767–772
Miccoli P, Bellantone R, Mourad M, Walz M, Raffaelli M, Berti P (2002) Minimally invasive video-assisted thyroidectomy: multi-institutional experience. WorldJSurg 26:972–975
Bhargav PRK, Kusumanjali A, Nagaraju R, Amar V (2011) What is the ideal CO2 insufflation pressure for endoscopic thyroidectomy? Personal experience with five cases of goiter. World J Endocrine Surg 3(1):3–6
Anuwong A (2016) Transoral endoscopic thyroidectomy vestibular approach: a series of the first 60 human cases. World J Surg 40:491–497
Gottllieb A, Sprung J, Zheng X-M et al (1997) Massive subcutaneous emphysema and severe hypercarbia in a patient during endoscopic transcervical parathyroidectomy using carbon dioxide insufflations. Anesth Analg 84:1154–1156
Lee WK, Choi YS, Chae YK, Kim YH, Chae YS, Lee JH et al (2004) Massive subcutaneous emphysema and hypercarbia during endoscopic thyroidectomy: a case report. Korean J Anaesthesiol 47:898–901
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of Interest
The authors declare that they have no conflict of interest.
Additional information
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Bhargav, P., Sabaretnam, M. & Amar, V. Endoscopic Thyroidectomy Through Oro-Vestibular Route (ETOVR). Indian J Surg 82, 598–603 (2020). https://doi.org/10.1007/s12262-020-02072-7
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12262-020-02072-7