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Transoral endoscopic thyroid surgery in a Korean population

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Abstract

Background

Transoral endoscopic thyroidectomy vestibular approach is expected to be a safe alternative to open surgery for certain patients and has been used increasingly by several surgeons around the world for the past 2 years. The purpose of this paper is to review our 2-year experience and describe in detail our preoperative considerations, patient selection, operating room settings, anesthetic considerations, surgical technique, postoperative management, and outcomes.

Methods

We reviewed the medical records of 65 consecutive patients who underwent transoral endoscopic thyroidectomy between July 2016 and May 2018 in our hospital.

Results

We have performed 65 thyroid surgeries (54 thyroid lobectomies, 1 completion thyroidectomy, and 10 total thyroidectomies) in 64 patients. Postoperative pathology revealed papillary carcinoma in 55 patients (84.6%), follicular carcinoma in two (3.1%), hyalinizing trabecular tumor in one (1.5%), and other benign tumor in seven (10.8%). All surgical margins were negative. Two (3.1%) patients developed transient vocal cord palsy but recovered within 2 months. One (1.5%) patient with vocal cord palsy had not recovered by 3 months after surgery. Five (7.7%) patients who underwent total thyroidectomy developed transient hypocalcemia but recovered within 2 months.

Conclusion

Although transoral thyroid surgery is a relatively recent technique requiring further validation, it affords several advantages. Transoral thyroid surgery has not yet been universally accepted, but may be the best choice for thyroid surgery in the future.

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References

  1. Ahn HS, Kim HJ, Welch HG (2014) Korea’s thyroid-cancer “epidemic"--screening and overdiagnosis. N Engl J Med 371:1765–1767

    Article  PubMed  Google Scholar 

  2. Tan CT, Cheah WK, Delbridge L (2008) “Scarless” (in the neck) endoscopic thyroidectomy (SET): an evidence-based review of published techniques. World J Surg 32:1349–1357

    Article  PubMed  Google Scholar 

  3. Kang SW, Jeong JJ, Nam KH, Chang HS, Chung WY, Park CS (2009) Robot-assisted endoscopic thyroidectomy for thyroid malignancies using a gasless transaxillary approach. J Am Coll Surg 209:e1–e7

    Article  PubMed  Google Scholar 

  4. Yoon JH, Park CH, Chung WY (2006) Gasless endoscopic thyroidectomy via an axillary approach: experience of 30 cases. Surg Laparosc Endosc Percutan Tech 16:226–231

    Article  PubMed  Google Scholar 

  5. Kang SW, Jeong JJ, Yun JS, Sung TY, Lee SC, Lee YS, Nam KH, Chang HS, Chung WY, Park CS (2009) Robot-assisted endoscopic surgery for thyroid cancer: experience with the first 100 patients. Surg Endosc 23:2399–2406

    Article  PubMed  Google Scholar 

  6. Kang SW, Lee SC, Lee SH, Lee KY, Jeong JJ, Lee YS, Nam KH, Chang HS, Chung WY, Park CS (2009) Robotic thyroid surgery using a gasless, transaxillary approach and the da Vinci S system: the operative outcomes of 338 consecutive patients. Surgery 146:1048–1055

    Article  PubMed  Google Scholar 

  7. Choe JH, Kim SW, Chung KW, Park KS, Han W, Noh DY, Oh SK, Youn YK (2007) Endoscopic thyroidectomy using a new bilateral axillo-breast approach. World J Surg 31:601–606

    Article  PubMed  Google Scholar 

  8. Terris DJ, Singer MC, Seybt MW (2011) Robotic facelift thyroidectomy: II. Clinical feasibility and safety. Laryngoscope 121:1636–1641

    Article  PubMed  Google Scholar 

  9. Terris DJ, Singer MC (2012) Qualitative and quantitative differences between 2 robotic thyroidectomy techniques. Otolaryngol Head Neck Surg 147:20–25

    Article  PubMed  Google Scholar 

  10. Byeon HK, Kim DH, Chang JW, Ban MJ, Park JH, Kim WS, Choi EC, Koh YW (2016) Comprehensive application of robotic retroauricular thyroidectomy: the evolution of robotic thyroidectomy. Laryngoscope 126:1952–1957

    Article  PubMed  Google Scholar 

  11. Moris DN, Bramis KJ, Mantonakis EI, Papalampros EL, Petrou AS, Papalampros AE (2012) Surgery via natural orifices in human beings: yesterday, today, tomorrow. Am J Surg 204:93–102

    Article  PubMed  Google Scholar 

  12. Wilhelm T, Metzig A (2011) Endoscopic minimally invasive thyroidectomy (eMIT): a prospective proof-of-concept study in humans. World J Surg 35:543–551

    Article  PubMed  Google Scholar 

  13. Wang Y, Xie QP, Yu X, Xiang C, Zhang ML, Zhao QZ, Yan HC, Wang P, Xu SM (2017) [Preliminary experience with transoral endoscopic thyroidectomy via vestibular approach: a report of 150 cases in a single center]. Zhonghua Wai Ke Za Zhi 55:587–591

    CAS  PubMed  Google Scholar 

  14. Karakas E, Steinfeldt T, Gockel A, Westermann R, Kiefer A, Bartsch DK (2010) Transoral thyroid and parathyroid surgery. Surg Endosc 24:1261–1267

    Article  PubMed  Google Scholar 

  15. Nakajo A, Arima H, Hirata M, Mizoguchi T, Kijima Y, Mori S, Ishigami S, Ueno S, Yoshinaka H, Natsugoe S (2013) Trans-oral video-assisted neck surgery (TOVANS). A new transoral technique of endoscopic thyroidectomy with gasless premandible approach. Surg Endosc 27:1105–1110

    Article  PubMed  Google Scholar 

  16. Fu J, Luo Y, Chen Q, Lin F, Hong X, Kuang P, Yan W, Wu G, Zhang Y (2018) Transoral endoscopic thyroidectomy: review of 81 cases in a single institute. J Laparoendosc Adv Surg Tech A 28:286–291

    Article  PubMed  Google Scholar 

  17. Anuwong A (2016) Transoral endoscopic thyroidectomy vestibular approach: A series of the first 60 human cases. World J Surg 40:491–497

    Article  PubMed  Google Scholar 

  18. Chai YJ, Chung JK, Anuwong A, Dionigi G, Kim HY, Hwang KT, Heo SC, Yi KH, Lee KE (2017) Transoral endoscopic thyroidectomy for papillary thyroid microcarcinoma: initial experience of a single surgeon. Ann Surg Treat Res 93:70–75

    Article  PubMed  PubMed Central  Google Scholar 

  19. Dionigi G, Bacuzzi A, Lavazza M, Inversini D, Boni L, Rausei S, Kim HY, Anuwong A (2017) Transoral endoscopic thyroidectomy: preliminary experience in Italy. Updates Surg 69:225–234

    Article  PubMed  Google Scholar 

  20. Park JO, Sun DI (2017) Transoral endoscopic thyroidectomy: our initial experience using a new endoscopic technique. Surg Endosc 31:5436–5443

    Article  PubMed  Google Scholar 

  21. Dionigi G, Tufano RP, Russell J, Kim HY, Piantanida E, Anuwong A (2017) Transoral thyroidectomy: advantages and limitations. J Endocrinol Invest 40:1259–1263

    Article  CAS  PubMed  Google Scholar 

  22. Peng XW, Li H, Li Z, Zhou X, Song DJ, Zhou B, Lv CL, Peng W (2017) Modified transoral endoscopic thyroid surgery for treatment of thyroid cancer: operative steps and video. Gland Surg 6:742–744

    Article  PubMed  PubMed Central  Google Scholar 

  23. Kim HY, Chai YJ, Dionigi G, Anuwong A, Richmon JD (2018) Transoral robotic thyroidectomy: lessons learned from an initial consecutive series of 24 patients. Surg Endosc 32:688–694

    Article  PubMed  Google Scholar 

  24. Jitpratoom P, Ketwong K, Sasanakietkul T, Anuwong A (2016) Transoral endoscopic thyroidectomy vestibular approach (TOETVA) for Graves’ disease: a comparison of surgical results with open thyroidectomy. Gland Surg 5:546–552

    Article  PubMed  PubMed Central  Google Scholar 

  25. Chai YJ, Kim HY, Kim HK, Jun SH, Dionigi G, Anuwong A, Richmon JD, Tufano RP (2018) Comparative analysis of 2 robotic thyroidectomy procedures: Transoral versus bilateral axillo-breast approach. Head Neck 40:886–892

    Article  PubMed  Google Scholar 

  26. Razavi CR, Russell JO (2017) Indications and contraindications to transoral thyroidectomy. Ann Thyroid 2:12

    Article  PubMed  PubMed Central  Google Scholar 

  27. Anuwong A, Sasanakietkul T, Jitpratoom P, Ketwong K, Kim HY, Dionigi G, Richmon JD (2018) Transoral endoscopic thyroidectomy vestibular approach (TOETVA): indications, techniques and results. Surg Endosc 32:456–465

    Article  PubMed  Google Scholar 

  28. Razavi CR, Fondong A, Tufano RP, Russell JO (2017) Central neck dissection via the transoral approach. Ann Thyroid 2:11

    Article  PubMed  PubMed Central  Google Scholar 

  29. Kim KN, Lee DW, Kim JY, Han KH, Tae K (2018) Carbon dioxide embolism during transoral robotic thyroidectomy: a case report. Head Neck 40:E25–E28

    Article  PubMed  Google Scholar 

  30. Anuwong A (2017) Strategy to prevent subcutaneous emphysema and gas insufflation-related complications in transoral endoscopic thyroidectomy vestibular approach: reply. World J Surg 41:2649–2650

    Article  PubMed  Google Scholar 

  31. Park EY, Kwon JY, Kim KJ (2012) Carbon dioxide embolism during laparoscopic surgery. Yonsei Med J 53:459–466

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

This work was supported by a National Research Foundation of Korea (NRF) grant funded by the Korea government (No. NRF-2014R1A2A2A03004802).

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Authors and Affiliations

  1. Department of Otolaryngology-Head and Neck Surgery, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea

    Jun-Ook Park

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

    Angkoon Anuwong

  3. Department of Otolaryngology-Head and Neck Surgery, Inje University College of Medicine, Haeundae Paik Hospital, Busan, South Korea

    Mi Ra Kim

  4. Department of Otolaryngology-Head and Neck Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea

    Dong-Il Sun & Min-Sik Kim

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  1. Jun-Ook Park
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  2. Angkoon Anuwong
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  3. Mi Ra Kim
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  4. Dong-Il Sun
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  5. Min-Sik Kim
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Corresponding author

Correspondence to Min-Sik Kim.

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Disclosures

Dr. JO Park, Dr. A Anuwong, Dr. MR Kim, Dr. DI Sun, and Dr. MS Kim have no conflicts of interest or financial ties to disclose.

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Park, JO., Anuwong, A., Kim, M.R. et al. Transoral endoscopic thyroid surgery in a Korean population. Surg Endosc 33, 2104–2113 (2019). https://doi.org/10.1007/s00464-018-6481-9

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  • DOI: https://doi.org/10.1007/s00464-018-6481-9

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