BackgroundTransoral endoscopic thyroidectomy vestibular approach (TOETVA) is a novel remote‐access endoscopic approach. In this study, we compared the surgical outcomes of TOETVA with those of conventional transcervical approach (TCA) in two tertiary hospitals.MethodsA total of 82 patients were done by TOETVA and 233 patients received TCA between January 2018 and April 2019. Propensity score matching was used to reduce selection bias.ResultsOperation time of the TOETVA group was longer than that of the TCA group. The mean number or retrieved lymph nodes were significantly higher in the TOETVA group. No significant difference was observed in the overall perioperative complications.ConclusionTOETVA is technically acceptable when compared to TCA in terms of equal baseline characteristics of patients. Although future large‐scale multicenter studies with longer follow‐up periods are needed, we expect this novel technique can be performed not only for cosmetic purposes but also for patients with papillary thyroid carcinoma.

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The bilateral axillary breast approach (BABA) is frequently utilized for remote access thyroid surgery. The first step in this surgical approach is to make a subcutaneous flap from the axilla to the neck, usually using a Harmonic ACE. Our institution has utilized LigaSure to create these flaps. This study reports comparative results with these 2 energy devices. Methods: Medical data and video clips from 73 patients who underwent robotic BABA thyroid surgery were retrospectively reviewed. Flaps for BABA were created by first and second year endocrine fellows under the guidance of an experienced endocrine surgeon. There were no criteria for allocation to energy devices. Results: Of the 73 patients, 31 and 42 underwent flap creation with the Harmonic ACE and LigaSure devices, respectively. Demographic characteristics were similar in the 2 groups. Mean time for flap creation was significantly shorter (33.46±8.33 vs. 38.27±7.14 min, P=0.012), and mean number of camera cleanings significantly lower (4.21±2.53 vs. 10.45±4.95, P<0.001), in the LigaSure group. Surgical site pain on day 2 was significantly lower in the LigaSure group. Postoperative bleeding and skin burn occurred only in patients in the Harmonic group. Conclusion: LigaSure showed better performance than the Harmonic ACE device for BABA flap creation, as shown by time for flap creation, postoperative pain scores, and complications. Because this study was a small sized retrospective comparison, large randomized controlled trials are needed to confirm these results.

Purpose: Remote access thyroid surgery using a bilateral axillary breast approach (BABA) or a transoral endoscopic thyroidectomy vestibular approach (TOETVA) are increasingly performed worldwide. In the Caucasus, these methods were first applied in the Republic of Georgia. This study compares these two methods of endoscopic thyroid surgery performed on patients in a tertiary hospital in Tbilisi, Georgia. Methods: Between December 2015 and January 2018, 41 patients underwent endoscopic thyroid surgery at the Aversi Clinic, including 32 who underwent BABA endoscopic thyroidectomy for benign nodules and nine who underwent TOETVA for thyroid cancers. Patients' medical records were retrospectively reviewed. Results: Tumors were significantly larger (2.38±0.38 cm versus 1.70±0.31 cm, p value <0.001), operation time was significantly longer (177.66±21.02 min versus 116.66±5.59 min, p value <0.001), and blood loss was significantly greater (149.07±28.10 ml versus 102.22±8.33 ml, p value <0.001) in patients who underwent BABA than TOETVA. There were no significant differences in postoperative complications between the two groups. Conclusion: Remote access thyroid surgery, either BABA or TOETVA, was successfully started, without harmful complications, at the Aversi Clinic in Tbilisi, Georgia. BABA is suitable for large sized benign nodules and TOETVA for thyroid cancers with central lymph node dissection.