A surgical and anatomo-histological study on Transoral Endoscopic Thyroidectomy Vestibular Approach (TOETVA)

Çelik, Servet; Makay, Özer; Yörük, Mustafa Deniz; Koçer, Ilke Bayzit; Özdemir, Murat; Kılıç, Kubilay Doğan; Tomruk, Canberk; Bilge, Okan; Dionigi, Gianlorenzo

doi:10.1007/s00464-019-06856-1

Cited by 31 publications

(25 citation statements)

References 34 publications

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“…[ 24 ] In addition, the surgeon has to master the anatomy of the perioral, chin, and submental regions to minimize possible complications. [ 25 ] Present TOETVA trainings in our country are carried out in local surgical centers and in certain periods to a limited number of participants. In our opinion, it is possible to reach this high patient potential by supporting TOETVA training, providing this training to a wider surgeon group, being included in the surgical assistant core program and increasing patient awareness.…”

Section: Discussionmentioning

confidence: 99%

Patient Eligibility for Transoral Endoscopic Thyroidectomy Vestibular Approach (TOETVA) in an Endemic Region

et al. 2021

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Objective: Transoral endoscopic thyroidectomy vestibular approach (TOETVA) is a scarless method that enables thyroidectomyusing natural orifice of the body. The opinion which is even common among TOETVA performing surgeons is that this surgery involves a small percentage of thyroidectomy applied patients. In this study, based on the currently accepted exclusion criteria, we aimed to determine what percentage of patients, who underwent thyroidectomy in an endemic area are actually suitable for TOETVA. Methods: Between January 2017 and December 2019, 1197 consecutive patients who underwent surgery for thyroid pathology in our clinic were analyzed retrospectively. Pre-operative evaluations were made according to the current exclusion criteria and as a result, patients with no previous neck surgery, no history of radiotherapy, no retrosternal thyroid extension, and none lymph node dissection operation been made and whose thyroid gland diameter is <10 cm and gland volume is not more than 45 ml, malignant nodule diameter is <2 cm, and benign nodule diameter is <4 cm are involved to this study by being considered appropriate for TOETVA procedure. Results: According to the criteria, 513 patients (42.8%) were found suitable for TOETVA. A total of 421 (82%) of these patients were female and 92 (18%) were male. The mean age was 46.2±13.2. A total of 192 (37%) of these patients were operated due to the benign reasons, and 321 (63%) of these patients operated due to the malignancy or suspicion of malignancy. Average nodule size was 1.9 cm, and the average thyroid volume was 23.8 ml among benign patients. Whereas among malignant patients, the average nodule size was 1.7 cm and the average thyroid volume was 21.8 ml. A total of 462 (90.1%) of the patients were applied to the total thyroidectomy and 51 (9.9%) of the patients were applied to the hemithyroidectomy. In the same period, 29 patients operated through TOETVA and 4 patients operated through bilateral axillary breast approach thyroidectomy. When the final pathology, results of the patients were examined, papillary thyroid carcinoma was seen in 301 (58.7%) patients, benign pathologies were seen in 192 (37.4%) patients, and 20 (3.9%) patients were diagnosed with other pathologies (follicular thyroid carcinoma, poorly differentiated carcinoma and Hürthle cell neoplasia, etc.). Conclusion: Although “patient willingness” factor could not be included in the study, TOETVA eligible patient repository is wider contrary to popular belief. In our humble opinion, TOETVA method is going to pursue its spread and become a part of the routine surgical training session due to its effectiveness in terms of credibility in today’s world where cosmetic concerns gradually gain prominence.

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Section: Discussionmentioning

confidence: 99%

Patient Eligibility for Transoral Endoscopic Thyroidectomy Vestibular Approach (TOETVA) in an Endemic Region

et al. 2021

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“…After incising the oral mucosa, the central incision was further dissected down to the lower edge of the mandible with an electrocautery or Kelly clamp. The mentalis muscle might be cut or penetrated during this process [ 18 , 35 , 36 , 37 , 38 ]. This injury might lead to uncoordinated movement of the lower face during pronunciation or smiling [ 39 , 40 ].…”

Section: Operative Techniquesmentioning

confidence: 99%

Working Space Creation in Transoral Thyroidectomy: Pearls and Pitfalls

Liang

Chen

Liu

2022

Cancers

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Transoral thyroidectomy is a novel technique that uses three small incisions hidden in the oral vestibule to remove the thyroid gland. It provides excellent cosmetic results and outcomes comparable to the open approach. One of the main obstacles for this technique is the creation of a working space from the lip and chin to the neck. The anatomy of the perioral region and the top-down surgical view are both unfamiliar to general surgeons. As a result, inadequate manipulation might easily occur and would lead to several unconventional complications, such as mental nerve injury, carbon dioxide embolism, and skin perforation, which are rarely observed in open surgery. Herein, we summarize the basic concepts, techniques, and rationales behind working space creation in transoral thyroidectomy to assist surgeons in obtaining an adequate surgical field while eliminating preventable complications.

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“…К настоящему времени наиболее популярной в мире является методика TOETVA, предложенная тайскими хирургами [7]. Интерес к новой методике только возрастает, о чем свидетельствуют работы, посвященные уточнению показаний и противопоказаний [12], стандартизации программ обучения хирургов [13], более пристальному изучению анатомических и гистологических нюансов [14]. При этом, трансоральная операция не представляется какой-то эксклюзивной, «штучной».…”

Section: хирургическая техникаunclassified

Transoral Thyroidectomy and Parathyroidectomy: Series of Cases

Gryaznov¹,

Melkonyan²,

Shulutko³

et al. 2021

Novosti Khirurgii

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Objective. To present the results of the author’s own series of transoral operations in patients with pathology of the thyroid and parathyroid glands. Methods. Transoral surgery was performed in women (n=20) and (n=1) man. All patients were operated on for the primary disease and met the selection criteria based on ultrasound and cytological examinations, hormonal levels, and somatic status. Indications for surgery were: nodular goiter in 17 cases, diffuse toxic goiter - in 2 cases, parathyroid adenoma - in 2 cases. The surgical technique included a three-port approach in the lower fornix of the vestibule of the mouth and a gas technique for maintaining the working cavity. Standard laparoscopic instruments and an energy based ultrasonic device were used for the operation. In the postoperative period, patients underwent a test for subjective assessment of the aesthetic result of the operation using the survey of thedermatology life quality index. Results. Thyroidectomy was performed in 4 patients, hemithyroidectomy - in 15 patients and parathyroidectomy - in 2 patients. In one patient, transoralparathyroidectomy was performed as a part of a simultaneous operation for multiple endocrine neoplasia type 1 syndrome. Papillary cancer T1N0M0 was verified in two patients after surgery. The mean operation time was 196.1 min (range 110 - 300 min). Average blood loss - 3 9.5 ml (range 10 - 300 ml). The nineth operation required the conversion due to severebleeding. In one case, the temporary recurrent laryngeal nerve(RLN)injury was reported, in one case - hematoma. After surgery, the median and average values of thedermatology life quality index were 1 (IQR 0-4) and 2.05, respectively, which indicates an insignificant effect on the quality of life. Conclusion. Transoral endoscopic surgery on the thyroid and parathyroid glands would be thepromising optimal choice in patients to avoid scarring on the neck.

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A surgical and anatomo-histological study on Transoral Endoscopic Thyroidectomy Vestibular Approach (TOETVA)

Cited by 31 publications

References 34 publications

Patient Eligibility for Transoral Endoscopic Thyroidectomy Vestibular Approach (TOETVA) in an Endemic Region

Patient Eligibility for Transoral Endoscopic Thyroidectomy Vestibular Approach (TOETVA) in an Endemic Region

Working Space Creation in Transoral Thyroidectomy: Pearls and Pitfalls

Transoral Thyroidectomy and Parathyroidectomy: Series of Cases

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