Comparative Study of Gasless Transaxillary, Bilateral Axillo-Breast, Unilateral Axillo-Breast With Carbon Dioxide Insufflation, Retroauricular, and Transoral Vestibular Endoscopic Thyroidectomy Approaches at a Single Institution: A Retrospective Analysis and Lessons Learned

Abstract

Objectives. This study aimed to present our experiences with various approaches for endoscopic thyroidectomy (ET) and to offer lessons for choosing an approach.Method. The medical records of 701 patients who underwent ET via different approaches such as transaxillary (TA), bilateral axillo-breast (BABA), unilateral axillo-breast with carbon dioxide insufflation (UABA), retroauricular (RA), or transoral vestibular (TO) between May 2008 and March 2020 were retrospectively reviewed.Results. The mean operative time of UABA was the shortest among five approaches (TA 194.65

Carbon dioxide embolism during transoral endoscopic thyroidectomy: A case report and literature review

“…Gas bubbles in the bleeding field during skin flap elevation were noted by Kim et al before the onset of CO 2 embolism 3 . Three cases presented only with mild hypercapnia/EtCO 2 elevation, while one patient developed a loud, coarse precordial murmur 1,8 . Fu et al confirmed the diagnosis of CO 2 embolism in two cases with the use of a precordial Doppler intraoperatively revealing gas formation 7 …”

“…3 Three cases presented only with mild hypercapnia/EtCO 2 elevation, while one patient developed a loud, coarse precordial murmur. 1,8 Fu et al confirmed the diagnosis of CO 2 embolism in two cases with the use of a precordial Doppler intraoperatively revealing gas formation. 7 The initial management of CO 2 embolism includes cessation of CO 2 insufflation, hyperventilation with 100% O 2 , positioning the patient in a steep head-down left lateral decubitus, and increasing positive end-expiratory pressure (PEEP).…”

“…If asystole develops, immediate chest compressions should be initiated. [1][2][3][4][5]7,8 Injured blood vessel(s) can be controlled by initially applying lateral neck compression and using advanced bipolar/ultrasonic devices (if vital signs permit). Although aspiration of a gas embolus can be performed via a central venous catheter, this was not necessary in the reported cases.…”

“…Since 2016, the transoral endoscopic thyroidectomy vestibular approach (TOETVA) has become popular for being a scarless procedure with improved cosmesis and patient satisfaction. 1 Laparo-endoscopic/robotic surgeries use carbon dioxide (CO 2 ) to insufflate abdominal or extraÀ/nonabdominal cavities. Gas insufflation provides sufficient operating space for instrument manipulation and visualization of anatomical structures.…”

The global status and hotspots of research in the field of trans-oral endoscopic thyroidectomy (TOET) from 2008 to 2022

“…A transoral endoscopic thyroidectomy transmandibular approach has recently been reported to be effective and safe, avoiding skin numbness in the central mandibular region and reducing the difficulty of establishing a surgical space ( 45 ). In addition, some studies have reported good results with inflation-free TOETVA, such as clear visual fields and no CO2 gas embolism complications ( 18 , 33 , 46 , 47 ). As the technology develops, several studies suggest TOETVA may be a feasible and safe thyroidectomy for children ( 48 ).…”