Complications of Transoral Thyroidectomy: Overview and Update

Tae, Kyung

doi:10.21053/ceo.2020.02110

Cited by 42 publications

(49 citation statements)

References 59 publications

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“…[1][2][3] Traditional thyroidectomy, innovative thyroidectomy techniques (including robotic and transoral approaches), and thyroid radiofrequency ablation are the most common treatment options for thyroid neoplasms. 4,5 Complication like recurrent laryngeal nerve (RLN) injury is of great concern for all types of therapeutic management. It may cause hoarseness, dysphagia, and even dyspnea, which may substantially affect quality of life.…”

Section: Introductionmentioning

confidence: 99%

Preoperative Visualized Ultrasound Assessment of the Recurrent Laryngeal Nerve in Thyroid Cancer Surgery: Reliability and Risk Features by Imaging

Yang

et al. 2021

CMAR

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Background Preoperative identification and visualization of tumor infiltration of the recurrent laryngeal nerve (RLN) in patients with thyroid cancer is important. The purpose of our study was to evaluate the reliability and feasibility of preoperative assessment by ultrasound and to identify ultrasound imaging features potentially associated with tumor infiltration of the RLN. Methods In this prospective study, patients undergoing thyroid cancer surgery at our institution between August 2020 and January 2021 were included, and preoperative ultrasound visualization of the RLN and thyroid lesions was performed. RLN infiltration was also confirmed surgically in all cases. Five patients with enlarged lymph nodes were selected to undergo injection of carbon nanoparticles to confirm the correctness of RLN identification by preoperative ultrasound. The repeatability of RLN assessment by ultrasound was evaluated by comparing the correlation between pre- and intraoperative, intra- and inter-group assessments. Parameters of normal RLNs according to age, sex, and body mass index were established. Finally, ultrasound imaging features of patients with RLN tumor infiltration were analyzed to identify potential risk predictors. Results According to the ultrasonic assessment, RLNs of 70 patients appeared normal, while 14 of those patients appeared to be infiltrated by tumors. During surgery, the 70 cases of normal RLNs were confirmed, but only 8 of the 14 suspected cases of infiltration were confirmed. In all five patients injected with carbon nanoparticles, the location of RLNs adjacent to the marked lymph nodes observed by surgeons corresponded to the RLN location identified by preoperative ultrasound. The repeatability of RLN estimation varied from moderate to excellent. There were no significant differences in cross-sectional area, width, or thickness of normal RLNs according to age, sex, or body mass index. Indistinct margin with tumor, incontinuous shape as ultrasound features by the analysis of patients with surgically confirmed RLN infiltration were associated with tumor invasion. Conclusion We show that preoperative ultrasound can be applied to visualize the RLN and may help predict tumor infiltration of the RLN.

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Section: Introductionmentioning

confidence: 99%

Preoperative Visualized Ultrasound Assessment of the Recurrent Laryngeal Nerve in Thyroid Cancer Surgery: Reliability and Risk Features by Imaging

Yang

et al. 2021

CMAR

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“…Furthermore, the oral mucosa of the wound regenerates much faster than the other parts of the wound, so recovery is faster than that of a skin incision. Since the surgery involves areas close to the tongue, a few complications associated with pronunciation or swallowing may still occur postoperatively [ 47 , 48 ]. However, as mentioned earlier, this is not a problem because the surgical procedure does not actually damage the muscles of the tongue.…”

Section: Discussionmentioning

confidence: 99%

“…In most cases, the surgical wound was clear after 3 months. Third, the transoral approach reduces the operation time [ 47 , 49 , 50 ]. Using an avascular space created via bilateral retraction of the GMs results in minimal bleeding and reduces the number of surgical steps, thereby decreasing the overall time required.…”

Section: Discussionmentioning

confidence: 99%

Endoscopically-Assisted Scar-Free Midline Neck Mass Excision

Kim

Woo

2021

Clin Exp Otorhinolaryngol

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Traditional open surgery is indicated for the treatment of selected tumor subsites in the head and neck. However, it can cause major cosmetic problems and functional pathologies. The endoscopically-assisted transoral approach is increasingly preferred in some surgical fields due to its superior cosmetic and functional outcomes. Nonetheless, endoscopically-assisted transoral approach is not yet standard in the head and neck due to their anatomical complexity. The transoral surgical approach has been used for head and neck masses since the 1960s, and its application continues to evolve with changing disease conditions and recent innovations in surgical instruments. The potential for wide application of transoral surgery continues to be investigated, with a focus on minimizing occurrence of the complications. This review presents details of the surgical procedure and postoperative clinical outcomes, as well as endoscopically-assisted scar-free techniques for the resection of midline neck masses.

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“…It takes some practice to blindly enter the correct subplatysmal plane through blunt dissection. If the dissecting plane is too shallow, skin dimpling and contracture may occur [ 54 ]. Bleeding may occur if the plane is too deep and enters the strap muscle, which makes further dissection difficult and results in postoperative bruising and ecchymosis.…”

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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Complications of Transoral Thyroidectomy: Overview and Update

Cited by 42 publications

References 59 publications

Preoperative Visualized Ultrasound Assessment of the Recurrent Laryngeal Nerve in Thyroid Cancer Surgery: Reliability and Risk Features by Imaging

Preoperative Visualized Ultrasound Assessment of the Recurrent Laryngeal Nerve in Thyroid Cancer Surgery: Reliability and Risk Features by Imaging

Endoscopically-Assisted Scar-Free Midline Neck Mass Excision

Working Space Creation in Transoral Thyroidectomy: Pearls and Pitfalls

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