Endoscopic minimally invasive thyroidectomy: first clinical experience

Abstract

With the development of an exclusively endoscopic approach for thyroid resection (eMIT) and its first clinical application, we could show the safety and feasibility of another natural orifice surgery procedure. One major concern before surgery was possible infection of the cervical spaces by introduction of oral flora to these regions. Investigating this infection risk, Hong and Yang evaluated the surgical results associated with the intraoral approach for submandibulectomy in a series of 77 cases of chronic sialadenitis and benign mixed tumors. The infection rate was 2.6% (2 patients) compared with 7.3% in a control group of 251 patients who underwent a transcervical procedure. Therefore, we estimated the infection risk to be lower than with conventional transcervical approaches. The clear advantages of this technique are its minimally invasive character, its reduction of surgical trauma, its direct access to surgical planes and spaces, its avoidance of swallowing disorders and postoperative dysphagia, and finally, its avoidance of any skin scars. Further trials are already being conducted.

Transoral endoscopic thyroidectomy using vestibular approach: updates and evidences

“…To ensure patients' safety, clinical evidence is the most important matter of concern before widespread use of that technique. For transoral endoscopic thyroidectomy, there were many studies in animals and cadavers before application to clinical practice (8)(9)(10)(11)(12)(13)(14)(15). The transoral approach is to operate from the mouth which is contaminated with many bacteria, to the neck, which is the sterile area.…”

“…A benefit of this innovative thyroid technique is its excellent cosmetic outcome due to scarless surgery. Despite its benefits, however, this procedure has been considered experimental due to the limitations of the previous sublingual approach (9)(10)(11)(12). The oral vestibular approach has since been introduced with better clinical outcomes (13)(14)(15).…”

Salient Anatomical Landmarks of Thyroid and Their Practical Significance in Thyroid Surgery: a Pictorial Review of Thyroid Surgical Anatomy (Revisited)

“…It is invested by the deep cervical fascia and often marginated by the anterior jugular veins on either side. LAN is the most frequent entrance for approaching goiter both in conventional open thyroidectomy and endoscopic thyroidectomy [39][40][41]. Larger goiters, strap muscle hypertrophy, excess fat, and asymmetrical anterior jugular veins preclude the identification of LAN due to distortion or deviation, especially in beginners.…”

Robotic and endoscopic transoral thyroidectomy: feasibility and description of the technique in the cadaveric model

“…Later same year, they reported the first clinical application of this technique in a 53-year-old man (28). The patient had no complications except for minimal neck swelling and hematoma.…”