Hybrid techniques and patients’ safety in implementing transoral sublingual thyroidectomy

Witzel, Kai; Benhidjeb, Tahar; Kaminski, Cornelia; Messenbaeck, Franz G.; Weitzendorfer, Michael

doi:10.1007/s12020-018-1539-y

Cited by 8 publications

(5 citation statements)

References 30 publications

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“…Combining the transoral technique with other minimally invasive techniques has also been proposed. 41 Although the latter procedures may be easier, they have not been included in this systematic review, because they go against the scarless principle of the transoral technique.…”

Section: Discussionmentioning

confidence: 99%

Transoral Endoscopic Thyroidectomy: A Systematic Review of the Practice So Far

Camenzuli

Schembri-Wismayer

Calleja‐Agius

2018

JSLS

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Background and Objectives:Thyroid disease largely affects young females, but the incidence is also increasing among males. In an effort to avoid the scarring of the neck that is synonymous with conventional thyroidectomy, endoscopic techniques have been developed over the years. The transoral endoscopic approach is the latest of these innovations that promises a scarless surgical outcome. This review evaluates whether this technique is safe and feasible in live patients and outlines the outcomes in published literature so far.Database:PubMed, Medline, BioMed Central, Cochrane Library, OVID and Web of Science were systematically searched by using a Medical Subject Heading (MeSH)–optimized search strategy. The selection of papers followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines after setting strict inclusion and exclusion criteria. Sixteen studies were included in the final analysis.Discussion:This systematic review presents cases of 785 patients. Surgeons in 15 of the studies used a completely vestibular approach, whereas those in the remaining 2 used the floor of the mouth for primary access. Conversion to open surgery took place in 1.3%. In total, 4.3% of patients experienced transient laryngeal nerve palsy, whereas 0.1% had permanent recurrent incidences of the condition. Transient hypocalcemia occurred in 7.4% of cases, with no recorded permanent cases. Carbon dioxide embolism occurred in 0.6% of cases, and another 0.6% had a deep-seated neck infection. The complication rates within the review were deemed acceptable and the overall technique feasible. A prospective randomized controlled trial was proposed to compare this technique with conventional thyroidectomy.

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Section: Discussionmentioning

confidence: 99%

Transoral Endoscopic Thyroidectomy: A Systematic Review of the Practice So Far

Camenzuli

Schembri-Wismayer

Calleja‐Agius

2018

JSLS

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“…The most important advantages of remote access robotic or endoscopic thyroidectomy over conventional transcervical thyroidectomy include superior aesthetic results and the improved surgical views obtained with magnification. [9][10][11][12][13][14][15][16] Of these, the oral vestibular approach has been most popular recently. [5][6][7][8] Recently, transoral thyroidectomy has been increasingly adopted by several institutions.…”

Section: Introductionmentioning

confidence: 99%

“…Transoral thyroidectomy includes the sublingual approach and the oral vestibular approach with or without CO 2 insufflation. [9][10][11][12][13][14][15][16] Of these, the oral vestibular approach has been most popular recently. However, the efficacy and feasibility of transoral robotic and endoscopic thyroidectomy has not been fully assessed although some institutes have reported its feasibility and safety, [17][18][19][20][21][22][23][24] and one study obtained comparable surgical outcomes to conventional transcervical thyroidectomy.…”

Section: Introductionmentioning

confidence: 99%

Early experience of transoral thyroidectomy: Comparison of robotic and endoscopic procedures

et al. 2018

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Background The aim of this study was to evaluate the feasibility, safety, and early surgical outcomes of transoral thyroidectomy and to compare robotic and endoscopic procedures. Methods A total of 37 patients underwent robotic (23 cases) or endoscopic (14 cases) transoral thyroidectomy. We compared the outcomes of the two procedures. Results Of the 37 patients, 2 were converted to the robotic facelift approach as a result of an intraoperative CO2 embolism and inability to remove the tumor. The mean operative time was 172.8 ± 37.5 minutes. Transient recurrent laryngeal nerve palsy occurred in one case, and transient hypoparathyroidism in two cases. Most of patients were satisfied with the postoperative cosmesis. There were no significant differences between the robotic and endoscopic procedures, except for operative time, which was significantly longer in the robotic group. Conclusion Robotic and endoscopic transoral thyroidectomies are both feasible and safe in appropriate patients.

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“…Transoral thyroidectomy is a form of NOTES (natural orifice transluminal endoscopic surgery) [ 16 ] technique with minimal invasiveness and no scar on body surface (Fig. 7 ), including vestibular approach and sublingual access [ 17 , 18 ], but the latter is obsolete because of the structural damage it may cause. The thyroid gland is a solid organ rich in blood, is adjacent to the complex anatomical structure and important blood vessels and nerves, and has no natural space around it.…”

Section: Discussionmentioning

confidence: 99%

A comparative study of two robotic thyroidectomy procedures: transoral vestibular versus bilateral axillary-breast approach

Zhu

et al. 2022

BMC Surg

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Objective To compare the surgical outcomes between the transoral-vestibular robotic thyroidectomy (TOVRT) and bilateral axillo-breast approach robotic thyroidectomy (BABART). Methods A total of 99 patients with papillary thyroid carcinoma but no distant metastasis were enrolled in this study from May 2020 to April 2021. Lobectomy or total thyroidectomy with central lymph node dissection were performed in all cases. All 99 patients were received an ultrasound guided fine needle aspiration biopsy prior to surgical intervention, out of which 49 patients underwent TOVRT, while rest 50 patients underwent BABART. During the procedure, intraoperative neuromonitoring system was used and all recurrent laryngeal nerves (RLNs) were preserved, additionally for TOVRT procedure, three intraoral ports or right axillary fold incision was used to allow for fine countertraction of tissue for radical oncological dissection. The clinical data including age, gender, height, weight, BMI, primary tumor size, number of central lymph node removed, central lymph node metastasis, operating time, total hospital stays, postoperative hospital stays, total postoperative drainage volume, postoperative pain score, cosmetic effect and complications were recorded and analyzed. Results There were no significant differences in gender, height, weight, BMI and removed central lymph nodes between the two groups (P > 0.05). Patients accepted TOVRT were younger and had smaller primary tumor size than those who accepted BABART. The TOVRT group had a longer surgical time than the BABART group, but with smaller postoperative drainage volume and superior cosmetic effect (under visual analogue scale, VAS) (P < 0.05). There was no significant difference in lymph node metastasis, hospital stay and postoperative pain score (under numerical rating scale, NRS) between the two groups (P > 0.05). Last but not least, certain peculiar complications were observed in TOVRT group: paresthesia of the lower lip and the chin (one case), surgical site infection (one case) and skin burn (one case). Conclusion Transoral-vestibular robotic thyroidectomy is safe and feasible for certain patients, which could be considered an alternative approach for patients who require no scarring on their neck.

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Hybrid techniques and patients’ safety in implementing transoral sublingual thyroidectomy

Cited by 8 publications

References 30 publications

Transoral Endoscopic Thyroidectomy: A Systematic Review of the Practice So Far

Transoral Endoscopic Thyroidectomy: A Systematic Review of the Practice So Far

Early experience of transoral thyroidectomy: Comparison of robotic and endoscopic procedures

A comparative study of two robotic thyroidectomy procedures: transoral vestibular versus bilateral axillary-breast approach

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