Minimally Invasive Approaches for Thyroid Surgery—Pitfalls and Promises

Duek, Irit; Duek, Ori Samuel; Fliss, Dan M.

doi:10.1007/s11912-020-00939-2

Cited by 15 publications

(9 citation statements)

References 87 publications

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“…Compared with the traditional open thyroidectomy, endoscopic approaches are recommended to minimize the surgical extent for well-differentiated TC and to meet the growing demand for improved cosmesis [ 14 ]. Transaxillary, retroauricular, transoral, and bilateral axillo-breast approach (BABA) robotic approaches have been reported to achieve endoscopic thyroidectomy [ 15 , 16 ].…”

Section: Discussionmentioning

confidence: 99%

Evaluation of the clinical value of carbon nanoparticles in endoscopic thyroidectomy and prophylactic central neck dissection through total mammary areolas approach for thyroid cancer

Zhang

Xia

2021

World J Surg Onc

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Background Carbon nanoparticles (CNs) are tracers used in thyroid surgery of patients with thyroid cancer (TC) to help remove lymph nodes and protect the parathyroid gland. The facilitative effect of carbon nanoparticles in endoscopic thyroidectomy and prophylactic central neck dissection (pCND) has not been reported. Methods The protective effect on parathyroid gland (PG) function and the numbers of identified parathyroid glands and central lymph nodes in endoscopic thyroid surgery through the total mammary areolas approach were compared between the CN and control groups. Results All endoscopic thyroidectomies were successfully completed. No difference was found in either group regarding the general characteristics or operative complications. The mean number of superior PGs and inferior PGs identified in situ or in the dissected central lymph tissues was not different between the groups. The mean number of lymph nodes removed by unilateral CND was greater in the CN group than in the control group. However, there was no difference in the number of harvested lymph nodes when excluding the LNs less than 5 mm, which exhibit an extremely low metastatic rate. Conclusion Carbon nanoparticles do not improve the protective effect on the parathyroid gland, especially the inferior glands, in endoscopic thyroid surgery through the total mammary areolas approach. There is no need to use CNs to facilitate the lymph node harvest in endoscopic prophylactic unilateral CND.

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Section: Discussionmentioning

confidence: 99%

Evaluation of the clinical value of carbon nanoparticles in endoscopic thyroidectomy and prophylactic central neck dissection through total mammary areolas approach for thyroid cancer

Zhang

Xia

2021

World J Surg Onc

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“…(2) As for other procedures, there will be a learning curve, additional costs and operative time. (5,(9)(10)(11)(12). Reassuringly, a recent metanalysis of six eligible nonrandomized studies involving 1151 patients revealed that TOETVA group had a signi cantly longer operative time but there were no signi cant differences in terms of postoperative outcomes.…”

Section: )mentioning

confidence: 99%

Feasibility, perceived aesthetic outcomes and patients’ interest in transoral endoscopic thyroidectomy (TOETVA) in a cohort of patients in the Thames Valley United Kingdom

Puttergill,

Asher,

Yarwood

et al. 2023

Preprint

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Introduction: Thyroid surgery techniques without visible scar have grown internationally with little traction in the UK. The aim was to assess the perception of neck scar after thyroid surgery, estimate the feasibility for transoral endoscopic thyroidectomy (TOETVA) and define the public demand for scarless thyroidectomy. Methods: A mixed cohort study approved by national ethics committee assessed retrospectively the feasibility of TOETVA based on current guidelines. A standardised questionnaire used Manchester Scar Scale (MSS) and explored patient-centred outcomes and views. Results: Out of 265 patients (75% women, median age 56 years) who underwent thyroid lobectomy for indeterminate nodules (n=160) or proven low-risk thyroid cancer (n=105), 64% would have been suitable for TOETVA, including 49% of cancers. Of 92 respondents, MSS was excellent (25%), good (56%; MSS<7) or poor (15%; MSS > 10). Negative scar perception preoperatively resulted in poor MSS scores post operatively (p<0.0001). Poor MSS impacted all individuals regardless of preoperative neck scar concerns (p<0.001). Worse MSS scores were significant in patients with complications or cancer recurrence concerns (p<0.002) independent of age (p=0.065) and gender (p=0.7118). Need for thyroid hormone replacement in 34% of patients didn’t correlate with to MSS. Patients’ interest in scarless technique didn’t correlate with MSS and appeared to be attributable to personal values, geographic accessibility, and intensity of aversion to complication (p<0.05). Overall, 29% of patients would consider a scarless technique and 31% opposed the idea. Conclusion: This study population showed comparable interest and feasibility for scarless thyroid surgery as international populations. How to respond to this need will become apparent in the coming years.

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“…The surgical approach to these endocrine glands typically involves an anterior cervical (or ‘Kocher’) incision, which is located in a highly visible (as typically not covered by clothing) and potentially sensitive area based on its anatomical location on the anterior aspect of the patient’s neck. In recent years, remote-access approaches (that is transoral, trans-axillary, and axillo-breast approaches) to resecting these glands have been pioneered with the purpose of improving cosmesis, increasing patient satisfaction, and reducing postoperative complications 4 , 5 . Despite these novel developments, most surgeons still rely upon using the conventional open anterior cervical incisions when performing thyroid or parathyroid surgery for the majority of cases 6 , 7 .…”

Section: Introductionmentioning

confidence: 99%

Optimal primary wound closure methods after thyroid and parathyroid surgery: network meta-analysis of randomized clinical trials

et al. 2023

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Background At present, there is no consensus on optimal neck wound closure methods after thyroid and parathyroid surgery. The aim of this study was to perform a systematic review and network meta-analysis of RCTs evaluating the optimal neck closure method after thyroid and parathyroid surgery. Methods A frequentist random-effects network meta-analysis was performed for RCTs comparing at least two closure methods according to PRISMA-network meta-analysis guidelines. Analysis was performed using R packages and Shiny. Results Eighteen RCTs evaluating six closure methods (that is adhesive (28.5 per cent, 404 patients), absorbable subcuticular suture (18.1 per cent, 257 patients), non-absorbable subcuticular suture (16.8 per cent, 238 patients), staples (26.3 per cent, 372 patients), steristrips (8.1 per cent, 115 patients), and conventional suture (2.1 per cent, 30 patients)) in 1416 patients were included. At network meta-analysis, there was no difference in complication, infection, dehiscence, or haematoma rates irrespective of closure method used. Staples reduced closure duration versus absorbable subcuticular suture (mean difference (MD) 8.50, 95 per cent c.i. 6.90 to 10.10) and non-absorbable subcuticular suture (MD 0.30, 95 per cent c.i. 0.23 to 0.37), whereas adhesives (MD −1.05, 95 per cent c.i. −1.31 to −0.79) reduced closure time relative to staples. Cosmesis was improved after non-absorbable subcuticular suture (odds ratio (OR) 3.41, 95 per cent c.i. 1.66 to 7.00) relative to staples. Staples reduced patient satisfaction (OR 0.04, 95 per cent c.i. 0.00 to 0.33) and ability to shower (OR 0.04, 95 per cent c.i. 0.00 to 0.33) relative to adhesives. Conclusion Despite staples decreasing closure times, this advantage is offset by reduced patient satisfaction, ability to shower, and cosmesis compared with patients with wounds closed using adhesives, absorbable subcuticular suture, and non-absorbable subcuticular suture. Therefore, these closure methods are favourable for closing neck wounds due to more acceptable patient-reported outcomes, without compromising the safety of the procedure.

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Minimally Invasive Approaches for Thyroid Surgery—Pitfalls and Promises

Cited by 15 publications

References 87 publications

Evaluation of the clinical value of carbon nanoparticles in endoscopic thyroidectomy and prophylactic central neck dissection through total mammary areolas approach for thyroid cancer

Evaluation of the clinical value of carbon nanoparticles in endoscopic thyroidectomy and prophylactic central neck dissection through total mammary areolas approach for thyroid cancer

Feasibility, perceived aesthetic outcomes and patients’ interest in transoral endoscopic thyroidectomy (TOETVA) in a cohort of patients in the Thames Valley United Kingdom

Optimal primary wound closure methods after thyroid and parathyroid surgery: network meta-analysis of randomized clinical trials

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