Novel Trocars and Suspension System Application in Gasless Transoral Endoscopic Thyroidectomy Vestibular Approach Oral Endoscopic Surgery

Abstract

In the current study, we reported our initial experience of gasless transoral endoscopic thyroidectomy vestibular approach (TOETVA) by novel trocars and a suspension system. Between February 2019 to September 2020, thyroid cancer patients with indicated central lymph node metastasis by imaging examination who had received gasless TOETVA by our designed trocars and suspension system in The First Affiliated Hospital of University of Science and Technology of China were reviewed. A total of 95 thyroid cancer patients that received gasless TOETVA were included in this analysis. Of note, 73 cases underwent one-sided lobectomy and the remaining 22 cases underwent total thyroidectomy. All thyroid cancer patients underwent central lymph node dissection (CND). The average total examined lymph nodes number was 8.55 ± 5.67 per individual. No serious complications occurred during or after the operation besides one patient who had a short-term recurrent laryngeal nerve (RLN) deficit and one patient who had delayed postoperative bleeding. In conclusion, the use of novel trocars and a suspension system can effectively improve the safety and efficacy of TOETVA.

En bloc resection of total thyroid and bilateral central compartment lymph nodes via a gasless transoral approach in papillary thyroid carcinoma

“…The three self-designed trocars (two operational trocars, one observational trocar) and thyroid retractor used were similar to those reported in our previous study (26). However, unlike our previous study, this study involved bending the Kirschner wire into a hook at a specific angle, named the skin suspension hook (Figure 1).…”

“…The posture and anesthesia used in this study were similar to those utilized in our previous study (26). The surgery was performed in two steps.…”

“…It has been recommended that righthanded surgeons should first treat the right thyroid lobe. A selfdesigned thyroid retractor was inserted into the medial edge of the sternocleidomastoid muscle under direct endoscopic vision and fixed in the head frame, which was mentioned in our previous study (26). Next, the suspensory ligament of the thyroid was cut to allow entry into the cricothyroid space.…”

“…Moreover, traditional CO 2 inflatable endoscopic surgery has several complications, including CO 2 embolism, which make the surgery ineffective and life-threatening (18-21). To avoid this situation, domestic and foreign scholars have explored gasless endoscopic thyroid surgery (22)(23)(24)(25)(26)(27). No studies have been conducted on en bloc resection of the total thyroid and bilateral central lymph nodes via a gasless transoral approach in papillary thyroid carcinoma.…”

Working Space Creation in Transoral Thyroidectomy: Pearls and Pitfalls

“…In transoral thyroidectomy, the classic setting is a 10–12 mm trocar in the center with two 5 mm trocar at each side near the oral commissure. Since the distances among the three trocars are relatively close, it would be better to use a trocar with a small head to avoid inter-trocar collision [ 56 ]. Furthermore, James et al [ 16 ] use a 5 mm trocar in the middle instead of the original 10 mm one to perform most of their transoral surgeries.…”