Patient Eligibility for Transoral Endocrine Surgery Procedures in the United States

Grogan, Raymon H.; Suh, Insoo; Chomsky-Higgins, Kate; Alsafran, Salman; Vasiliou, Elya; Razavi, Christopher R.; Chen, Lena; Tufano, Ralph P.; Duh, Quan Yang; Angelos, Peter; Russell, Jonathon O.

doi:10.1001/jamanetworkopen.2019.4829

Cited by 41 publications

(29 citation statements)

References 26 publications

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“…Transoral neck surgery has gained significant attention over the last several years as a new and promising remote‐access approach to the neck. The transoral vestibular technique was first described by Richmon et al 37 in cadavers and later modified into the current TOETVA technique by Anuwong et al 22 The most common remote access technique currently used in the United States for thyroidectomy is TOETVA 29 . Several recent systematic reviews have demonstrated the safety and efficacy of TOETVA to be comparable to that of the traditional TCA 17,38‐40 .…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, TOETVA utilizes a familiar anatomical orientation and dissection planes that mirror those of TCA, likely contributing to its excellent safety profile demonstrated in the literature 17,18,21‐28 . While the operative time for TOETVA is longer than that for TCA operations, 22 its comparable safety profile and perceived cosmetic advantage warrant further investigation into the broad applicability of this technique, as a large portion of patients presenting to academic centers with thyroid pathology are candidates for the procedure 29,30 . This is of particular relevance to the patients who are willing to accept a greater financial and/or surgical risk burden to enhance their post‐thyroidectomy scar cosmesis 31 .…”

Section: Introductionmentioning

confidence: 99%

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Cosmetic outcomes following transoral versus transcervical thyroidectomy

et al. 2020

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Background: Central neck scars following thyroidectomy can negatively impact patient quality of life. Transoral endoscopic thyroidectomy can reduce postoperative cosmetic burden. Methods: Prospective cohort study of patients seen between June 2018 and January 2019. Scar cosmesis was determined using the validated Scar Cosmesis Assessment and Rating (SCAR) scale and a Visual Analog Scale (VAS) measuring color, contour, and irregularity. Results: Eighty-one patients (80% female, mean age 43.7 years) were analyzed, with 60% and 40% receiving transcervical and transoral thyroidectomy. Median time from surgery was 3.4 (range: 1-37.1) weeks. Mean SCAR score was greater for transcervical recipients (4.69 vs transoral 0.99, P < .001), indicating worse cosmesis. Mean surgeon-rated total VAS score was similarly increased for transcervical recipients (72.84 vs transoral 16.73, P < .001). Interrater reliability for both SCAR and total VAS scores was excellent (intraclass correlation 0.93; 95% CI: 0.90-0.95 for both). Conclusion: Transoral thyroidectomy provides significantly enhanced early cosmesis over the transcervical approach.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Cosmetic outcomes following transoral versus transcervical thyroidectomy

et al. 2020

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“…The momentum for this novel approach gained favor among international circles, and several trials have reproduced the safety and efficacy of TOETVA in Asia, Europe, and the United States ( 18 , 22 – 29 ). When compared to open surgical approaches, TOETVA has reliably demonstrated similar rates of postoperative infection, reduced pain, safety, and a similar complication profile to open techniques (recurrent laryngeal nerve injury and hypoparathyroidism) ( 17 , 22 , 25 , 26 , 30 )…”

Section: Transoral Endoscopic Thyroid Surgery Vestibular Approachmentioning

confidence: 99%

“…Other remote access techniques include the retroauricular approach, trans-axillary technique, and bilateral axillo-breast approach ( 13 – 16 ). To date, none of these other approaches have become common in the West, while TOETVA is becoming relatively popular due to broad operative indications, wide eligibility and applicability for patients with benign or malignant disease, and even with a BMI greater than 30 ( 17 – 19 ). Although TOETVA has longer operative time when compared to the conventional open technique, patient satisfaction and cosmesis are superior with TOETVA ( 20 , 21 ).…”

Section: Transoral Endoscopic Thyroid Surgery Vestibular Approachmentioning

confidence: 99%

Novel Approaches for Treating Autonomously Functioning Thyroid Nodules

et al. 2020

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Benign thyroid nodules are exceedingly common in the adult population. Only a small percentage of nodules are toxic or autonomously functioning thyroid nodules (AFTNs). The options clinicians have for treating the symptoms of hyperthyroidism include anti-thyroidal medications, radioactive iodine, or surgery. Depending on the patient population treated, these options may not be suitable or have inherent risks that are undesirable to the patient. On the other hand, untreated hyperthyroidism can lead to osteoporosis, atrial fibrillation, emotional lability, and neurological consequences. Thus, we present a review of two novel safe and effective approaches for treating AFTN; one surgical (transoral endoscopic thyroid surgery) and one non-surgical (radiofrequency ablation), as a means for expanding our treatment armamentarium.

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“…Finally, the third argument against this approach is that very few patients will actually qualify for the operation. However, a cross‐sectional review of 1000 thyroid and parathyroid operations at three high volume practices showed that more than half of patients undergoing thyroid and parathyroid surgery would potentially be eligible for TES 11 . Therefore, the need to develop and establish TES practices throughout the country and world should be pursued.…”

Section: Argument For Adoption Of Tesmentioning

confidence: 99%

Transoral endocrine surgery: Considerations for adopting a new technique

James

Angelos

Grogan

2020

Journal of Surgical Oncology

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Transoral endocrine surgery encompasses a group of operations whereby the thyroid or parathyroid gland is removed through the oral vestibule. This operation has the advantage of leaving no cutaneous scar and a risk profile similar to open surgery. Adoption of this technique has increased dramatically over the last several years. It is of paramount importance for surgeons to undergo adequate training before adopting this technique. K E Y W O R D S endoscopic parathyroidectomy, endoscopic thyroidectomy, minimally invasive surgery, remote access surgery, transoral endocrine surgery, transoral parathyroid surgery, transoral thyroid surgery 1 | INTRODUCTION In the early 1900s, Kocher documented the open surgical approach to thyroidectomy using a transverse cervical incision. 1 This approach persisted as the gold standard operation for thyroidectomy for more than a century. However, over the last two decades, there has been a dramatic rise in alternatives to the conventional transcervical Kocher approach with the goal to avoid leaving a visible scar on the neck. Broadly speaking, these approaches include remote access through axillary incisions, periariolar incisions, and retroauricular incisions and more recently, incisions in the lower lip. Transoral endocrine surgery (TES) encompasses a group of operations that can be performed using the Transoral Endoscopic Vestibular Approach. While the former three remote access approaches have been present for over two decades, they have failed to gain general popularity for several reasons. First, all three earlier remote access sites are associated with morbidity not seen in the standard open approach, such as axillary abscesses and possible paresthesia along with the dissection flaps. Second, axillary, periareolar and retroauricular approaches all require extensive flap dissection far greater than those created in open thyroid and parathyroid surgery. Finally, they still require a cutaneous incision which leaves a scar, albeit in less visible locations. 2,3 In 2011, Richmond et al, 4 published the first report of removing the thyroid gland via the oral vestibule in two cadavers. 4 Five years later, Anuwong published the first series of 60 consecutive endoscopic thyroidectomies via the vestibular approach in humans. 5 A subsequent landmark article from Anuwong in 2018 showed that endoscopic vestibular approach outcomes were equivalent to the standard open operation. 6 Anuwong termed this approach TransoralEndoscopic Thyroidectomy Vestibular Approach (TOETVA). The approach has since been used for parathyroidectomies, lymph node dissections, and has also been done with robotic assistance. TES is an all-encompassing term that describes any of these neck operations being done via the oral vestibule. Since the first case series by Anuwong was published, there has been a rapid rise in attention to this new approach in the endocrine surgery community and has been explored and adopted throughout the world with enthusiasm not seen with previous remote access techniques. There are sever...

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Patient Eligibility for Transoral Endocrine Surgery Procedures in the United States

Cited by 41 publications

References 26 publications

Cosmetic outcomes following transoral versus transcervical thyroidectomy

Cosmetic outcomes following transoral versus transcervical thyroidectomy

Novel Approaches for Treating Autonomously Functioning Thyroid Nodules

Transoral endocrine surgery: Considerations for adopting a new technique

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