Prevention of transoral thyroidectomy complications: An analysis of surgical outcomes in 423 consecutive series

You, Ji Young; Kim, Hoon-Yub; Park, Da Won; Yang, Hsien Wen; Dionigi, Gianlorenzo; Tufano, Ralph P.

doi:10.1016/j.surg.2021.05.003

Cited by 15 publications

(22 citation statements)

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“…In addition, one other group found different pain control experiences with similar or more analgesics needed for adequate pain control perioperatively [ 27 ]. Recently, postoperative pain management with administration of oral acetaminophen (650 mg) supplemented with intramuscular ketorolac tromethamine injection (30 mg) if needed was proposed to reduce pain after TOETVA [ 28 ]. More research regarding short-term and long-term postoperative pain assessment and management is needed.…”

Section: Discussionmentioning

confidence: 99%

Feasibility and Safety of Ambulatory Transoral Endoscopic Thyroidectomy via Vestibular Approach (TOETVA)

et al. 2022

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Background In search of an ideal cosmesis, transoral endoscopic thyroidectomy via vestibular approach (TOETVA) has recently been introduced to avoid a visible scar. Although ambulatory thyroid surgery is considered safe in carefully selected patients, this remains unclear for TOETVA. Methods All consecutive adult patients who underwent ambulatory TOETVA or open thyroid surgery at a French university hospital were prospectively enrolled from 12/2020 until 11/2021. The primary outcome was postoperative morbidity (recurrent laryngeal nerve (RLN) palsy, re-intervention for bleeding, wound morbidity, or hospital readmission). The secondary outcome was quality of life (QoL), measured by a survey including a validated questionnaire (SF-12) and a modified thyroid surgery questionnaire six weeks after surgery. Results Throughout the study period, 374 patients underwent a unilateral lobectomy or isthmectomy in ambulatory setting, of which 34 (9%) as TOETVA (including 21 (62%) for a possible malignancy). In the TOETVA group, younger age (median 40 vs. 51 (40-60) years, P \ 0.001) and lower BMI (median 23.1 (20.9-25.4) vs. 24.9 (22.1-28.9) kg/m 2 , P = 0.001) were noted. No cases were converted to open cervicotomy. TOETVA was at least as good as open cervicotomy with nil versus four (1%) re-interventions for bleeding, one temporary (5%) versus 13 (4%) (temporary) RLN palsies, and one (\1%) wound infection (open cervicotomy group). No hospital readmissions occurred in all ambulatory surgery patients. No differences were found in physical (P = 0.280) and mental (P = 0.569) QoL between TOETVA and open surgery. Conclusions In carefully selected patients, the feasibility and safety of ambulatory TOETVA are comparable to open surgery.

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Section: Discussionmentioning

confidence: 99%

Feasibility and Safety of Ambulatory Transoral Endoscopic Thyroidectomy via Vestibular Approach (TOETVA)

et al. 2022

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“…No significant difference was found in the comparison of surgical complications in the types of A, B, and C, including postoperative vocal cord paralysis and hypoparathyroidism. Mental nerve injury is a unique complication of TOETVA ( 10 ). And the incidence of mental nerve injury is quite diverse ( 11 ).…”

Section: Discussionmentioning

confidence: 99%

Comparison of Different Mandibular Jawlines Classifications on Transoral Endoscopic Thyroidectomy for Papillary Thyroid Carcinoma: Experiences of 690 Cases

Xing

Jiang

et al. 2022

Front. Endocrinol.

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BackgroundThe influences of patients’ different mandibular jawlines on transoral endoscopic thyroidectomy via vestibular approach (TOETVA) have not been described before. The objective of this study was to introduce a new classification to assess different mandibular jawlines, and to evaluate the effects on TOETVA in terms of safety, feasibility, and postoperative feelings in the treatment of papillary thyroid carcinoma (PTC).MethodsThe crossing angle of esthetic plane and mandibular plane was defined as Wang Angle, used to assess patients’ different mandibular jawlines. Mandibular classifications of A (angle: 80° ~ 110°), B (angle > 110°), and C (angle < 80°) types were compared to evaluate the surgical outcomes of TOETVA by a retrospective study. 690 patients of PTC who received TOETVA were included in this study, which were divided into three groups according to mandibular classifications.ResultsClinicopathological characteristics of the patients including age, gender, body mass index, tumor size, Hashimoto thyroiditis were similar in the three groups. Patients’ length of jay in group C was significantly longer than group A and group B (P < 0.01). The ratios of using suspension system in group C were significantly higher than group A and group B (P < 0.01). The scores of postoperative visual analogue scale (VAS) and ratios of mandibular swell in group C were significantly higher than group A and group B (P < 0.01). There was no significant difference in the three groups regarding surgical outcomes, including postoperative vocal cord paralysis, hypocalcemia, serum white blood cells and C-reactive protein levels.ConclusionsThe Wang angle and mandibular jawline classifications were firstly introduced in TOETVA. All the patients of class A, B, and C mandibular jawline can achieve safe and effective surgical outcomes in the treatment of PTC with TOETVA. Patients of class C need more assistance of suspension system, would experience higher scores of VAS, and higher ratios of mandibular swell compared with class A and B.

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“…In addition, a study of 17 patients was done in two different hospitals, where all the patients were female and of the same average age, which showed a feasible and safe central lymph nodes dissection that was successively performed in 13 cases with scarless post-operative results and a mean operative time of 254 minutes [1], and a mean nodule size of 1.2 centimeters. Due to the recent engagement of this technique, there is a lack of comparative studies with the conventional open approach, the reason why multiple studies on a large number of patients with a long follow-up are needed [12].…”

Section: Discussionmentioning

confidence: 99%

“…Risk of bias assessment. SANRA* *Scale for the quality Assessment of Narrative Review Articles Richmon and Kim [1]; Aidan et al [8]; Pavlidis et al [9]; Chang et al [4]; Alzahrani et al [3]; Liu and Kim [5]; Kaliszewski et al [7]; Fregoli et al [10]; You et al (Gland Surg., 2021) [11]; You et al (surgery, 2021)[12] …”

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confidence: 99%

The Advantages of Robotic Over Open Thyroidectomy in Thyroid Diseases: A Systematic Review

Ismail¹,

Tavalla²,

Uppal³

et al. 2022

Cureus

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Over a hundred thousand thyroid surgeries are performed per year in the United States. Although conventional thyroidectomy has successful surgical outcomes, robotic minimally invasive procedures, known for their scar free (regarding the neck, no collar incision) surgical outcomes gained popularity through the years. Furthermore, these techniques are new and still debatable. The purpose is to know the advantages of robotic over open thyroidectomy in thyroid diseases. Note that we didn't aim to compare different robotic techniques due to the lack of data.We performed a systematic review comparing surgical approaches for thyroidectomy, open vs robotic techniques, from January 2017 to December 2021, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. All papers with no full free article access and not in the English language were excluded. The outcomes of interest were superior cosmetics outcome, costeffectiveness, limitations, operation time, length of hospital stay and postoperative pain or complications, and future outcomes.A literature search was carried out in electronic databases (PubMed, Google Scholar) in order to retrieve all papers comparing the effectiveness of robotic vs open thyroidectomy. An initial reference search yielded 433 articles. Finally, we chose nine studies covering different robotic thyroidectomy techniques compared to the open thyroidectomy approach. Promising results were seen in these studies, especially with superior cosmetic results, less post-operative pain, swallowing discomfort, and voice changes. In addition, the risk of recurrent laryngeal nerve injury is almost the same as the open approach. Multiple types of biases were caused by the selection of the population and the limitation of the studies to certain regions associated with the low numbers of robotic thyroidectomy approaches in Europe and the United States of America and the lack of randomized trials and long-term follow-up respectively. All studies discussed the importance of the surgeon's skills and the patient decision in choosing the appropriate approach for the thyroidectomy depending on the risk factors, a larger number of patients, and longer follow-up from multiple hospitals.

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Prevention of transoral thyroidectomy complications: An analysis of surgical outcomes in 423 consecutive series

Cited by 15 publications

References 15 publications

Feasibility and Safety of Ambulatory Transoral Endoscopic Thyroidectomy via Vestibular Approach (TOETVA)

Feasibility and Safety of Ambulatory Transoral Endoscopic Thyroidectomy via Vestibular Approach (TOETVA)

Comparison of Different Mandibular Jawlines Classifications on Transoral Endoscopic Thyroidectomy for Papillary Thyroid Carcinoma: Experiences of 690 Cases

The Advantages of Robotic Over Open Thyroidectomy in Thyroid Diseases: A Systematic Review

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