Robotic transoral thyroidectomy: Total thyroidectomy and ipsilateral central neck dissection with da Vinci Xi Surgical System

Abstract

Background Transoral approach for thyroidectomy draws attention recently among the thyroid surgeons, with the merits of cosmetic outcomes and minimal flap dissection. The aim of this study is to demonstrate the details and the steps of transoral robotic thyroidectomy. Methods We made three incisions in the gingival‐buccal sulcus for three 8‐mm intraoral ports: one inverted U‐shaped 1‐cm midline incision approximately 2 cm above the frenulum, and two 0.5‐cm lateral incisions near the commissure of lips. An additional 8‐mm axilla port was inserted for countertraction and later drain insertion. Results Right thyroid lobectomy, ipsilateral central neck dissection, and left thyroid lobectomy were performed with preserving recurrent laryngeal nerves and parathyroid glands. There was no development of transient or permanent hypoparathyroidism, vocal cord palsy, postoperative bleeding, or surgical site infection. Conclusion Transoral robotic total thyroidectomy and ipsilateral central neck dissection using the da Vinci Xi Surgical System are feasible and safe.

Transoral thyroid and parathyroid surgery via the vestibular approach—a 2020 update

“…The first attempts were discouraging, as the sublingual approach resulted in devastating adverse effects, including hypoglossal nerve injury (15,16). Subsequently, Richmon et al utilized the oral vestibule as an alternative to the sublingual approach (12) which was ultimately adopted by Anuwong. Following the initial series, multiple institutions around the world have adopted this new technique with similar results (17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32). Currently, TOETVA, with approximately 900 reported cases, perhaps more than other remote-access techniques, is attracting patients who are interested in avoiding a neck scar (17,33).…”

Transoral robotic thyroidectomy on two human cadavers using the Intuitive da Vinci single port robotic surgical system and CO2 insufflation: Preclinical feasibility study

“…Its proximity to the thyroid gland through oral mucosa not only provides an excellent cosmetic outcome but also minimizes the flap dissection necessary with other remote access approaches hence more approximating the idea of true minimally invasive surgery . Since our cadaveric experiment report of a robotic transoral periosteal thyroidectomy in 2015, this technique has been successfully applied in clinical setting as transoral robotic thyroidectomy (TORT) procedure for benign and malignant thyroid disease . In addition, the use of the robotic system provides 3‐dimensional, high‐resolution visualization for excellent depth perception, while articulating instruments with a tremor‐filtering system enhance control and accuracy during fine dissection around the critical structures.…”

“…12,20 Since our cadaveric experiment report of a robotic transoral periosteal thyroidectomy in 2015, 23 this technique has been successfully applied in clinical setting as transoral robotic thyroidectomy (TORT) procedure for benign and malignant thyroid disease. 10,16,21,22 In addition, the use of the robotic system provides 3-dimensional, high-resolution visualization for excellent depth perception, while articulating instruments with a tremor-filtering system enhance control and accuracy during fine dissection around the critical structures.…”

“…The working space boundaries were the sternal notch inferiorly, thyroid cartilage superiorly and medial border of the sternocleidomastoid muscle on both sides. This is the approach that has been reported on a number of occasions . Once the working space formation was completed, the midline incision was extended to 20‐ to 25‐mm for further dilation with the da Vinci single port (SP) cannula.…”

“…This is the approach that has been reported on a number of occasions. 12,[19][20][21][22] Once the working space formation was completed, the midline incision was extended to 20-to 25-mm for further dilation with the da Vinci single port (SP) cannula. This is followed by the insertion of the Alexis wound retractor (XXS size) through the midline incision, and the inferior part of the retraction ring was securely placed under the inferior edge of mandible.…”