Transoral Endoscopic Thyroidectomy: A Systematic Review of the Practice So Far

Abstract

Background and Objectives:Thyroid disease largely affects young females, but the incidence is also increasing among males. In an effort to avoid the scarring of the neck that is synonymous with conventional thyroidectomy, endoscopic techniques have been developed over the years. The transoral endoscopic approach is the latest of these innovations that promises a scarless surgical outcome. This review evaluates whether this technique is safe and feasible in live patients and outlines the outcomes in published literature so far.Database:PubMed, Medline, BioMed Central, Cochrane Library, OVID and Web of Science were systematically searched by using a Medical Subject Heading (MeSH)–optimized search strategy. The selection of papers followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines after setting strict inclusion and exclusion criteria. Sixteen studies were included in the final analysis.Discussion:This systematic review presents cases of 785 patients. Surgeons in 15 of the studies used a completely vestibular approach, whereas those in the remaining 2 used the floor of the mouth for primary access. Conversion to open surgery took place in 1.3%. In total, 4.3% of patients experienced transient laryngeal nerve palsy, whereas 0.1% had permanent recurrent incidences of the condition. Transient hypocalcemia occurred in 7.4% of cases, with no recorded permanent cases. Carbon dioxide embolism occurred in 0.6% of cases, and another 0.6% had a deep-seated neck infection. The complication rates within the review were deemed acceptable and the overall technique feasible. A prospective randomized controlled trial was proposed to compare this technique with conventional thyroidectomy.

Safety and efficacy of transoral robotic and endoscopic thyroidectomy: The first 100 cases

“…However, numerous publications from Thailand, Korea, China, and the United States have reported only few wound infections after transoral vestibular endoscopic and robotic thyroidectomy . Rates of surgical site infection in the meta‐analyses were also very low (0.1%‐1%) . There is no standard definition of surgical site infection.…”

“…The most important priority in evaluating and adopting a new surgical procedure is its safety. In recent studies, including four meta‐analyses, transoral endoscopic and robotic thyroidectomy has been reported to be safe and comparable to conventional transcervical thyroidectomy . However, most studies of transoral thyroidectomy are case series with relatively small sample sizes, and there are only a few studies involving more than 100 cases .…”

Transoral Endoscopic Thyroidectomy via Vestibular Approach With 4 Trocars: A New Technique

“…Many studies have shown the safety and feasibility of this technique in both benign and malignant lesions of the thyroid. 4,5 As this procedure only requires some of the basic endoscopic instruments, TOETVA can be broadly applied to plenty of health facilities worldwide, even in places whose medical facilities have not developed yet. 6 Furthermore, the learning curve for TOETVA appears to be relatively short.…”

Transoral neck surgery prevents attentional bias towards the neck compared to open neck surgery

“…Scarless neck surgery to remove the thyroid or parathyroid glands, through various robotic and endoscopic approaches, has garnered increasing attention over the past decade. 1 In particular, transoral endoscopic thyroidectomy via a vestibular approach (TOETVA) is lauded as the least invasive of the remote access thyroidectomy approaches because it makes use of a natural orifice and avoids skin incisions entirely. 2,3 Numerous studies have demonstrated the safety and efficacy of TOETVA compared to alternate scarless approaches as well as to traditional open neck surgery in the appropriate patient population.…”

“…2,3 Numerous studies have demonstrated the safety and efficacy of TOETVA compared to alternate scarless approaches as well as to traditional open neck surgery in the appropriate patient population. 1,4,5 As indications for the transoral approaches expand, 6,7 studies to further understand its impact on patient outcomes is warranted.…”