Transoral endoscopic thyroidectomy vestibular approach (TOETVA) for Graves’ disease: a comparison of surgical results with open thyroidectomy

Abstract

Background: Transoral endoscopic thyroidectomy vestibular approach (TOETVA) provides excellent cosmetic results from its potential for scar-free operation. The procedure has been applied successfully for Graves' disease by the authors of this work and compared with the standard open cervical approach to evaluate its safety and outcomes.Methods: From January 2014 to November 2016, a total of 97 patients with Graves' disease were reviewed retrospectively. Open thyroidectomy (OT) and TOETVA were performed in 49 patients and 46 patients, respectively. For TOETVA, a three-port technique through the oral vestibule was utilized. The thyroidectomy was done endoscopically using conventional laparoscopic instruments and an ultrasonic device. Patient demographics and surgical variables, including operative time, blood loss, and complications, were investigated and compared.Results: TOETVA was performed successfully in all 45 patients, although conversion to open surgery was deemed necessary in one patient. All patient characteristics for both groups were similar. Operative time was shorter for the OT group compared to the TOETVA group, which totaled 101.97±24.618 and 134.11±31.48 minutes, respectively (P<<0.5). Blood loss was comparable for both groups. The visual analog scale (VAS) pain score for the TOETVA group was significantly lower than for the OT group on day 1 (2.08±1.53 vs. 4.57±1.35), day 2 (0.84±1.12 vs. 2.57±1.08) and day 3 (0.33±0.71 vs. 1.08±1.01) (P<<0.05).Transient recurrent laryngeal nerve (RLN) palsy was found in four and two cases of TOETVA and OT group, respectively. Transient hypocalcemia was found in ten and seven cases of TOETVA and OT group, respectively. No other complications were observed.Conclusions: TOETVA is a feasible and safe treatment for Graves' disease in comparison to the standard open cervical approach. It is considered a viable alternative for patients who have been indicated for surgery with excellent cosmetic results.

Transoral endoscopic thyroidectomy using vestibular approach: updates and evidences

“…The technique will be described in brief in the technique section. Udelsman et al at reported a series of 7 cases of TOETVA (2 parathyroidectomy and 5 thyroidectomy) with no complications, which was the first series in the United (30). The operative time was longer in the TOETVA group.…”

Indications and contraindications to transoral thyroidectomy

“…expanded this to include patients with Grave’s disease with at least one of the following: suspicious nodules, toxic multinodular goiter, failure or recurrence after 2 years of anti-thyroid medication, local compressive symptoms, and patients with side effects from anti-thyroid medication. Of note, all patients in this series were euthyroid at the time of the procedure (38). Each group’s inclusion criteria have been summarized in Table 1 (22–25,27,36,38–40).…”

“…Of note, all patients in this series were euthyroid at the time of the procedure (38). Each group’s inclusion criteria have been summarized in Table 1 (22–25,27,36,38–40). …”

“…define a maximum allowable thyroid diameter as 10 cm, while Wang et al . utilize an 8-cm maximum thyroid diameter value in addition to a 2-cm maximum nodule size (22,28,38,39). Dionigi et al .…”

“…Patients whom were deemed unfit for surgery or could not tolerate general anesthesia were also excluded (22–24,27,30,38). Most high-volume authors additionally note that lymph node metastasis and evidence of extrathyroidal extension such as tracheal or esophageal invasion should be contraindications (24,25,27,36,39,40).…”