Transoral endoscopic thyroidectomy vestibular approach: Experience from a multicenter national group with 412 patients

Lira, Renan Bezerra; Cicco, Rafael De; Rangel, Leonardo; Bertelli, Antônio Augusto Tupinambá; Silva, Guilherme Duque; Vanderlei, João Paulo de Medeiros; Kowalski, Luiz Paulo

doi:10.1002/hed.26846

Cited by 26 publications

(31 citation statements)

References 32 publications

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“…The safety and feasibility of TOETVA have also been confirmed in different centers [ 31 – 33 ]. Compared with previous studies, the rate of permanent RLN injury in this study is lower [ 18 , 20 , 34 , 35 ], which may benefit from the neuroprotective techniques mentioned above.…”

Section: Discussionmentioning

confidence: 93%

Safety and feasibility of the transoral endoscopic thyroidectomy vestibular approach with neuroprotection techniques for papillary thyroid carcinoma

et al. 2022

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Background This study aimed to evaluate the feasibility and safety of the trans-oral endoscopic thyroidectomy vestibular approach (TOETVA) with neuroprotection techniques for the surgical management of papillary thyroid carcinoma (PTC). Methods Patients with PTC who underwent TOETVA between December 2016 and July 2020 were included in this study, and their relevant clinical characteristics, operational details, and surgical outcomes were reviewed and extracted from their medical records for further analysis. Results A total of 75 patients successfully underwent TOETVA with zero conversions. Unilateral lobectomy with isthmectomy and total thyroidectomy were completed for 58 and 17 patients, respectively, all using our unique neuroprotective procedure and ipsilateral central neck dissection (CND). The mean number of retrieved lymph nodes versus positive lymph nodes was 6.8 ± 3.7 vs. 1.5 ± 2.3. Postoperative complications included three cases of transient superior laryngeal nerve (SLN) palsy (4.0%), five cases of transient recurrent laryngeal nerve (RLN) palsy (6.7%), 14 cases of transient hypoparathyroidism (18.7%), two cases of numb chin (2.7%) and two cases of flap perforation (2.7%). The follow-up period for patients with PTC lasted for 15.6 ± 10.9 months, during which no other complications or tumor recurrence were observed. Conclusion TOETVA can be safely performed for patients with PTC with satisfactory results during the short-term follow-up period. Our neuroprotection techniques can be integrated into TOETVA, which is worth recommending for PTC patients who desire better cosmetic surgical outcomes.

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Section: Discussionmentioning

confidence: 93%

Safety and feasibility of the transoral endoscopic thyroidectomy vestibular approach with neuroprotection techniques for papillary thyroid carcinoma

et al. 2022

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“…In a study of TET using the TOVA, Anuwong et al reported a 10.9% incidence. 6 In another TOVA study, Lira et al reported transient and persistent hypocalcemia rates of 4.0% and 0.8%, respectively; 3 yet another noted a 14.1% incidence of transient hypoparathyroidism. 10 A meta-analysis of endoscopic and open thyroidectomy in PTC patients showed that rates of transient hypocalcemia after endoscopic resection ranged between 0.3% and 49%; those for permanent hypocalcemia ranged from 0% to 13%.…”

Section: Discussionmentioning

confidence: 96%

“… 2 The incidence of complications, including hypoparathyroidism, is similar between TET and open thyroidectomy. 3 , 4 However, the BA and TOVA are different TET approaches and have different observation angles. The TOVA can provide excellent surgical exposure for PTC resection and allows direct access to both sides of the central neck with limited tissue dissection.…”

Section: Introductionmentioning

confidence: 99%

Hypoparathyroidism Risk After Total Endoscopic Thyroidectomy for Papillary Thyroid Cancer: A Comparison of the Transoral Vestibular and Breast Approaches

Xu¹,

Teng²,

Ding³

et al. 2022

CMAR

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Background This study aimed to compare the risk of hypoparathyroidism between the transoral vestibular approach (TOVA) and the breast approach (BA) in patients undergoing total endoscopic thyroidectomy (TET) for papillary thyroid carcinoma (PTC). Methods The medical records of 121 PTC patients (all women) who underwent total TET from January 2015 to January 2021 were retrospectively analyzed. Patients were grouped according to surgical approach (BA or TOVA). Clinical status and concentrations of parathyroid hormone (PTH) and calcium were monitored in the perioperative period and 1, 6, and 12 months after surgery. Results The BA and TOVA groups comprised 101 and 20 patients, respectively. Clinicopathologic and characteristics and surgical data were comparable between the groups. Incidence of transient hypoparathyroidism was significantly lower in the TOVA group than the BA group (10% vs 63.4%; p <0.01). Incidence of permanent hypoparathyroidism was comparable (5% vs 6.9%). Two days after TET, mean PTH concentration was significantly higher and incidence of abnormal PTH was significantly lower in the TOVA group. The incidence of abnormal calcium concentration 2 days after surgery was significantly lower in the TOVA group. One month after surgery, the mean calcium concentration was significantly higher in the TOVA group. Univariate and multivariate Cox regression analysis suggested that patients who underwent TOVA had a lower risk of transient hypoparathyroidism (hazard ratio 0.05, 95% confidence interval, 0.01–0.23; p<0.01). No clinicopathological factors examined were significantly associated with permanent hypoparathyroidism. Conclusion In patients undergoing TET for PTC, the incidence of transient hypoparathyroidism may be lower with the TOVA than the BA. Surgeons should be aware of the relatively high risk of transient hypoparathyroidism when performing the BA.

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“…Since a large case series of transoral endoscopic thyroidectomy was reported in 2016, multiple hospital centers worldwide have introduced this technique and reported their initial experience ( 7 ). Up to now, transoral endoscopic thyroidectomy via vestibular approach (TOETVA) has become one of the most widely used techniques in scarless endoscopic thyroidectomy ( 8 ). Our group has reported a large cohort of TOETVA cases, in which we demonstrated that transoral endoscopic thyroidectomy has the same surgical safety compared with total endoscopic thyroidectomy via areola approach, and conventional open thyroidectomy ( 9 ).…”

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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Transoral endoscopic thyroidectomy vestibular approach: Experience from a multicenter national group with 412 patients

Cited by 26 publications

References 32 publications

Safety and feasibility of the transoral endoscopic thyroidectomy vestibular approach with neuroprotection techniques for papillary thyroid carcinoma

Safety and feasibility of the transoral endoscopic thyroidectomy vestibular approach with neuroprotection techniques for papillary thyroid carcinoma

Hypoparathyroidism Risk After Total Endoscopic Thyroidectomy for Papillary Thyroid Cancer: A Comparison of the Transoral Vestibular and Breast Approaches

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

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