Transoral Thyroidectomy: Initial Results of the European TOETVA Study Group

Abstract

Background The aim of this study was to evaluate a new surgical technique by the European Transoral Endoscopic Thyroidectomy Vestibular Approach (TOETVA) Study Group. Methods This study included 391 patients (47 [(12%]) male and 344 [(88%)] female) who had undergone endoscopic thyroid or parathyroid surgery via the vestibular approach between February 2016 and May 2022 at nine centers. The data were analyzed with regard to complications, surgery time and specimen retrieval. Results Overall, 376 (96.2%) TOETVA and 15 (3.8%) transoral endoscopic parathyroidectomy vestibular approach interventions were performed with an average surgery time of 145 (± 61.2) minutes and 509 nerves at risk. The specimens were retrieved via a transoral vestibular and retroauricular approach in 66 (16.9%) patients and via a transaxillary approach in 8 (2%). Benign histology including Grave’s disease was identified in 272 (69.6%) patients, 1 (0.3%) presented noninvasive follicular thyroid neoplasms with papillary-like nuclear features, and 103 (26.3%) showed differentiated thyroid carcinoma. Solitary parathyroid adenoma were removed in 15 (3.8%) patients. Conversion to open surgery was necessary in 13 (3.3%) and revision had to be performed in 2 (0.5%) patients. Transient recurrent laryngeal nerve palsy (RLNP) was present in 18 (4.6%) and permanent RLNP in 2 (0.5%) patients. Fifteen (3.8%) patients experienced transient hypoparathyroidism after thyroidectomy. No case of permanent hypoparathyroidism was observed. Postoperative surgical site infection occurred in 1 (0.3%) patient. Despite a higher rate of sensory and motor disorders and skin discoloration at discharge, permanent disorders were present in only 3 (0.8%) and 16 (4.1%) patients, respectively. Conclusion Our results show that transoral endoscopic surgery, performed by experienced endocrine surgeons, is a safe alternative to conventional thyroid surgery.

Comparison of safety, efficacy, and patient satisfaction with thermal ablation versus endoscopic thyroidectomy for benign thyroid nodules in a propensity-matched cohort

“…The most common complication after RFA is tumour rupture secondary to acute volume expansion caused by haemorrhage, consistent with previous studies 16 . One patient who underwent TOETVA developed a surgical site infection, an occurrence reported in roughly 0.3% of patients in previous studies 32 . Notably, none of the patients in our study developed subsequent abscesses, and long-term antibiotic treatment was not required.…”

TOETVA parathyroid autofluorescence detection: hANDY-i endoscopy attachment

“…Advancements in video-assisted endoscopic surgery hold a wealth of opportunities for patient outcome improvement beyond the capacity of open surgeries. Remote access thyroidectomy methods have significantly improved cosmetic outcomes ( 15 , 16 ) while achieving comparable complication rates ( 17 – 22 ), garnering increasing attention globally since the first completely video-assisted endoscopic thyroid lobectomy was introduced in 1997 ( 23 – 25 ). Additional features that allow assessment of PG viability in real time without the need for ICG or other injectables will add value to patients and surgeons.…”

Invited Commentary: The Path Toward Broader Validation and Adoption of Transoral Thyroidectomy

“…1,2 The study by Arikan and colleagues published in this issue of the World Journal of Surgery has made significant strides toward addressing these limitations by presenting the combined experience of the transoral technique from the European TOETVA Study Group, a collective of nine European medical centers. 3 They included 376 patients undergoing thyroid resection and 15 patients undergoing parathyroidectomy, which is the largest published experience from Europe and among the largest series overall in the literature to date. The pooled outcomes were excellent, with rates of endocrine-specific complications such as recurrent laryngeal nerve injury, hypoparathyroidism, and neck hematoma roughly equivalent to well-described benchmarks from the conventional open techniques.…”