Transoral thyroidectomy: limitations, patients’ safety, and own experiences

Abstract

For patients undergoing thyroidectomy, the minimally invasive aspect and the cosmetic advantage of the procedure seem to be important factors in surgery. Studies in cadaver and animals have shown that different endoscopic techniques can be performed in a safe and successful way. In the evolution of thyroid surgery, for many endocrine surgeons, the transoral approach seems to be the next step. Even if such procedures are more and more frequently applied in patients, these procedures are far from being generally implemented in routine surgery. In this study, we report on our own experience and considerations in the process of finding a sublingual endoscopic transoral way to the endoscopic transoral thyroidectomy. We describe our failures, risk assessment and compare that with the available literature on transoral sublingual and vestibular thyroid surgery. The access itself needs to be further refined, and even more suitable and better adapted instruments need to be developed, so that optimal and safe results that meet all requirements on endocrine surgery can be achieved. A learning curve at the risk of patients' lives should be avoided. Furthermore, a combination of transoral endoscopic non-transoral techniques might be a useful safer, but more traumatising alternative for implementation. The sublingual access seems to be less invasive than the vestibular access. For a sublingual single-access routine surgery, better instruments are needed. Only in highly specialized centres for endocrine and endoscopic surgery, transoral thyroidectomy should be performed.

Complications of Trans-oral Endoscopic Thyroidectomy Vestibular Approach: A Systematic Review

“…Different treatment guidelines, health insurance policies, economic constraints, patient's culture or personal expectations determine length of hospital time. Series from USA or Europe report discharge after an overnight stay while those of eastern origin usually after 48-72 hours (40,66). In our review median length of hospital stay in days was 3.15±1.47.…”

Video-assisted neck surgery (VANS) using a gasless lifting procedure for thyroid and parathyroid diseases: “The VANS method from A to Z”

“…Recently, intraoperative nerve monitoring [38][39][40][41], a transoral approach [42][43][44][45][46], and robotic surgery [47][48][49][50] have emerged in endoscopic thyroid surgery. We believe that intraoperative nerve monitoring is efficient for identifying and preserving the recurrent nerve and external branch of the superior laryngeal nerve.…”

Safety and Outcomes of the Transoral Endoscopic Thyroidectomy Vestibular Approach

“…However, debate remains about whether TOETVA is appropriate. 19 Furthermore, only a few published series of TOETVA are available, with none specifically comparing TOETVA with the traditional open thyroidectomy (OT). [20][21][22][23][24] To our knowledge, the current study is the largest series of TOETVA to date.…”