TIROIDECTOMÍA TRANS-ORAL ENDOSCOPICA CON ABORDAJE VESTIBULAR (TOETVA) VERSUS TIROIDECTOMÍA ENDOSCÓPICA: COMPLICACIONES POSTQUIRURGICAS.

Introduction: thyroid gland surgical excision has been performed since the 19th century, which was first employed by Theodor Kocher, this technique since its inception presented certain post-surgical complications and left an aesthetically uncomfortable scar in patients; however a few years ago new techniques have been carried out under laparoscopic approaches which leave less scarring; under this same concept, in 2016 the TOETVA technique (Endoscopic trans-oral thyroidectomy with vestibular approach) is presented, with which fewer postoperative complications have been evidenced. Objective: To identify post-surgical complications, surgical and hospitalization time between TOETVA versus endoscopic techniques. Materials and Methods: a retrospective study of two surgical interventions was carried out, which included patient’s surgery by Endoscopic Trans-oral Thyroidectomy and patient’s surgery by other endoscopic techniques at Hospital General IESS Ibarra in the period between January 2017 - March 2019. Thirty-three patients met the inclusion criteria, 19 patients were tested for Endoscopic Trans-oral Thyroidectomy with TOETVA vestibular approach, and 14 with cervical endoscopic thyroidectomy. Descriptive and inferential statistical analysis was performed using SPSS software. Version 19. Results: the entire studied population was female, with 45.3 years old in average, 42.42% resided in Ibarra, while 15.5% were from Otavalo, these two populations were the most representative. Regarding to the issue, 68.4% patient’s surgery by TOETVA technique and 71.42% % patient’s surgery by cervical endoscopic thyroidectomy technique did not present complications. The surgical time in which it was reported that Endoscopic Trans-oral Thyroidectomy with vestibular approach was also studied, TOETVA had a mean of 129.84 minutes, while the cervical endoscopic had a mean of 131.07 minutes. The hospital stay was shorter for cervical endoscopic thyroidectomy due to complications presented with TOETVA with a mean of 6.32 and 4.14 days respectively. Conclusions: trans-oral Endoscopic Thyroidectomy with vestibular approach (TOETVA) is a technique that is in the process of implementation and learning in Ecuador and that as a result of the present investigation it could be concluded that there are no significant differences regarding post-surgical complications between the techniques studied.

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Practice Patterns and Learning Curve in Transoral Endoscopic Thyroidectomy Vestibular Approach With Neuromonitoring

Frontiers in Endocrinology ◽

10.3389/fendo.2021.744359 ◽

2021 ◽

Vol 12 ◽

Author(s):

Ting-Chun Kuo ◽

Quan-Yang Duh ◽

Yi-Chia Wang ◽

Chieh-Wen Lai ◽

Kuen-Yuan Chen ◽

...

Keyword(s):

Learning Curve ◽

Practice Patterns ◽

Endoscopic Thyroidectomy ◽

Operation Time ◽

Access To Information ◽

Surgical Interventions ◽

Graphic Model ◽

Mature Phase ◽

Two Phases ◽

Vestibular Approach

ObjectivesIntraoperative neuromonitoring has not been routinely applied in early experience with the transoral endoscopic thyroidectomy vestibular approach (TOETVA). Because the preparation and surgical interventions are much different from conventional thyroidectomies, most endocrine surgeons willing to adapt to TOETVA lack access to information regarding the practice pattern and proficiency in the learning curve. We aimed to investigate the outcomes and to define the learning curve for TOETVA in this study.MethodsA retrospective analysis was used on patients who underwent TOETVA at our hospital between December 2016 and July 2019. The cumulative sum graphic model was used to implement the learning curve as a surrogate for procedural proficiency.ResultsThe 119 patients had a mean age of 44.65 years and a mean body mass index of 22.49 k/m2, including 107 women, 20 thyroiditis, and 106 hemithyroidectomy. The learning curve revealed two phases, an initial (35 cases) and a mature (84 cases) phase, for surgeons based on operation time (144.2 vs. 114.2 min, p = 0.0001). There were more bilateral thyroidectomies (15.5% vs. 0, p = 0.0100), larger indicated nodules (6.06 cm3vs. 3.32 cm3, p = 0.0468), or larger thyroids to resect (16.38 cm3vs. 8.75 cm3, p = 0.0001) in the mature phase. Procedure-related complications decreased significantly in the mature phase in comparison to the initial phase (3.57% vs. 31.43%, p = 0.0001).ConclusionsThe learning curve of TOETVA with neuromonitoring is 35 cases. With the accumulation of proficiency, the indications will expand. Step-by-step improvements from the experience of each case can reduce procedure-related complications.

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New Techniques in Thyroid Surgery – Critical Evaluation

Polish Journal of Surgery ◽

10.5604/01.3001.0013.2092 ◽

2019 ◽

Vol 91 (Suplement 1) ◽

pp. 12-16

Author(s):

Krzysztof Kaczka ◽

Lech Pomorski

Keyword(s):

Thyroid Surgery ◽

Endoscopic Thyroidectomy ◽

Critical Evaluation ◽

Thyroid Neoplasms ◽

Fluorescence Angiography ◽

New Techniques ◽

Search Terms ◽

Narrowband Imaging ◽

Continuous Neuromonitoring ◽

Vestibular Approach

Introduction: Operations due to benign and malignant thyroid neoplasms constitute a significant percentage of operations in general and oncological surgery wards. Therefore, unsurprisingly, better and better methods are being sought to avoid the occurrence of two major complications after those operations, i.e. laryngeal nerve palsy and hypoparathyroidism and new minimally invasive accesses. M aterial and methods: Authors searched MEDLINE database using the following search terms: modern technologies AND/ OR thyroid surgery AND/OR intermittent neuromonitoring AND/OR continuous neuromonitoring AND/OR parathyroid preservation AND/OR transoral endoscopic thyroidectomy AND/OR TOETVA. Results: The paper discusses the following new techniques of thyroid surgery with particular focus on limitations: neuromonitoring, narrowband imaging, fluorescence angiography and transoral endoscopic thyroidectomy by vestibular approach. Conclusions: Some of the new techniques are highly clinically useful. Their use can become a routine element of standard thyroidectomy.

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Recent Trends in Surgical Approach to Thyroid Cancer

Frontiers in Endocrinology ◽

10.3389/fendo.2021.699805 ◽

2021 ◽

Vol 12 ◽

Author(s):

Leonardo Rossi ◽

Gabriele Materazzi ◽

Sohail Bakkar ◽

Paolo Miccoli

Keyword(s):

Thyroid Cancer ◽

Minimally Invasive ◽

Endoscopic Thyroidectomy ◽

Remote Access ◽

New Techniques ◽

Surgical Technology ◽

Recent Trends ◽

Alternative Approaches ◽

Transaxillary Thyroidectomy ◽

Vestibular Approach

Over the past decade, the incidence of thyroid cancer has rapidly increased worldwide, and thyroid surgery has become one of the most common performed surgical procedure. Even though conventional open thyroidectomy remains the gold standard, this approach leaves a neck scar which could be worrying mainly for young women. The recent progress in surgical technology, as well as patient cosmetic requests, have led to the development of alternative access to the thyroid lodge. Thus, alternative techniques have been established in order to potentially provide a more appealing cosmetic result, both with a minimally-invasive cervical or remote-access approach. However, the introduction of these new techniques was initially approached with caution due to technical challenges, the introduction of new complications and, above all, skepticism about the oncologic effectiveness. Among several alternative approaches proposed, the minimally invasive video-assisted thyroidectomy and the robot-assisted transaxillary thyroidectomy became popular and obtained the favor of the scientific community. Moreover, the recent introduction of the trans-oral endoscopic thyroidectomy with vestibular approach, although the safety and the efficacy are still under discussion, deserves particular attention since it represents the only technique truly scarless and provides the best cometic result. The purpose of this article is to provide an overview of the current main alternative approaches for the treatment of thyroid cancer with particular focus on the oncological effectiveness of the procedures.

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A Single Surgeon’s 10-Year Experience in Remote-Access Thyroid and Parathyroid Surgery

The American Surgeon ◽

10.1177/0003134820950300 ◽

2020 ◽

pp. 000313482095030

Author(s):

Emad Kandil ◽

Mounika Akkera ◽

Hosam Shalaby ◽

Ruhul Munshi ◽

Abdallah Attia ◽

...

Keyword(s):

Learning Curve ◽

Evoked Potential ◽

Operative Time ◽

Endoscopic Thyroidectomy ◽

Remote Access ◽

Parathyroid Surgery ◽

American Institute ◽

Effective Learning ◽

Select Group ◽

Vestibular Approach

Background Remote-access thyroid and parathyroid surgery has gained popularity recently due to its benefit of avoiding visible neck scars. Most of these techniques were described and performed in Asia, on patients with different body habitus compared to American patients. We aim to analyze the learning curve in performing these operations in North America.  Methods This is a retrospective cohort study of a 10-year experience by a single surgeon at a North American institute. Patients who underwent thyroid or parathyroid procedures by a transaxillary, retroauricular, or transoral endoscopic thyroidectomy vestibular approach (TOETVA) were included. Cumulative sum (CUSUM) was used to analyze learning curves based on intraoperative blood loss and total operative times and learning phases were divided accordingly. Results Three hundred seventy-two remote-access thyroid and parathyroid procedures were performed during the study period. Total operative time for transaxillary procedures was initially reduced after the 69th procedure and then again after the 134th case. For retroauricular procedures, marked reduction in the operative time was observed after 21 procedures. Most patients (57.02%) were discharged home on the same day during the mastering phase. In the transaxillary procedures, only 1 case of brachial plexus injury occurred prior to the routine use of somatosensory evoked potential (SSEP) monitoring. Discussion Remote-access thyroid and parathyroid surgeries can be performed safely with minimal complications in a select group of patients. Analysis of the learning curve in performing these operations aids in structuring a safe and effective learning period for endocrine surgeons seeking to venture into this modality of treatment.

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A predictive model of operative time in transoral endoscopic thyroidectomy vestibular approach

Head & Neck ◽

10.1002/hed.26581 ◽

2020 ◽

Author(s):

Ved A. Tanavde ◽

Christopher R. Razavi ◽

Lena W. Chen ◽

Rohit Ranganath ◽

Ralph P. Tufano ◽

...

Keyword(s):

Predictive Model ◽

Operative Time ◽

Endoscopic Thyroidectomy ◽

Vestibular Approach

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An Unusual Case of Meckel Diverticulitis Misdiagnosed as an Infected Urachal Cyst

Medicina ◽

10.3390/medicina57050495 ◽

2021 ◽

Vol 57 (5) ◽

pp. 495

Author(s):

Ioana Anca Stefanopol ◽

Magdalena Miulescu ◽

Liliana Baroiu ◽

Aurelian-Dumitrache Anghele ◽

Dumitru Marius Danila ◽

...

Keyword(s):

Meckel’S Diverticulum ◽

Surgical Excision ◽

Cyst Formation ◽

Meckel's Diverticulum ◽

Urachal Cyst ◽

Macroscopic Appearance ◽

Surgical Interventions ◽

Bladder Dome ◽

Low Sensitivity ◽

Tract Infections

Introduction: Meckel’s diverticulum (MD), a remnant of the omphaloenteric duct, is among the most frequent intestinal malformations. Another embryonic vestige is the urachus, which obliterates, becoming the median umbilical ligament; the failure of this process can lead to a urachal cyst formation. We present a case of Meckel diverticulitis misdiagnosed as an infected urachal cyst. Presentation of case: A 16-year-old girl presented with hypogastric pain, fever and vomiting. She had undergone an appendectomy 6 years prior and no digestive malformation had been documented. In the last 2 years, she had 3 events of urinary tract infections with Escherichia coli, and anabdominal ultrasound discovered a 28/21 mm hypoechogenic preperitoneal round tumor, anterosuperior to the bladder. We established the diagnosis of an infected urachal cyst, confirmed later by magnetic resonance imaging. Intraoperative, we found MD with necrotic diverticulitis attached to the bladder dome. Discussions: Meckel’s diverticulum and urachal cyst (UC) are embryonic remnants. Both conditions are usually asymptomatic, being incidentally discovered during imaging or surgery performed for other abdominal pathology. Imaging diagnosis is accurate for UC, but for MD they are low sensitivity and specificity. For UC treatment, there is a tendency to follow an algorithm related to age and symptoms, but there is no general consensus on whether to perform a routine resection of incidentally discovered MD. Conclusion: Preoperatory diagnosis of MD represents a challenge. We want to emphasize the necessity of a thorough inspection of the small bowel during all abdominal surgical interventions and MD surgical excision regardless of its macroscopic appearance. These two actions seem to be the best prophylaxis measures for MD complications and consequently to avoid emergency surgery, in which case more extensive surgical procedures on an unstable patient may be needed.

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