New Techniques in Thyroid Surgery – Critical Evaluation

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.

How I Do It: New Dissector Device Allows for Effective Operative Field in Transoral Endoscopic Thyroid Surgery Using Vestibular Approach

2018 ◽  
Vol 25 (5) ◽  
pp. 444-449 ◽  
Author(s):  
Verena Müller ◽  
Martina Mogl ◽  
Philippa Seika ◽  
Thomas Jöns ◽  
Igor Sauer ◽  
...  
Keyword(s):  
Thyroid Surgery ◽  
Endoscopic Thyroidectomy ◽  
Parathyroid Glands ◽  
Superior Thyroid Artery ◽  
Anterior Neck ◽  
Operative Field ◽  
Linea Alba ◽  
New Device ◽  
Clinical Series ◽  
Vestibular Approach

Background. Minimally invasive thyroid and parathyroid resections are rarely performed. Promising new endoscopic transoral approaches to the anterior neck (transoral endoscopic thyroidectomy vestibular approach [TOETVA]) have been described with good results and few complications. This study evaluates a new device to allow the safe entrance of trocars in the subplatysmal space for TOETVA in a cadaver model. Methods. The technique was performed in 4 unilateral thyroidectomies in female cadavers. The technical steps consisted of a 10-mm incision made at the center of the oral vestibule followed by subplatysmal hydrodissection. The blunt dissector is a metallic stick with an olive at the end and promotes progressive gain in subplatysmal space enlarging the operative field. The instrument was inserted creating a space below the platysma to the anterior neck and the strap muscles. Three trocars were inserted in the vestibular area. The dissection begins by cutting the linea alba cervicalis. The isthmus was dissected and transected. Anatomical structures as the superior thyroid artery, parathyroid glands, and the recurrent laryngeal nerve could be safely identified with magnified vision. Results. Optimal operative field due to subplatysmal dissection by the device allowed for exposition of thyroid and parathyroid glands in all cases. Unilateral thyroidectomy was performed in a mean of 54 minutes with excellent aesthetic results. Conclusions. The new device is a promising feature to allow safe transoral thyroid surgery in a cadaver model. Further studies in clinical series are needed to evaluate the broad application of the device.

scholarly journals Recent Trends in Surgical Approach to Thyroid Cancer

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.

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

2021 ◽  
Vol 32 (1) ◽  
Author(s):  
María Isabel Frías ◽  
Elva Beatriz Arias
Keyword(s):  
Surgical Complications ◽  
Endoscopic Thyroidectomy ◽  
Surgical Excision ◽  
New Techniques ◽  
Surgical Interventions ◽  
Endoscopic Techniques ◽  
Vestibular Approach ◽  
Theodor Kocher ◽  
The 19Th Century ◽  
Two Populations

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.

INTRAOPERATIVE CONTINUOUS NEUROMONITORING OF LARYNGEAL RECCURENT NERVES IN PATIENTS WITH THYROID CANCER

2019 ◽  
Vol 65 (3) ◽  
pp. 342-348
Author(s):  
Viktor Makarin ◽  
Anna Uspenskaya ◽  
Arseniy Semenov ◽  
Natalya Timofeeva ◽  
Roman Chernikov ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Postoperative Complications ◽  
Recurrent Laryngeal Nerve ◽  
Thyroid Surgery ◽  
Intraoperative Neuromonitoring ◽  
Laryngeal Nerve ◽  
Laryngeal Muscles ◽  
Neural Transmission ◽  
Continuous Neuromonitoring ◽  
Surgical Manipulation

Laryngeal muscles paresis ranks second in prevalence of postoperative complications after thyroid surgery. Intraoperative neuromonitoring (IONM) of recurrent laryngeal nerve (RLN) results in reduction of cases with dysphonia and prevents such severe complication as bilateral paresis. Currently there are two types of monitoring: intermittent and continual. When using intermittent IONM surgeon has no opportunity to control electrophysiology state of RLN during intervals between stimulations. In case of continual IONM date on amplitude and latency are available to surgeon in real time every second, allowing him instantly react to any disturbance of neural transmission to prevent its damage by changing surgical manipulation. This work presents the first experience of using continual neuromonitoring of RLN in Russia, the procedure is described in details its safety. It is represented the possibility of prevention of bilateral laryngeal muscles paresis.

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

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.

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

Head & Neck ◽  
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

scholarly journals Comparing quality of life between patients undergoing trans-areola endoscopic thyroid surgery and trans-oral endoscopic thyroid surgery

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Shuang Shen ◽  
Xiaochi Hu ◽  
Rui Qu ◽  
Youming Guo ◽  
Libo Luo ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Thyroid Surgery ◽  
Short Form ◽  
Endoscopic Thyroidectomy ◽  
Operation Time ◽  
Endoscopic Thyroid Surgery ◽  
Sf 36 ◽  
Areola Approach ◽  
High Level

Abstract Background Compared with conventional open surgery, endoscopic thyroidectomy via the oral vestibular approach (ETVOA) and endoscopic thyroidectomy via the areola approach (ETAA) avoided scarring of the skin, which may help patients achieve a better quality of life (QOL). However, the benefit of the QOL from this technique has not been adequately investigated, therefore this study compared the QOL outcomes between ETVOA and ETAA. Methods 131 patients were enrolled in this study. ETAA surgery and ETVOA surgery were performed in 74 patients and 57 patients, respectively. These patients were followed up at 2 weeks, 4 weeks, and 8 weeks, and their QOL was evaluated using a thyroid surgery-specific questionnaire and a short-form health survey (SF-36). Results There were no differences in clinical characteristics such as gender, age, body mass index (BMI), and tumor size between the two groups. The volume of intraoperative blood loss, cost of hospitalization, and complications between the two procedures showed no differences. Compared with ETAA, ETVOA has a longer operation time, no drainage, and shorter hospital stay. In the QOL questionnaire, several parameters in ETVOA were better. The satisfaction scores of patients undergoing ETVOA were higher. In addition, the cosmetic satisfaction in patients who received ETOVA was significantly better than that of patients who underwent ETAA. The degree of neck movement disorder in patients with ETVOA was milder. Patients who received ETVOA had higher score on the SF-36. Conclusions The trans-oral endoscopic approach can acquire better cosmetic results and achieved high-level QOL.

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