Flexible Single Port Access in Transoral Endoscopic Thyroidectomy Vestibular Approach

Overview

Journal Gland Surg

Publisher AME Publishing Company

Specialty Endocrinology

Date 2022 Jun 13

PMID 35694100

Authors

Michael de Cillia

Christian Obrist

Christof Mittermair

Elias Karakas

Helmut Weiss

Affiliations

Soon will be listed here.

Abstract

Background: Transoral endoscopic thyroidectomy vestibular approach (TOETVA) is regarded the only no-scar technique which combines minimized surgical trauma with all advantages of endoscopy such as enhanced view, fluorescent parathyroid imaging (FPI) and optimum cosmesis. Addressing TOETVA specific local risk profiles like mental nerve injury, the potential of skin lesions or difficult specimen retrieval we modified the three trocar based TOETVA towards a soft single port platform.

Methods: Single port-TOETVA (SP-TOETVA) was established and retrospectively analysed in five patients using a soft handmade single port housing multiple trocar valves. Standard laparoscopic instruments, one articulating instrument and a vessel-sealing device were utilized. CO insufflation was maintained at 6-8 mmHg.

Results: In all patients SP-TOETVA was completed successfully. Hemigland and total thyroid volumes ranged from 5-40 and 55 mL, respectively. Neither additional trocars nor conversion to open was required. Operation time yielded 102-214 min. Neuromonitoring and FPI were applied. The soft wound protection foil served for convenient specimen harvest. No intra- or postoperative complication occurred. In particular, no functional impairment on mental nerve was seen.

Conclusions: SP-TOETVA with the soft and flexible handmade single port system is feasible and ensures wound protection. It allows for easy instrument application and benefits of minimally invasive surgery without the specific risk of lateral vestibular incisions.

Citing Articles

TOETVA: a single surgeon's learning curve and a case report of CASTLE thyroid tumor.

Jin X, Huang Z, Guo P, Yuan R Langenbecks Arch Surg. 2023; 408(1):398.

PMID: 37831199 DOI: 10.1007/s00423-023-03140-8.

References

Miccoli P, Berti P, Raffaelli M, Conte M, Materazzi G, Galleri D . Minimally invasive video-assisted thyroidectomy. Am J Surg. 2001; 181(6):567-70. DOI: 10.1016/s0002-9610(01)00625-0. View

Mohiuddin K, Swanson S . Maximizing the benefit of minimally invasive surgery. J Surg Oncol. 2013; 108(5):315-9. DOI: 10.1002/jso.23398. View

Celik S, Makay O, Yoruk M, Kocer I, Ozdemir M, Kilic K . A surgical and anatomo-histological study on Transoral Endoscopic Thyroidectomy Vestibular Approach (TOETVA). Surg Endosc. 2019; 34(3):1088-1102. DOI: 10.1007/s00464-019-06856-1. View

Karakas E, Anuwong A, Ketwong K, Kounnamas A, Schopf S, Klein G . [Transoral thyroid and parathyroid surgery : Implementation and evaluation of the transoral endoscopic technique via the vestibular approach (TOETVA)]. Chirurg. 2018; 89(7):537-544. DOI: 10.1007/s00104-018-0635-0. View

Ikeda Y, Takami H, Sasaki Y, Kan S, Niimi M . Endoscopic neck surgery by the axillary approach. J Am Coll Surg. 2000; 191(3):336-40. DOI: 10.1016/s1072-7515(00)00342-2. View

Kulkarni N, Arulampalam T . Laparoscopic surgery reduces the incidence of surgical site infections compared to the open approach for colorectal procedures: a meta-analysis. Tech Coloproctol. 2020; 24(10):1017-1024. PMC: 7346580. DOI: 10.1007/s10151-020-02293-8. View

Shimazu K, Shiba E, Tamaki Y, Takiguchi S, Taniguchi E, Ohashi S . Endoscopic thyroid surgery through the axillo-bilateral-breast approach. Surg Laparosc Endosc Percutan Tech. 2003; 13(3):196-201. DOI: 10.1097/00129689-200306000-00011. View

Park D, Shaear M, Chen Y, Russell J, Kim H, Tufano R . Transoral robotic thyroidectomy on two human cadavers using the Intuitive da Vinci single port robotic surgical system and CO insufflation: Preclinical feasibility study. Head Neck. 2019; 41(12):4229-4233. DOI: 10.1002/hed.25939. View

Kavic M . Natural orifice translumenal endoscopic surgery: "NOTES". JSLS. 2006; 10(2):133-4. PMC: 3016136. View

10.

Anuwong A, Sasanakietkul T, Jitpratoom P, Ketwong K, Kim H, Dionigi G . Transoral endoscopic thyroidectomy vestibular approach (TOETVA): indications, techniques and results. Surg Endosc. 2017; 32(1):456-465. DOI: 10.1007/s00464-017-5705-8. View

11.

Karakas E, Klein G, Michlmayr L, Schardey M, Schopf S . Transoral thyroid surgery vestibular approach: is there an increased risk of surgical site infections?. Updates Surg. 2021; 74(1):303-308. PMC: 8827351. DOI: 10.1007/s13304-021-01191-4. View

12.

Ikeda Y, Takami H, Sasaki Y, Takayama J, Niimi M, Kan S . Clinical benefits in endoscopic thyroidectomy by the axillary approach. J Am Coll Surg. 2003; 196(2):189-95. DOI: 10.1016/S1072-7515(02)01665-4. View

13.

Anuwong A, Ketwong K, Jitpratoom P, Sasanakietkul T, Duh Q . Safety and Outcomes of the Transoral Endoscopic Thyroidectomy Vestibular Approach. JAMA Surg. 2017; 153(1):21-27. PMC: 5833624. DOI: 10.1001/jamasurg.2017.3366. View

14.

Yang H, Shin K, Min J, Woo S . Anatomical study of gasless transoral thyroidectomy and clinical application. Surg Endosc. 2019; 34(8):3414-3423. DOI: 10.1007/s00464-019-07117-x. View

15.

Dionigi G, Lavazza M, Bacuzzi A, Inversini D, Pappalardo V, Tufano R . Transoral Endoscopic Thyroidectomy Vestibular Approach (TOETVA): From A to Z. Surg Technol Int. 2017; 30:103-112. View

16.

Tae K . Complications of Transoral Thyroidectomy: Overview and Update. Clin Exp Otorhinolaryngol. 2020; 14(2):169-178. PMC: 8111399. DOI: 10.21053/ceo.2020.02110. View

17.

Park Y, Kim D, Moon Y, Lim J, Choi E, Kim S . Gasless transoral robotic thyroidectomy using the DaVinci SP system: Feasibility, safety, and operative technique. Oral Oncol. 2019; 95:136-142. DOI: 10.1016/j.oraloncology.2019.06.003. View

18.

Henry J . Minimally invasive thyroid and parathyroid surgery is not a question of length of the incision. Langenbecks Arch Surg. 2008; 393(5):621-6. DOI: 10.1007/s00423-008-0406-3. View

19.

Keus F, de Jong J, Gooszen H, van Laarhoven C . Laparoscopic versus open cholecystectomy for patients with symptomatic cholecystolithiasis. Cochrane Database Syst Rev. 2006; (4):CD006231. DOI: 10.1002/14651858.CD006231. View

20.

Witzel K, von Rahden B, Kaminski C, Stein H . Transoral access for endoscopic thyroid resection. Surg Endosc. 2007; 22(8):1871-5. DOI: 10.1007/s00464-007-9734-6. View