Transoral thyroidectomy vestibular approach versus non-transoral endoscopic thyroidectomy: a comprehensive systematic review and meta-analysis

PurposeConventional thyroidectomy has been standard of care for surgical thyroid nodules. For cosmetic purposes different minimally invasive and remote-access surgical approaches have been developed. At present, the most used robotic and endoscopic thyroidectomy approaches are minimally invasive video assisted thyroidectomy (MIVAT), bilateral axillo-breast approach endoscopic thyroidectomy (BABA-ET), bilateral axillo-breast approach robotic thyroidectomy (BABA-RT), transoral endoscopic thyroidectomy via vestibular approach (TOETVA), retro-auricular endoscopic thyroidectomy (RA-ET), retro-auricular robotic thyroidectomy (RA-RT), gasless transaxillary endoscopic thyroidectomy (GTET) and robot assisted transaxillary surgery (RATS). The purpose of this systematic review was to evaluate whether minimally invasive techniques are not inferior to conventional thyroidectomy.MethodsA systematic search was conducted in Medline, Embase and Web of Science to identify original articles investigating operating time, length of hospital stay and complication rates regarding recurrent laryngeal nerve injury and hypocalcemia, of the different minimally invasive techniques.ResultsOut of 569 identified manuscripts, 98 studies met the inclusion criteria. Most studies were retrospective in nature. The results of the systematic review varied. Thirty-one articles were included in the meta-analysis. Compared to the standard of care, the meta-analysis showed no significant difference in length of hospital stay, except a longer stay after BABA-ET. No significant difference in incidence of recurrent laryngeal nerve injury and hypocalcemia was seen. As expected, operating time was significantly longer for most minimally invasive techniques.ConclusionsThis is the first comprehensive systematic review and meta-analysis comparing the eight most commonly used minimally invasive thyroid surgeries individually with standard of care. It can be concluded that minimally invasive techniques do not lead to more complications or longer hospital stay and are, therefore, not inferior to conventional thyroidectomy.

Download Full-text

Feasibility of Transoral Thyroidectomy by Vestibular Approach

Bengal Journal of Otolaryngology and Head Neck Surgery ◽

10.47210/bjohns.2020.v28i1.176 ◽

2020 ◽

Vol 28 (1) ◽

pp. 67-70

Author(s):

Kshitij Shah ◽

Shivali Patekar ◽

Tejal Patel ◽

Renuka Bradoo

Keyword(s):

Minimally Invasive Surgery ◽

Minimally Invasive ◽

Endoscopic Thyroidectomy ◽

Open Approach ◽

Initial Experience ◽

Transoral Thyroidectomy ◽

Open Procedure ◽

Endoscopic Thyroid Surgery ◽

Vestibular Approach ◽

Good Exposure

Introduction An open approach to thyroidectomies through neck provides good exposure and safe dissection however, the patient still has a scar. Endoscopic thyroid surgery has been practised since the late 90s. The latest addition is the transoral endoscopic thyroidectomy by vestibular approach. Materials and Methods We at our centre performed this surgery on 3 patients. Here we present our initial experience of transoral endoscopic thyroidectomy by vestibular approach (TOETVA). Results Two of the three patients did not have any complication. Diffuse bleeding was encountered during one instance and decision was taken to convert it into an open procedure. Conclusion The preliminary experience of transoral thyroidectomy by vestibular approach shows it to be a feasible and promising ‘scarless’ and ‘minimally invasive’ surgery.

Download Full-text

Complications of transoral endoscopic thyroidectomy vestibular approach (TOETVA)

Revista do Colégio Brasileiro de Cirurgiões ◽

10.1590/0100-6991e-20202557 ◽

2021 ◽

Vol 48 ◽

Author(s):

GILBERTO MENDES MENDERICO JR ◽

ABRAHÃO LOTHAR WEISSENBERG ◽

CLARA MARINHO BORBA ◽

GIOVANNA MORALES SALLANI ◽

JANAÍNA DE OLIVEIRA POY

Keyword(s):

Systematic Review ◽

Endoscopic Thyroidectomy ◽

Neck Surgery ◽

Recurrent Laryngeal Nerve Injury ◽

Cochrane Library ◽

Safe Procedure ◽

Cervical Incision ◽

The Aesthetic ◽

Vestibular Approach ◽

Favorable Conditions

ABSTRACT The thyroidectomy is the most frequently executed procedure in head and neck surgery. Since its first description by Kocher, the transverse cervical incision has been the main access to the thyroid site, as it provides broad exposure of the central neck compartment. Despite the meticulous suture of the incision, the development of a scar with variable dimensions is unavoidable and, hence, some patients might not agree to the approach, due to this consequence. The transoral endoscopic thyroidectomy vestibular access (TOETVA) gains importance as an alternative to the traditional surgery, since it avoids the formation of visible scars. The objective of this study is to develop a systematic review on the currently available literature to evaluate possible complications related to the TOETVA. The systematic review was based on the databases of Medline, Cochrane library, Embase and Scielo/Lilacs, resulting in the selection of six studies, which were compared in regard of the type of study duration of the study and identified complications. Our study showed that TOETVA is related to complications similar to the ones identified in the conventional approach, such as hematoma, seroma, recurrent laryngeal nerve injury, hypoparathyroidism, surgical site infection. The TOETVA was associated to a higher risk of thermic injury of the skin and mentual nerve paresthesia. Moreover, it was possible to conclude that TOETVA is a safe procedure for well selected patients, with favorable conditions and concerned about the aesthetic outcome. The risk of complications of the procedure should always be explained to those patients.

Download Full-text

The effects of low-ratio n-6/n-3 PUFA on biomarkers of inflammation: a systematic review and meta-analysis

Food & Function ◽

10.1039/d0fo01976c ◽

2021 ◽

Author(s):

Yali Wei ◽

Yan Meng ◽

Na Li ◽

Qian Wang ◽

Liyong Chen

Keyword(s):

Systematic Review ◽

Fatty Acid ◽

Polyunsaturated Fatty Acid ◽

Meta Analysis ◽

Chain Polyunsaturated Fatty Acid ◽

Inflammation Markers ◽

Pufa Supplementation ◽

Long Chain

The purpose of the systematic review and meta-analysis was to determine if low-ratio n-6/n-3 long-chain polyunsaturated fatty acid (PUFA) supplementation affects serum inflammation markers based on current studies.

Download Full-text