scholarly journals Trans-oral endoscopic endocrine surgery vestibular approach: Pioneering the technique in the Gulf Cooperation Council Countries – A case series

2021 ◽  
pp. 103114
Author(s):  
Salman Alsafran ◽  
Danah Quttaineh ◽  
Dalia Albloushi ◽  
Sarah Al Safi ◽  
Abdullah Alfawaz ◽  
...  
Keyword(s):  
Case Series ◽  
Gulf Cooperation Council ◽  
Endocrine Surgery ◽  
Vestibular Approach

Endoscopic approaches in head and neck endocrine surgery − introduction of TOETVA (TransOral Endoscopic Thyroidectomy by Vestibular Approach) into clinical use at the Department of Surgery of the University Hospital in Brno

2020 ◽  
Vol 99 (11) ◽  
Keyword(s):  
Minimally Invasive ◽  
Endoscopic Thyroidectomy ◽  
Follicular Carcinoma ◽  
Neck Surgery ◽  
Parathyroid Glands ◽  
University Hospital ◽  
Endocrine Surgery ◽  
Operating Field ◽  
First Case ◽  
Vestibular Approach

Transoral endoscopic surgery of the thyroid and parathyroid glands is a modification of neck surgery using natural orifices. The classic approach in neck surgery is the gold standard, which we modified in 2007 by introducing Minimally Invasive Video-Assisted Thyroidectomy/Parathyroidectomy (MIVAT/P). We have been using TransOral Endoscopic Thyroidectomy/Parathyroidectomy by Vestibular Approach (TOETVA/TOEPVA) since the end of the last year and have operated on four patients. This method is more attractive for patients because it does not leave a visible scar on the neck, which is common in MIVAT/P. TOETVA is a promising procedure with many advantages, such as healing without visible scars, less pain, minimally invasive dissection and a clear operating field to both thyroid lobes and parathyroid glands. Presentation of the first case. Patients indicated for TOETVA must meet certain criteria – nodule(s) up to 3.5 cm, gland volume up to 30 ml, benign FNAB, papillary, follicular carcinoma not advanced, well differentiated, up to the nodule size of 10 mm with 1 lymph node up to 10 mm. The contraindications include a large goiter, previous neck surgery, history of thyroiditis, lymphadenopathy of the neck, advanced thyroid cancer. Relative contraindications include previous radiotherapy to the throat, Grave´s disease, and obese patients with a short neck. Intraoperative findings may result in a modification of the procedure. TOETVA is an excellent choice for selected patients who want to avoid a neck incision. This method provides the benefit of using standard endoscopic instruments and techniques. It is a safe and effective procedure that provides a good cosmetic result and considerable comfort in terms of clarity of the operating field by zooming in with an endoscopic camera. Longer operating times become shorter due to the learning curve effect.

scholarly journals Tiroidectomía transoral endoscópica por abordaje vestibular

2020 ◽  
Vol 112 (2) ◽  
pp. 185-188
Author(s):  
Alejandro M. Zalazar ◽  
◽  
Javier L. Rossi ◽  
José M. Moreno Negri ◽  
Francisco Santucho Saravia
Keyword(s):  
Operative Time ◽  
Endoscopic Thyroidectomy ◽  
Case Series ◽  
Needle Aspiration ◽  
First Case ◽  
Human Cadavers ◽  
Vestibular Approach ◽  
First Time ◽  
Benign Thyroid Nodules ◽  
Benign Thyroid

Natural orifice transluminal endoscopic surgery (NOTES) was applied for the first time by K. Witzel in 2008, introducing the transoral endoscopic resection of the thyroid gland in human cadavers and living pigs. In 2016, A. Anuwong published the first case series using the vestibular approach in humans. We report the case of a 37-year-old female patient with a mass in the anterior aspect of the neck which appeared two months before consultation. The thyroid ultrasound reported multinodular goiter. The fine-needle aspiration (FNA) biopsy reported hyperplastic follicular nodule in both lobes. The patient underwent transoral endoscopic thyroidectomy by vestibular approach. Operative time was 180 minutes and blood loss was 20 mL. Pain was minimal and hospital stay was 36 hours. We report our first experience with total thyroidectomy in a patient with benign thyroid nodules.

scholarly journals Transoral endoscopic thyroidectomy vestibular approach: early experience in a single centre

2019 ◽  
Vol 6 (6) ◽  
pp. 2016
Author(s):  
Siddhartha Chakravarthy N. ◽  
Anish Jacob Cherian ◽  
Deepak Thomas Abraham ◽  
Paul M. J.
Keyword(s):  
Total Thyroidectomy ◽  
Thyroid Nodules ◽  
Operative Time ◽  
Endoscopic Thyroidectomy ◽  
Endocrine Surgery ◽  
Mental Nerve ◽  
Excessive Bleeding ◽  
Open Thyroidectomy ◽  
Scarless Surgery ◽  
Vestibular Approach

Background: Conventional open thyroidectomy is associated with a visible scar in the neck which may cause significant psychological distress to some patients, especially young women. Transoral endoscopic thyroidectomy vestibular approach (TOETVA) is an adaptation of the natural orifice transluminal endoscopic surgery (NOTES) technique to thyroid surgery and allows for a scarless surgery with minimal dissection.Methods: This study retrospectively reviewed all TOETVA surgeries performed at the department of endocrine surgery between August 2016 and July 2018. Protocol for selecting patients for this novel approach included patients with clinically benign thyroid nodules less than 6cm in diameter, with a strong preference for scarless surgery. The surgery was performed endoscopically through the inferior oral vestibule using conventional laparoscopic instruments.Results: A total of 11 patients were included. The mean size of the thyroid nodules was 3.72 cm. Hemithyroidectomy was performed in 7 patients and total thyroidectomy in 4. The median operative time was 150 minutes for hemithyroidectomy and 225 minutes for total thyroidectomy. One patient required conversion to open thyroidectomy due to excessive bleeding. Adverse effects included transient mental nerve palsy in 2 patients, temporary RLN palsy in 1 patient and temporary hpoparathyroidism in 1 patient. All 10 patients who underwent successful TOETVA reported satisfaction with the cosmetic outcome.Conclusions: TOETVA can be used to offer scar free thyroidectomy in appropriately selected patients. Attention to the anatomy of the mental nerve is essential to prevent nerve injury. Additionally the relatively longer operative time could lessen with increasing operator experience.

scholarly journals Robot-assisted adrenalectomy: state of the art

2020 ◽  
Author(s):  
Gabriele Materazzi ◽  
Leonardo Rossi
Keyword(s):  
Laparoscopic Adrenalectomy ◽  
Operative Time ◽  
Case Series ◽  
Standard Technique ◽  
Robotic System ◽  
Endocrine Surgery ◽  
Robot Assisted ◽  
3D Vision ◽  
Additional Degree ◽  
Robotic Adrenalectomy

Abstract Currently, laparoscopic adrenalectomy is worldwide considered the gold standard technique. Both transperitoneal and retroperitoneal approaches have proved their efficacy with excellent outcomes. Since the introduction of da Vinci System (Intuitive Surgical, Sunnyvale, CA), robotic surgery has made many steps forward gaining progressively more diffusion in the field of general and endocrine surgery. The robotic technique offers advantages to overcome some laparoscopic shortcomings (rigid instruments, loss of 3D vision, unstable camera). Indeed, the robotic system is provided of stereoscopic 3D-magnified vision, additional degree of freedom, tremor-filtering technology and a stable camera. Recently, several case series have demonstrated the feasibility and the safety of robot-assisted adrenalectomy in high-volume centers with outcomes comparable to laparoscopic adrenalectomy. Notwithstanding, the technical advantages of the robotic system have not yet demonstrated significant improvements in terms of outcomes to undermine laparoscopic adrenalectomy. Moreover, robotic adrenalectomy harbor inherits drawbacks, such as longer operative time and elevated costs, that limit its use. In particular, the high cost associated with the use of the robotic system is primarily related to the purchase and the maintenance of the unit, the high instruments cost and the longer operative time. Notably, these aspects make robotic adrenalectomy up to 2.3 times more costly than laparoscopic adrenalectomy. This literature review summarizes the current available studies and provides an overview about the robotic scenario including applicability, technical details and surgical outcomes.

scholarly journals MON-489 Comorbidity of Primary Hyperparathyroidism and Papillary Thyroid Cancer. A Single Center Outcomes

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Nektaria Papadopoulou ◽  
Eleni Papanikolaou ◽  
George P Chrousos ◽  
Evangelos Karvounis
Keyword(s):  
Thyroid Cancer ◽  
Primary Hyperparathyroidism ◽  
Papillary Thyroid Cancer ◽  
Thyroid Nodules ◽  
Age Groups ◽  
Case Series ◽  
Distant Metastases ◽  
Endocrine Surgery ◽  
Papillary Thyroid ◽  
Papillary Cancer

Abstract Introduction Concurrence of primary hyperparathyroidism in patients with thyroid disease has been previously reported by several studies. However, comorbidity between primary hyperparathyroidism (PHPT) and papillary thyroid cancer (PTC) has been sparsely described by previous, mostly case-series studies, and is considered rare. Since pathophysiological mechanisms behind the two diseases are supposed to be different, any link between these diseases has not been explained as yet. Hypothesis: Aim of the study was to investigate the possible concurrence for the two diseases in people who underwent thyroidectomy for suspected thyroid nodules. Methodology Retrospective observational study that included 2913 patients (24% men with mean age 49.82 yrs, 76% women mean aged 47.73 yrs), who underwent total thyroidectomy during the last 13 years (2005-2018) at the Department of Endocrine Surgery, Euroclinic Hospital, in Greece. The patient-groups were categorised according to histopathology criteria of the thyroid and/ or parathyroid glands (in case of comorbidity of primary hyperparathyroidism (PHPT) diagnosed prior to surgery). Results: Statistical analysis revealed benign histopathology findings in 1945 patients (64%), while papillary cancer was found in 978 (32%). Among patients with non-malignancy, 16 (11 women/5 men) had PHPT, but in those with papillary cancer, PHPT was diagnosed in 38 (33 women/5 men) individuals. The relative risk for the concurrence of PHPT and PTC was 2.033 (95%CI 1.69 to 2.43, P<0.0001). Age groups between 30 and 60 yrs were associated with the highest relative frequency of comorbidity (82%). A significant positive correlation was observed between less aggressive PTC histopathology findings and PHPT concurrence (P<0.0001). Interestingly, no patient with PTC and PHPT had either capsular invasion or regional/distant metastases. Moreover, most patients with comorbidity (92%) had a tumour diameter smaller (mean 6.3 mm) than those with PTC alone (mean 18 mm). Conclusions: Our study found that the comorbidity between primary hyperparathyroidism and PTC may be considered as possible. Endocrinologist’s diagnostic approach may add serum calcium and parathormone levels in patients who undergo evaluation for suspected thyroid nodules. Patients with PHPT and PTC had mostly microcarcinomas, and histopathology findings showed a less aggressive PTC pattern. Further large cohorts as well as genetic studies, are needed to duplicate our results and further highlight possible common pathogenetic pathways behind PHPT and PTC concurrence.

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