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

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.

scholarly journals Transoral Vestibular Thyroidectomy: Current State of Affairs and Considerations for the Future

2019 ◽  
Vol 104 (9) ◽  
pp. 3779-3784 ◽  
Author(s):  
Jonathon O Russell ◽  
Christopher R Razavi ◽  
Mohammad Shaear ◽  
Lena W Chen ◽  
Andrew H Lee ◽  
...  
Keyword(s):  
English Literature ◽  
Evidence Synthesis ◽  
Endoscopic Thyroidectomy ◽  
Remote Access ◽  
Minimally Invasive Thyroidectomy ◽  
The Past ◽  
Current State ◽  
The Future ◽  
State Of Affairs ◽  
Vestibular Approach

Abstract Context The transoral endoscopic thyroidectomy vestibular approach (TOETVA) is a recently described procedure for surgical management of select thyroid pathology that avoids a cutaneous scar. TOETVA is far from the first described remote-access approach to the thyroid. In fact, numerous such techniques have been described over the past 20 years, although none has gained widespread implementation in North America or Europe. However, with its rapid growth worldwide and excellent outcomes to date, TOETVA may succeed where these prior techniques have failed. Evidence Acquisition The English literature was reviewed using the following keywords: transoral thyroidectomy, remote-access thyroidectomy, minimally invasive thyroidectomy, and TOETVA. Because three systematic reviews of this technique were recently conducted, this manuscript does not seek to provide a fourth. Rather, we summarize salient findings from these reviews and focus on candidates for the procedure, technique-specific characteristics that have led to early success with TOETVA, and prospects for the future. Evidence Synthesis TOETVA is the only thyroidectomy approach obviating the need for a cutaneous incision, and it offers several advantages over previously described remote-access thyroidectomy techniques. These include a favorable anatomic surgical perspective, a comparatively short learning curve, no requirement for expensive instrumentation, and a broad inclusion criterion. These characteristics have facilitated the excellent surgical outcomes to date. Conclusions TOETVA is a suitable surgical option with proven safety and feasibility for a carefully selected patient population. The potential value of the procedure outside enhanced cosmesis continues to be defined.

scholarly journals Trans Oral Endoscopic Thyroidectomy Vestibular Approach (TOETVA) in Brazil: Safety and complications during learning curve

2021 ◽  
Vol 65 (3) ◽  
pp. 259-264
Author(s):  
Antonio Augusto Tupinambá Bertelli ◽  
Leonardo Guimarães Rangel ◽  
Renan Bezerra Lira ◽  
Marco Antonio Scirea Tesseroli ◽  
Izabella Costa Santos ◽  
...  
Keyword(s):  
Learning Curve ◽  
Endoscopic Thyroidectomy ◽  
Vestibular Approach

scholarly journals Case Report: Transoral Endoscopic Thyroidectomy via Vestibular Approach in Pediatric Thyroid Cancer

2021 ◽  
Vol 9 ◽  
Author(s):  
Duy Q. Ngo ◽  
Duong T. Le ◽  
Giap N. Hoang ◽  
Quy X. Ngo ◽  
Quang V. Le
Keyword(s):  
Thyroid Cancer ◽  
Neck Dissection ◽  
Pediatric Patients ◽  
Operative Time ◽  
Endoscopic Thyroidectomy ◽  
High Volume ◽  
Central Neck Dissection ◽  
Central Neck ◽  
The Mean ◽  
Vestibular Approach

Background: Transoral endoscopic thyroidectomy via vestibular approach (TOETVA) is a new technique that has become more popular worldwide because of its many advantages. However, this novel approach for thyroid cancer treatment in children is highly challenging, even for high-volume surgeons. In our study, we report our experiences with TOETVA for pediatric patients with thyroid cancer.Patients and Methods: This study included four pediatric patients who underwent TOETVA performed by a single surgeon between June and December 2020. Patient demographics and surgical outcomes including operative time, incidence of complications, and length of hospital stay were evaluated.Results: Four patients successfully underwent TOETVA with no complications. All patients were girls, aged from 13 to 18. Three patients underwent lobectomy and isthmusectomy, plus prophylactic unilateral central neck dissection. One patient had a total thyroidectomy, plus prophylactic bilateral central neck dissection. The mean operative time was 85 min for the lobectomy and 120 min for total thyroidectomy plus central neck dissection. The median hospital stay was 4.1 days. No drains were used. The histological examination showed four cases of malignant disease (papillary thyroid carcinoma). The mean number of harvested lymph nodes was 4.2 (ranged 3 to 8).Conclusion: In the hands of a high-volume surgeon, TOETVA is a novel, feasible, and safe approach for treating selected pediatric patients with thyroid cancer.

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.

The Learning Curve for Surgeons Regarding Endoscopic Thyroidectomy via the Oral-vestibular Approach

2018 ◽  
Vol 28 (6) ◽  
pp. 380-384 ◽  
Author(s):  
Rui Qu ◽  
Jianxue Wang ◽  
Jinyi Li ◽  
Zhiyong Dong ◽  
Jingge Yang ◽  
...  
Keyword(s):  
Learning Curve ◽  
Endoscopic Thyroidectomy ◽  
Vestibular Approach

scholarly journals Transoral Endoscopic Thyroidectomy Vestibular Approach (TOETVA) for Thyroid Nodules: A Series of the First 10 Patients in a Single Institution

2020 ◽  
Vol 35 (1) ◽  
pp. 39-45
Author(s):  
Lawrence Maliwat ◽  
Rowald Rey Malahito ◽  
Erasmo Gonzalo Llanes
Keyword(s):  
Thyroid Gland ◽  
Blood Loss ◽  
Total Thyroidectomy ◽  
Operative Time ◽  
Endoscopic Thyroidectomy ◽  
Postoperative Hospital Stay ◽  
Intraoperative Blood Loss ◽  
Pain Scores ◽  
Thyroid Lobectomy ◽  
Vestibular Approach

ABSTRACT Objective: To present the perioperative data of patients with solitary or multinodular goiter and/ or papillary thyroid carcinoma who underwent Transoral Endoscopic Thyroidectomy Vestibular Approach (TOETVA) in a single tertiary medical center. Methods: Design: Case series Setting: Tertiary Government Hospital Participants: Records of 10 patients who underwent TOETVA from June 2018 to July 2019 (9 thyroid lobectomies, 1 total thyroidectomy) were reviewed. Outcomes and measures included conversion to open surgery, operative time, intraoperative blood loss, size of the thyroid gland, postoperative hospital stay, visual analogue pain scores (VAS), and postoperative complications. Results: None of the 10 patients were converted to an open procedure. The average preoperative thyroid size was 4.73 cm in widest diameter using thyroid ultrasound (±1.88 cm, range 3.6 to 6.5 cm). Mean operative time for thyroid lobectomy and total thyroidectomy was 4 hours and 29 minutes and 4 hours and 15 minutes, respectively. Mean intraoperative blood loss was 140 ml (±47.96 ml, range 80 to 200 ml) for thyroid lobectomy and 100 ml for total thyroidectomy. The average intraoperative size of the thyroid gland measured in widest diameter (larger lobe for total thyroidectomy) was 4.48 cm (±0.919 cm, range 3 to 5.5 cm). Median postoperative hospital stay was 2 days (±1.55 days, range 2 to 12 days). Mean VAS pain scores for postoperative days 1, 2, 3, and 7 were 5, 3, 2, and 0, respectively. Transient recurrent laryngeal nerve injury (of 3 months duration) occurred in 1 patient. Two cases had surgical site infection, 2 had wound dehiscence, 1 had seroma and 1 had skin burn as a complication. None had hypocalcemia or mental nerve injury in the series. Conclusions: TOETVA was replicated in the local setting and a presentation of the perioperative data of all the patients who underwent this novel technique, the indications, as well as surgical and patient outcomes, were described. Keywords: TOETVA; thyroidectomy; transoral; endoscopic; minimally invasive

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 Transoral Endoscopic Thyroidectomy via Vestibular Approach: A series of the first ten cases in Iraq

2019 ◽  
Vol 19 (1) ◽  
pp. 68 ◽  
Author(s):  
Sadq G. Kadem ◽  
Sarmad M. Habash ◽  
Ali H. Jasim
Keyword(s):  
Nerve Palsy ◽  
Operative Time ◽  
Average Duration ◽  
Case Reports ◽  
Endoscopic Thyroidectomy ◽  
Mental Nerve ◽  
Duration Of Hospital Stay ◽  
Average Operative Time ◽  
Oral Vestibule ◽  
Vestibular Approach

Transoral endoscopic thyroidectomy was first described as an experimental sublingual approach. This approach was modified to a vestibular approach to avoid complications. In this report, we describe the results of the first ten cases of a transoral endoscopic thyroidectomy via vestibular approach (TOETVA) performed in Iraq. All operations were performed at Al Shifa General Hospital, Basrah, Iraq, in 2017 using three laparoscopic ports inserted at the oral vestibule. One out of ten patients underwent a near total thyroidectomy, the remaining cases underwent thyroid lobectomies. The average operative time was 113.5 minutes and the average duration of hospital stay was 41.9 hours. One case of mild cervical emphysema and one case of temporary mental nerve palsy were reported but both were treated conservatively without permanent sequelae. In conclusion, TOETVA is a safe, feasible procedure with an excellent cosmetic outcome when the patients are selected carefully.Keywords: Thyroidectomy; Endoscopy; Mouth; Robotics; Case Reports; Iraq.

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