scholarly journals TransOral Endoscopic Thyroidectomy via Submental and Vestibular Approach: A Preliminary Report

2020 ◽  
Vol 7 ◽  
Author(s):  
Yilong Fu ◽  
Mengwei Wu ◽  
Jinbo Fu ◽  
Suqiong Lin ◽  
Zhengfu Song ◽  
...  
Keyword(s):  
Demographic Data ◽  
Endoscopic Thyroidectomy ◽  
Postoperative Bleeding ◽  
Operation Time ◽  
Recurrent Laryngeal Nerve Paralysis ◽  
Papillary Thyroid ◽  
Average Hospital ◽  
Nerve Paralysis ◽  
Lateral Incision ◽  
Vestibular Approach

Purpose: Transoral endoscopic thyroidectomy via vestibular approach (TOETVA), with its excellent cosmetic effect, has become increasingly popular worldwide. Nonetheless, anatomic obstacles have limited its development to a certain extent. Here, we present our preliminary outcomes of transoral endoscopic thyroidectomy via submental and vestibular approach (TOETSMVA), which can overcome those limitations.Methods: From November 2019 to March 2020, we performed TOETSMVA in 21 consecutive patients with thyroid carcinoma at Zhongshan Hospital, Xiamen University. A 1.5-cm lateral incision was made at two fingers below the mandible; two 5-mm incisions were made in the vestibule near the first molars; TOETSMVA was completed through these incisions. The demographic data and surgical outcomes of the patients were retrospectively reviewed.Results: Twenty-one patients with a mean age of 37.5 ± 10.4 years were incorporated into this study. Fourteen patients had papillary thyroid micro-carcinomas, two had papillary thyroid carcinomas, and five had benign nodules. Eight patients had lymph node metastases. All surgeries were performed successfully without conversion to open thyroidectomy. The mean operation time was 138.8 ± 33.2 min; the average hospital stay was 3.3 ± 0.8 days. No patients developed cutaneous paralysis in the midline chin region. Transient recurrent laryngeal nerve paralysis was observed in one patient. There was no evidence of postoperative bleeding, infection, tetany, or other complications.Conclusion: TOETSMVA was shown to be a safe and advisable alternative for selected patients. This approach can overcome the limitations of TOETVA without sacrificing cosmetic results.

scholarly journals Novel Trocars and Suspension System Application in Gasless Transoral Endoscopic Thyroidectomy Vestibular Approach Oral Endoscopic Surgery

2021 ◽  
Vol 11 ◽  
Author(s):  
Jing Fang ◽  
Jianjun Liu ◽  
Xucai Zheng ◽  
Shengying Wang
Keyword(s):  
Thyroid Cancer ◽  
Lymph Node ◽  
Cancer Patients ◽  
Endoscopic Thyroidectomy ◽  
Postoperative Bleeding ◽  
Suspension System ◽  
Central Lymph Node ◽  
Central Lymph Node Dissection ◽  
Central Lymph ◽  
Vestibular Approach

In the current study, we reported our initial experience of gasless transoral endoscopic thyroidectomy vestibular approach (TOETVA) by novel trocars and a suspension system. Between February 2019 to September 2020, thyroid cancer patients with indicated central lymph node metastasis by imaging examination who had received gasless TOETVA by our designed trocars and suspension system in The First Affiliated Hospital of University of Science and Technology of China were reviewed. A total of 95 thyroid cancer patients that received gasless TOETVA were included in this analysis. Of note, 73 cases underwent one-sided lobectomy and the remaining 22 cases underwent total thyroidectomy. All thyroid cancer patients underwent central lymph node dissection (CND). The average total examined lymph nodes number was 8.55 ± 5.67 per individual. No serious complications occurred during or after the operation besides one patient who had a short-term recurrent laryngeal nerve (RLN) deficit and one patient who had delayed postoperative bleeding. In conclusion, the use of novel trocars and a suspension system can effectively improve the safety and efficacy of TOETVA.

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 Morbidity and long-term survival in patients with cervical re-exploration for papillary thyroid carcinoma

2019 ◽  
Vol 4 (3) ◽  
pp. 91-99
Author(s):  
Nenia Baerbock ◽  
Anke Mittelstädt ◽  
Joachim Jähne
Keyword(s):  
Papillary Thyroid Carcinoma ◽  
Thyroid Carcinoma ◽  
Recurrent Laryngeal Nerve Paralysis ◽  
Papillary Thyroid ◽  
Two Stage ◽  
Term Survival ◽  
Nerve Paralysis ◽  
Long Term Survival ◽  
Significant Difference

AbstractBackgroundPapillary thyroid carcinoma (PTC) has a favorable prognosis following one-stage surgical therapy, whereas two-stage resections bear the risk of increased morbidity and possibly impaired prognosis. To further elucidate the value of surgical re-exploration in PTC, a retrospective study was performed.MethodsThe study involved 187 patients with PTC who underwent total thyroidectomy with central lymph node dissection between 2001 and 2011. The number of two-stage surgeries, the rates of recurrent laryngeal nerve paralysis (RLNP) as well as hypocalcemia, and the long-term survival were assessed.ResultsTwo-stage surgeries were performed in 43%. No statistically significant difference was seen between the one- and two-stage resection groups regarding the rate of RLNP (transient 5.6% vs. 6.3%, permanent 2.6% vs. 0%) nor for hypocalcemia (transient 25.2% vs. 18.8%, permanent 14.0% vs. 22.5%). The 10-year recurrence-free survival was 95.5% and the 10-year disease-specific survival was 98.9% with no difference between groups.ConclusionEven though two-stage surgeries do not lead to a higher incidence of RLNP and hypocalcemia, optimal preoperative and intraoperative diagnostics have to be carried out to reduce the amount of completion surgeries.

Comparison of three - dimensional endoscopic thyroidectomy to two - dimensional thyroidectomy via areola approach in patients with papillary thyroid microcarcinoma (PTMC)

2019 ◽  
Author(s):  
HUIJUAN DAI ◽  
AIJUN SUN ◽  
CHONGGAO WANG ◽  
YONGGANG SONG
Keyword(s):  
Lymph Nodes ◽  
Endoscopic Thyroidectomy ◽  
Three Dimensional ◽  
Operation Time ◽  
Error Rates ◽  
Papillary Thyroid Microcarcinoma ◽  
Two Dimensional ◽  
Papillary Thyroid ◽  
Thyroid Microcarcinoma ◽  
Areola Approach

Background: To explore clinical advantages and benefits of three-dimensional (3D) endoscopic thyroidectomy through areola approach in patients with papillary thyroid microcarcinoma (PTMC) and compare it to two - dimensional (2D) endoscopic thyroidectomy. Methods: 103 female patients diagnosed with PTMC in our department from January 2015 to December 2016 were reported. They underwent thyroid lobectomy and isthmus resection with dissection of central group lymph nodes endoscopically. 60 cases chose 3D endoscopy, and 43 cases chose 2D endoscopy. We observed the differences of the operation time, intraoperative error rates, intraoperative suction drain, number of lymph nodes dissection, postoperative serum calcium, parathyroid hormone, postoperative drain time, postoperative drain, postoperative hospital stay and hospital costs between the two groups. Results: Total operation time and operation time of every part during the whole thyroidectomy process in 3D group were evidently lower than those in 2D group (P < 0.05). Intraoperative error rates reduced obviously by employing 3D endoscopy (P < 0.05); there were no significant differences in other parameters between the two groups (P > 0.05). Conclusions: Using areola approach through 3D endoscopy for PTMC patients is convenient and safe. It provides significant improvement in operation time and intraoperative error rates for endoscopic surgeons during endoscopic thyroidectomy. Key words： two / three - dimensional, endoscopic thyroidectomy, papillary thyroid microcarcinoma

106 THE HYBRID POSITION IS SUPERIOR TO THE PRONE POSITION FOR THORACOSCOPIC ESOPHAGECTOMY WITH UPPER MEDIASTINAL LYMPHADENECTOMY

2020 ◽  
Vol 33 (Supplement_1) ◽  
Author(s):  
H Kikuchi ◽  
Y Hiramatsu ◽  
W Soneda ◽  
S Kawata ◽  
A Hirotsu ◽  
...  
Keyword(s):  
Recurrent Laryngeal Nerve ◽  
Prone Position ◽  
Operation Time ◽  
Laryngeal Nerve ◽  
Thoracoscopic Esophagectomy ◽  
Recurrent Laryngeal Nerve Paralysis ◽  
Nerve Paralysis ◽  
Laryngeal Nerve Paralysis ◽  
Left Lateral Decubitus Position ◽  
Lateral Decubitus

Abstract   Thoracoscopic esophagectomy (TE) is becoming a common surgical method for esophageal cancer. TE is performed with the patient the left lateral decubitus position, prone position, or hybrid position combining the left lateral decubitus and prone positions. However, only few studies have compared the clinical utility of these TE positions. Methods In our institute, we introduced TE in the prone position (prone TE) in 2014, and have performed TE in the hybrid position (hybrid TE) since March 2017. The present study compared the short-term outcomes of prone TE versus hybrid TE. One-hundred-and-three patients with esophageal or esophagogastric junction cancer who underwent TE between March 2014 and December 2019 were included. Patients were divided into those who underwent prone TE (prone TE group; n = 43) and those who underwent hybrid TE (hybrid TE group; n = 60). Clinicopathological data were retrospectively reviewed and compared between groups. Results There were no differences between groups in age, tumor histology, and tumor location. Compared with the hybrid TE group, the prone TE group had a smaller tumor depth (P &lt; 0.001), lower grade of lymph node metastasis (P = 0.003), and less severe tumor stage (P = 0.001). The operation time for the thoracoscopic procedure was shorter in the hybrid TE group (318.9 vs 249.2 min, P = 0.002). The rate of recurrent laryngeal nerve paralysis (Clavien-Dindo grade I–III) was significantly lower in the hybrid TE group (41.9% vs 11.7%, P &lt; 0.001), whereas there were no differences between groups in the rates of anastomotic leakage, atelectasis, or pneumonia. Conclusion The most significant differences between prone TE and hybrid TE involved the upper mediastinal procedures. In hybrid TE, the motion of the assistant’s forceps causes less interference with the operative field, and the angle at which the operator's forceps approach the upper mediastinal lymph nodes enables the maintenance of appropriate traction. These advantages of hybrid TE appeared to result in a shorter operation time and less recurrent laryngeal nerve paralysis compared with prone TE.

scholarly journals Nontoxic Multinodular Goitre and Incidental Thyroid Cancer: What Is the Best Surgical Strategy?—A Retrospective Study of 2032 Patients

2018 ◽  
Vol 2018 ◽  
pp. 1-8 ◽  
Author(s):  
Krzysztof Kaliszewski ◽  
Beata Wojtczak ◽  
Jędrzej Grzegrzółka ◽  
Jacob Bronowicki ◽  
Sawsan Saeid ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Retrospective Study ◽  
Radical Surgery ◽  
Postoperative Bleeding ◽  
Recurrent Laryngeal Nerve Paralysis ◽  
Multinodular Goitre ◽  
Early Complications ◽  
Nerve Paralysis ◽  
Laryngeal Nerve Paralysis ◽  
Observation Period

Objectives. A discussion with regard to the most optimal surgical procedure in nontoxic multinodular goitre (NTMNG). We assessed and compared three main types of operations in 2032 patients with NTMNG. Methods. This is a retrospective study of 2032 patients operated on in one center due to NTMNG. The observation period was 48 to 120 months (mean and SD: 87 ± 20). Results. The early complications included uni- and bilateral recurrent laryngeal nerve paralysis (URLNP, BRLNP), overt tetany (OT), and postoperative bleeding (POB). We observed after TT, STT, and DO URLNP: 15 (1.73%), 3 (0.64%), and 2 (0.28%), respectively (p<0.05); BRLNP: 3 (0.34%), 2 (0.43%), and 0 (0.0%), respectively (p=0.25); OT: 42 (4.84%), 6 (1.29%), and 9 (1.28%), respectively (p<0.0001); and POB: 11 (1.26%), 4 (0.86%), and 3 (0.42%), respectively (p=0.209). Persistent complications we observed after TT, STT, and DO are the following: URLNP: 9 (1.03%), 3 (0.64%), and 1 (0.14%), respectively (p=0.086); BRLNP: 1 (0.11%), 1 (0.21%), and 0 (0.0%), respectively (p=0.51); and OT: 11 (1.26%), 2 (0.43%), and 2 (0.28%), respectively (p=0.052). Incidental thyroid cancer (ITC) was recognized after TT, STT, and DO in 18 (2.07%), 21 (4.52%), and 11 (1.56%), respectively (p=0.039). Recurrent goitre (RG) was observed in 1 (0.11%) after TT, 3 (0.64%) after STT, and 2 (0.28%) after DO (p=0.234). Conclusions. Performing less radical surgery in NTMNG is associated with a significantly lower risk of early and late URLNP and OT. In the case of BRLNP (early and persistent) and POB, no statistically significant differences are seen. The occurrence of ITC is higher following more radical surgeries. Less radical surgery is connected with a higher risk of RG.

scholarly journals Prognostic Factors in Mortality and Morbidity in Patients with differentiated Thyroid Cancer

2002 ◽  
Vol 81 (12) ◽  
pp. 856-863 ◽  
Author(s):  
Robert L. Witt ◽  
Ann Marie McNamara
Keyword(s):  
Thyroid Cancer ◽  
Total Thyroidectomy ◽  
Papillary Thyroid Cancer ◽  
Tumor Size ◽  
Recurrent Laryngeal Nerve Paralysis ◽  
Papillary Thyroid ◽  
Nerve Paralysis ◽  
Mortality And Morbidity ◽  
Risk Of Death ◽  
Thyroid Lobectomy

We attempted to determine if women younger than 45 years of age who have isolated papillary thyroid cancer and whose tumors are smaller than 4 cm (T2N0M0) are at low risk for mortality and morbidity following thyroid lobectomy. To this end, we analyzed information on both women and men obtained from our review of the literature, and we integrated it with data compiled in the Delaware Cancer Registry. We performed a secondary analysis to determine if the risk of death and recurrence can be predicted on the basis of age, tumor size, sex, histology, and the type of operation. We found that among patients who had undergone either thyroid lobectomy or total thyroidectomy, mortality rates were 1.3% for those younger than 45 years of age and 15.6% for those 45 years and older (p< 0.0001). With respect to tumor size, patients whose masses were smaller than 4 cm had significantly lower mortality (3.0%) and recurrence (11.1%) rates than did those whose tumors were 4 cm or larger (16.8 and 33.3%, respectively; p< 0.0001). Other significant risk factors for death were male sex and the presence of follicular thyroid cancer (as opposed to papillary thyroid cancer). The risk of permanent hypocalcemia was significant among patients who had undergone total thyroidectomy, but not among those who had been treated with lobectomy. The subgroup of patients who had the lowest risk of mortality and morbidity was made up of women younger than 45 years who had a papillary thyroid tumor smaller than 4 cm that was limited to one lobe and who had undergone lobectomy. On the other hand, we found that lobectomy might carry a higher risk of recurrence (from a micrometastasis in the cervical lymph node) than does total thyroidectomy. Experienced surgeons whose rates of hypocalcemia and recurrent laryngeal nerve paralysis following total thyroidectomy are low offer their patients the unambiguous advantage of superior follow-up with thyroglobulin and radioactive iodine.

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