Video-assisted thyroid lobectomy through a small wound in the submandibular area

doi:10.1016/S0002-9610(02)00801-2

The American Journal of Surgery

Volume 183, Issue 3, March 2002, Pages 286-289

https://doi.org/10.1016/S0002-9610(02)00801-2 Get rights and content

Abstract

Background: Endoscopic thyroidectomy has not gained wide acceptance because of the expertise required, the long operation time, the wide dissection, and the extra cost of specialized instruments. We developed a video-assisted hemithyroidectomy procedure that requires only one small incision at the upper neck.

Methods: Hemithyroidectomy was performed through a 25 to 30 mm transverse incision made in the upper lateral neck for the treatment of benign thyroid nodule. No gas or external lift dissection was needed.

Results: The mean age of 39 patients was 33.8 years. The tumor size ranged from 1.9 to 5.5 cm (mean 3.1 cm). All patients underwent total lobectomy without conversion to traditional cervicotomy. The mean operation time was 56 minutes (range 36 to 90). Follicular adenoma was the final pathologic diagnosis in 25 patients and adenomatous goiter in 14. Transient recurrent laryngeal nerve palsy was seen in 1 patient.

Conclusions: Our technique is safe, minimally invasive, less time consuming, and cosmetically excellent.

Section snippets

Patients

We treated 39 women ranging in age from 18 to 55 years (mean 33.8). All were diagnosed with benign thyroid nodules by both ultrasonography and fine needle aspiration cytology. All gave informed consent for the surgical procedure. Direct preoperative laryngoscopic examination showed normal vocal cord function in all 39 patients.

Operative procedures

The patient is put under general anesthesia with the neck in a natural or slightly extended position. The patient is prepared and draped as in conventional thyroidectomy

Results

All patients underwent total lobectomy without conversion to traditional cervicotomy. The mean operation time was 57 minutes (range 36 to 85) and mean blood loss was 24 mL. The tumor size ranged from 1.9 to 5.5 cm (mean 3.1 cm). Follicular adenoma was the final pathologic diagnosis in 29 patients, and adenomatous goiter in 12. There was micropapillary cancer (4 × 3 mm) coexisting with follicular adenoma in 1 patient. This patient is being carefully monitored by thyroglobulin assay and

Comments

Several endoscopic thyroidectomy procedures have been described [2], [3], [4] for treatment of the thyroid nodule [5], [6], [7], [8], [9], [10], [11], [12], [13], but none has become widely used as other endoscopic procedures for abdominal and thoracic surgery. Endoscopic surgery is indicated when a cosmetic benefit can be achieved, but it must also be shown that it will be less invasive, that it is safe, and that the same surgical outcome will be produced as would be by conventional surgery.

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Cited by (67)

Transoral endoscopic thyroidectomy vestibular approach (TOETVA): A novel surgical technique for scarless thyroidectomy in pediatric surgery
2022, Journal of Pediatric Surgery
Citation Excerpt :
One of the most critical problems in thyroid surgery is visible neck scars after surgery, which are sometimes considered as important as the final treatment outcomes, especially in adolescents and their parents with severe cosmetic concerns. In literature, various surgical techniques have been reported to prevent surgical scar formation after thyroid surgery [1–5]. Transoral endoscopic thyroidectomy vestibular approach (TOETVA) is a novel surgical procedure that has been used more frequently in adults in recent years [6–10].
Transoral endoscopic thyroidectomy vestibular approach (TOETVA) is a novel surgical technique in thyroid surgery that provides a feasible opportunity to avoid a visible neck scar. In recent years, TOETVA became popular in the thyroid surgery of selected adult patients with cosmetic concerns. We conducted a right lobectomy with the TOETVA technique in a 17-year-old adolescent with a suspicious thyroid nodule the present report aimed to describe the details of the operative technique step by step.
Level of evidence: LEVEL IV, case series with no comparison group
Minimally invasive compared with conventional thyroidectomy for nodular goitre
2014, Best Practice and Research: Clinical Endocrinology and Metabolism
Citation Excerpt :
On a technical note, MNIT comes closest to the conventional open thyroidectomy. It can be performed through a central [3,20] or lateral [21–23] neck incision smaller than 3 cm under video-endoscopic or complete endoscopic guidance, or without endoscopic guidance through a much longer, 3–6 cm [24–26] neck incision that barely qualifies as “minimal”. A total of 10 prospective randomized studies [27–36] and five systematic reviews [37–41] examined the minimally invasive video-assisted (MIVAT) central approach, which is the most commonly used variant.
Since minimally invasive thyroidectomy was introduced in 1997, different surgical approaches to the thyroid have been described: the minimal neck incision and the anterior chest, areolar breast or axillary access. Whereas conventional open thyroidectomy is suitable for any thyroid disease, minimal neck incision thyroidectomy or extracervical scarless neck thyroidectomy are limited to small-volume disease. In 11 prospective randomized studies and six systematic reviews, minimally invasive video-assisted thyroidectomy via a central or lateral neck approach afforded better cosmesis in the first 3 months than conventional open thyroidectomy, with less postoperative pain for the first 48 h. Surgical morbidity did not differ in these limited studies. No head-to-head comparison is available for extracervical scarless neck thyroidectomy and conventional open thyroidectomy. Extracervical scarless neck thyroidectomy caused more postoperative pain and gave rise to complications not seen with minimal neck incision thyroidectomy or conventional open thyroidectomy. In the absence of evidence to the contrary, conventional open thyroidectomy continues to remain the gold standard for any nodular goitre.
Thyroidectomy: A novel endoscopic oral vestibular approach
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To date, no report has discussed endoscopic thyroidectomy using the oral vestibular approach (ETOVA). The objective of this study was to evaluate the feasibility, safety, efficacy, and cosmetic results of endoscopic thyroidectomy involving this surgical approach.
Twenty-four patients with benign thyroid nodules were randomized into the ETOVA (n = 12) and the endoscopic thyroidectomy by areola approach (ETAA) groups (n = 12). Therapeutic effects were assessed at follow-up by physical examination. All patients were followed to evaluate thyroid function and scar formation from endoscopic treatment.
Complete resection of all the lesions was performed endoscopically, and no conversion to open surgery was needed. There was no difference between the 2 groups with respect to surgical time (60.4 vs 59.6 min), blood loss (10.8 vs 13.8 mL), postoperative hospital stay (4.9 vs 4.6 d), or cost of surgery (17.6 vs 17.4 thousand yuan). Patients who underwent the areola approach had 3 scars, 10 × 2 mm, 5 × 1 mm, and 5 × 1 mm in size, all of which were visible at the 6-month follow-up. Patients in the ETOVA group did not have any scars. Follow-up showed a significant difference (P = .019) in the satisfaction score between the ETOVA (2.33 ± 0.65) and the ETAA group (1.58 ± 0.79). Imaging showed that all patients had complete resection and no residual disease. Severe complications such as subcutaneous accumulation of blood and fluid, superior or recurrent laryngeal nerve injury, and parathyroid dysfunction were not observed.
ETOVA was found to be safe and feasible and did not leave any scars; however, large-scale, randomized clinical trials are necessary for confirmation.
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How I do itVideo-assisted thyroid lobectomy through a small wound in the submandibular area

Abstract

Section snippets

Patients

Operative procedures

Results

Comments

Surgery

J Am Coll Surg

Am J Surg

J Am Coll Surg

Am J Surg

Endoscopic subtotal parathyroidectomy in patients with primary hyperparathyroidism

Br J Surg

Minimally invasive videoscopic parathyroidectomya feasibility study in dogs and humans

J Laparoendosc Adv Surg Tech A

How I do it
Video-assisted thyroid lobectomy through a small wound in the submandibular area