Skip to main content
Erschienen in: Surgical Endoscopy 12/2020

13.01.2020

Transoral endoscopic thyroidectomy using the vestibular approach with an endoscopic retractor in thyroid cancer: experience with the first 132 patients

verfasst von: Soo Young Kim, Seok-Mo Kim, Özer Makay, Hojin Chang, Bup-Woo Kim, Yong Sang Lee, Cheong Soo Park, Hang-Seok Chang

Erschienen in: Surgical Endoscopy | Ausgabe 12/2020

Einloggen, um Zugang zu erhalten

Abstract

Background

Transoral endoscopic thyroidectomy using the vestibular approach (TOETVA) is a novel technique for thyroid cancer surgery. We aimed to review our initial experiences with TOETVA for the management of thyroid carcinoma, using retrospective analyses of a larger single-center case series.

Methods

From September 2016 to April 2018, 132 patients with thyroid cancer underwent TOETVA. A three-port technique through the oral vestibule was used to perform endoscopic thyroidectomy with ipsilateral central compartment dissection using conventional laparoscopic instruments, and an endoscopic retractor that we developed.

Results

All patients had papillary thyroid carcinoma. Less-than total or total thyroidectomy with ipsilateral central compartment node dissection was performed (124 vs. 8). The mean operation time was 87.6 min (range 56–213 min). The average number of lymph nodes resected was 2.6 (range 1—12). Six patients experienced transient hoarseness, which was resolved within 3 months. Most of the patients were discharged within 3 days after surgery.

Conclusions

In this large series from a single center, we found that TOETVA with the endoscopic retractor can be performed safely and radically in selected patients with thyroid cancer.
Literatur
1.
Zurück zum Zitat Gagner M (1996) Endoscopic subtotal parathyroidectomy in patients with primary hyperparathyroidism. Br J Surg 83:875CrossRef Gagner M (1996) Endoscopic subtotal parathyroidectomy in patients with primary hyperparathyroidism. Br J Surg 83:875CrossRef
2.
Zurück zum Zitat Sasaki A, Nakajima J, Ikeda K, Otsuka K, Koeda K, Wakabayashi G (2008) Endoscopic thyroidectomy by the breast approach: a single institution's 9-year experience. World J Surg 32:381–385CrossRef Sasaki A, Nakajima J, Ikeda K, Otsuka K, Koeda K, Wakabayashi G (2008) Endoscopic thyroidectomy by the breast approach: a single institution's 9-year experience. World J Surg 32:381–385CrossRef
3.
Zurück zum Zitat Miccoli P, Berti P, Bendinelli C, Conte M, Fasolini F, Martino E (2000) Minimally invasive video-assisted surgery of the thyroid: a preliminary report. Langenbeck's Arch Surg 385:261–264CrossRef Miccoli P, Berti P, Bendinelli C, Conte M, Fasolini F, Martino E (2000) Minimally invasive video-assisted surgery of the thyroid: a preliminary report. Langenbeck's Arch Surg 385:261–264CrossRef
4.
Zurück zum Zitat Kang SW, Lee SC, Lee SH, Lee KY, Jeong JJ, Lee YS, Nam KH, Chang HS, Chung WY, Park CS (2009) Robotic thyroid surgery using a gasless, transaxillary approach and the da Vinci S system: the operative outcomes of 338 consecutive patients. Surgery 146:1048–1055CrossRef Kang SW, Lee SC, Lee SH, Lee KY, Jeong JJ, Lee YS, Nam KH, Chang HS, Chung WY, Park CS (2009) Robotic thyroid surgery using a gasless, transaxillary approach and the da Vinci S system: the operative outcomes of 338 consecutive patients. Surgery 146:1048–1055CrossRef
5.
Zurück zum Zitat Byrd JK, Duvvuri U (2013) Current trends in robotic surgery for otolaryngology. Curr Otorhinolaryngol Rep 1:153–157CrossRef Byrd JK, Duvvuri U (2013) Current trends in robotic surgery for otolaryngology. Curr Otorhinolaryngol Rep 1:153–157CrossRef
6.
Zurück zum Zitat Witzel K, von Rahden BH, Kaminski C, Stein HJ (2008) Transoral access for endoscopic thyroid resection. Surg Endosc 22:1871–1875CrossRef Witzel K, von Rahden BH, Kaminski C, Stein HJ (2008) Transoral access for endoscopic thyroid resection. Surg Endosc 22:1871–1875CrossRef
7.
Zurück zum Zitat Benhidjeb T, Wilhelm T, Harlaar J, Kleinrensink GJ, Schneider TA, Stark M (2009) Natural orifice surgery on thyroid gland: totally transoral video-assisted thyroidectomy (TOVAT): report of first experimental results of a new surgical method. Surg Endosc 23:1119–1120CrossRef Benhidjeb T, Wilhelm T, Harlaar J, Kleinrensink GJ, Schneider TA, Stark M (2009) Natural orifice surgery on thyroid gland: totally transoral video-assisted thyroidectomy (TOVAT): report of first experimental results of a new surgical method. Surg Endosc 23:1119–1120CrossRef
8.
Zurück zum Zitat Karakas E, Steinfeldt T, Gockel A, Schlosshauer T, Dietz C, Jager J, Westermann R, Sommer F, Richard HR, Exner C, Sesterhenn AM, Bartsch DK (2011) Transoral thyroid and parathyroid surgery: development of a new transoral technique. Surgery 150:108–115CrossRef Karakas E, Steinfeldt T, Gockel A, Schlosshauer T, Dietz C, Jager J, Westermann R, Sommer F, Richard HR, Exner C, Sesterhenn AM, Bartsch DK (2011) Transoral thyroid and parathyroid surgery: development of a new transoral technique. Surgery 150:108–115CrossRef
9.
Zurück zum Zitat Liu S, Zheng XM, Jiang DZ, Zhang W, Shan CX, Qiu M (2011) New technique for retraction of the strap muscles in endoscopic thyroidectomy. Surg Innov 18:141–144CrossRef Liu S, Zheng XM, Jiang DZ, Zhang W, Shan CX, Qiu M (2011) New technique for retraction of the strap muscles in endoscopic thyroidectomy. Surg Innov 18:141–144CrossRef
10.
Zurück zum Zitat Zhang W, Dang CP, Shan CX, Liu S, Jiang ZG, Wang B, Qiu M (2014) Use of a mini-instrument in endoscopic thyroidectomy via a breast approach to improve cosmetic outcomes. Biosci Trends 8:280–285CrossRef Zhang W, Dang CP, Shan CX, Liu S, Jiang ZG, Wang B, Qiu M (2014) Use of a mini-instrument in endoscopic thyroidectomy via a breast approach to improve cosmetic outcomes. Biosci Trends 8:280–285CrossRef
11.
Zurück zum Zitat Anuwong A (2016) Transoral Endoscopic Thyroidectomy Vestibular Approach: A Series of the First 60 Human Cases. World J Surg 40:491–497CrossRef Anuwong A (2016) Transoral Endoscopic Thyroidectomy Vestibular Approach: A Series of the First 60 Human Cases. World J Surg 40:491–497CrossRef
12.
Zurück zum Zitat Sasanakietkul T, Jitpratoom P, Anuwong A (2016) Transoral endoscopic parathyroidectomy vestibular approach: a novel scarless parathyroid surgery. Surg Endosc 31(9):3755–3763 Sasanakietkul T, Jitpratoom P, Anuwong A (2016) Transoral endoscopic parathyroidectomy vestibular approach: a novel scarless parathyroid surgery. Surg Endosc 31(9):3755–3763
13.
Zurück zum Zitat Udelsman R, Anuwong A, Oprea AD, Rhodes A, Prasad M, Sansone M, Brooks C, Donovan PI, Jannitto C, Carling T (2016) Trans-oral vestibular endocrine surgery: a new technique in the United States. Ann Surg 264:e13–e16CrossRef Udelsman R, Anuwong A, Oprea AD, Rhodes A, Prasad M, Sansone M, Brooks C, Donovan PI, Jannitto C, Carling T (2016) Trans-oral vestibular endocrine surgery: a new technique in the United States. Ann Surg 264:e13–e16CrossRef
14.
Zurück zum Zitat Wang Y, Yu X, Wang P, Miao C, Xie Q, Yan H, Zhao Q, Zhang M, Xiang C (2016) Implementation of Intraoperative Neuromonitoring for Transoral Endoscopic Thyroid Surgery: A Preliminary Report. J Laparoendosc Adv Surg Tech Part A 26:965–971CrossRef Wang Y, Yu X, Wang P, Miao C, Xie Q, Yan H, Zhao Q, Zhang M, Xiang C (2016) Implementation of Intraoperative Neuromonitoring for Transoral Endoscopic Thyroid Surgery: A Preliminary Report. J Laparoendosc Adv Surg Tech Part A 26:965–971CrossRef
15.
Zurück zum Zitat Park JO, Kim MR, Kim DH, Lee DK (2016) Transoral endoscopic thyroidectomy via the trivestibular route. Ann Surg Treat Re 91:269–272CrossRef Park JO, Kim MR, Kim DH, Lee DK (2016) Transoral endoscopic thyroidectomy via the trivestibular route. Ann Surg Treat Re 91:269–272CrossRef
16.
Zurück zum Zitat Angwong A, Ketwong K, Jitpratoom P, Sasanakietkul T, Duh QY (2017) Safety and outcomes of the transoral endoscopic thyroidectomy vestibular approach. JAMA Surg 153:21–27 Angwong A, Ketwong K, Jitpratoom P, Sasanakietkul T, Duh QY (2017) Safety and outcomes of the transoral endoscopic thyroidectomy vestibular approach. JAMA Surg 153:21–27
17.
Zurück zum Zitat Brierley JD (2017) TNM classification of malignant tumours. Wiley, New York Brierley JD (2017) TNM classification of malignant tumours. Wiley, New York
18.
Zurück zum Zitat Camenzuli C, Schembri Wismayer P, Calleja Agius J (2018) Transoral endoscopic thyroidectomy: a systematic review of the practice so far. JSLS 22(3):e2018.00026 Camenzuli C, Schembri Wismayer P, Calleja Agius J (2018) Transoral endoscopic thyroidectomy: a systematic review of the practice so far. JSLS 22(3):e2018.00026
19.
Zurück zum Zitat Kim SY, Kim BW, Pyo JY, Hong SW, Chang HS, Park CS (2018) Macrometastasis in papillary thyroid cancer patients is associated with higher recurrence in lateral neck nodes. World J Surg 42:123–129CrossRef Kim SY, Kim BW, Pyo JY, Hong SW, Chang HS, Park CS (2018) Macrometastasis in papillary thyroid cancer patients is associated with higher recurrence in lateral neck nodes. World J Surg 42:123–129CrossRef
20.
Zurück zum Zitat Razavi CR, Vasiliou E, Tufano RP, Russell JO (2018) Learning curve for transoral endoscopic thyroid lobectomy. Otolaryngol Head Neck Surg 159:625–629CrossRef Razavi CR, Vasiliou E, Tufano RP, Russell JO (2018) Learning curve for transoral endoscopic thyroid lobectomy. Otolaryngol Head Neck Surg 159:625–629CrossRef
22.
Zurück zum Zitat Chai YJ, Chung JK, Anuwong A, Dionigi G, Kim HY, Hwang KT, Heo SC, Yi KH, Lee KE (2017) Transoral endoscopic thyroidectomy for papillary thyroid microcarcinoma: initial experience of a single surgeon. Ann Surg Treat Res 93:70–75CrossRef Chai YJ, Chung JK, Anuwong A, Dionigi G, Kim HY, Hwang KT, Heo SC, Yi KH, Lee KE (2017) Transoral endoscopic thyroidectomy for papillary thyroid microcarcinoma: initial experience of a single surgeon. Ann Surg Treat Res 93:70–75CrossRef
23.
Zurück zum Zitat Inabnet WB 3rd, Suh H, Fernandez-Ranvier G (2017) Transoral endoscopic thyroidectomy vestibular approach with intraoperative nerve monitoring. Surg Endosc 31:3030CrossRef Inabnet WB 3rd, Suh H, Fernandez-Ranvier G (2017) Transoral endoscopic thyroidectomy vestibular approach with intraoperative nerve monitoring. Surg Endosc 31:3030CrossRef
24.
Zurück zum Zitat Lee YS, Nam KH, Chung WY, Chang HS, Park CS (2010) Postoperative complications of thyroid cancer in a single center experience. J Korean Med Sci 25:541–545CrossRef Lee YS, Nam KH, Chung WY, Chang HS, Park CS (2010) Postoperative complications of thyroid cancer in a single center experience. J Korean Med Sci 25:541–545CrossRef
25.
Zurück zum Zitat Kim SM, Kim HK, Kim KJ, Chang HJ, Kim BW, Lee YS, Chang HS, Park CS (2015) Recovery from permanent hypoparathyroidism after total thyroidectomy. Thyroid 25:830–833CrossRef Kim SM, Kim HK, Kim KJ, Chang HJ, Kim BW, Lee YS, Chang HS, Park CS (2015) Recovery from permanent hypoparathyroidism after total thyroidectomy. Thyroid 25:830–833CrossRef
26.
Zurück zum Zitat Witzel K, Messenbaeck F, Weitzendorfer M, Benhidjeb T (2017) Transoral thyroidectomy: limitations, patients' safety, and own experiences. Updates Surg 69:193–198CrossRef Witzel K, Messenbaeck F, Weitzendorfer M, Benhidjeb T (2017) Transoral thyroidectomy: limitations, patients' safety, and own experiences. Updates Surg 69:193–198CrossRef
27.
Zurück zum Zitat Campbell RL, Shamaskin RG, Harkins SW (1987) Assessment of recovery from injury to inferior alveolar and mental nerves. Oral Surg Oral Med Oral Pathol 64:519–526CrossRef Campbell RL, Shamaskin RG, Harkins SW (1987) Assessment of recovery from injury to inferior alveolar and mental nerves. Oral Surg Oral Med Oral Pathol 64:519–526CrossRef
Metadaten
Titel
Transoral endoscopic thyroidectomy using the vestibular approach with an endoscopic retractor in thyroid cancer: experience with the first 132 patients
verfasst von
Soo Young Kim
Seok-Mo Kim
Özer Makay
Hojin Chang
Bup-Woo Kim
Yong Sang Lee
Cheong Soo Park
Hang-Seok Chang
Publikationsdatum
13.01.2020
Verlag
Springer US
Erschienen in
Surgical Endoscopy / Ausgabe 12/2020
Print ISSN: 0930-2794
Elektronische ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-019-07336-2

Weitere Artikel der Ausgabe 12/2020

Surgical Endoscopy 12/2020 Zur Ausgabe

Update Chirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

S3-Leitlinie „Diagnostik und Therapie des Karpaltunnelsyndroms“

CME: 2 Punkte

Prof. Dr. med. Gregor Antoniadis Das Karpaltunnelsyndrom ist die häufigste Kompressionsneuropathie peripherer Nerven. Obwohl die Anamnese mit dem nächtlichen Einschlafen der Hand (Brachialgia parästhetica nocturna) sehr typisch ist, ist eine klinisch-neurologische Untersuchung und Elektroneurografie in manchen Fällen auch eine Neurosonografie erforderlich. Im Anfangsstadium sind konservative Maßnahmen (Handgelenksschiene, Ergotherapie) empfehlenswert. Bei nicht Ansprechen der konservativen Therapie oder Auftreten von neurologischen Ausfällen ist eine Dekompression des N. medianus am Karpaltunnel indiziert.

Prof. Dr. med. Gregor Antoniadis
Berufsverband der Deutschen Chirurgie e.V.

S2e-Leitlinie „Distale Radiusfraktur“

CME: 2 Punkte

Dr. med. Benjamin Meyknecht, PD Dr. med. Oliver Pieske Das Webinar S2e-Leitlinie „Distale Radiusfraktur“ beschäftigt sich mit Fragen und Antworten zu Diagnostik und Klassifikation sowie Möglichkeiten des Ausschlusses von Zusatzverletzungen. Die Referenten erläutern, welche Frakturen konservativ behandelt werden können und wie. Das Webinar beantwortet die Frage nach aktuellen operativen Therapiekonzepten: Welcher Zugang, welches Osteosynthesematerial? Auf was muss bei der Nachbehandlung der distalen Radiusfraktur geachtet werden?

PD Dr. med. Oliver Pieske
Dr. med. Benjamin Meyknecht
Berufsverband der Deutschen Chirurgie e.V.

S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“

CME: 2 Punkte

Dr. med. Mihailo Andric
Inhalte des Webinars zur S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“ sind die Darstellung des Projektes und des Erstellungswegs zur S1-Leitlinie, die Erläuterung der klinischen Relevanz der Klassifikation EAES 2015, die wissenschaftliche Begründung der wichtigsten Empfehlungen und die Darstellung stadiengerechter Therapieoptionen.

Dr. med. Mihailo Andric
Berufsverband der Deutschen Chirurgie e.V.