Endoscopic Thyroidectomy Through Oro-Vestibular Route (ETOVR)

Abstract

Nodular goitre is the most common endocrine disease requiring surgical thyroidectomy for its cure. Though surgical exploration is routinely performed through conventional open-neck approach, a wide range of minimal access and minimally invasive endoscopic techniques (gasless and with gas) have been attempted in the past two decades. In this context, we report the feasibility and safety of an innovative transoral endoscopic thyroidectomy technique, which marks a paradigm shift in the endocrine surgery. This is a prospective study conducted at a tertiary care endocrine surgery department in Southern India from May 2016 to November 2018. We employed a novel transoral, lower vestibular route for endoscopic thyroidectomy. All the clinical, investigative, operative, pathological and post-operative data were collected from our prospectively filled proformas. Statistical analysis was performed with SPSS 20.0 version. Descriptive analysis was done. Out of the 604 goitre cases operated during the study period, 123 (20.4%) were operated by this technique. Hemithyroidectomy was performed in 104 and total thyroidectomy in 19 cases respectively. Mean operative time was 124 ± 18 min (100–220). There was extended subcutaneous emphysema on to upper chest in one case. Otherwise, the post-operative course was uneventful with no major morbidity, hypocalcemia, or recurrent laryngeal nerve palsy. All the cases had benign histopathology. We conclude that this novel transoral vestibular route thyroidectomy is a comparably optimal approach for nodular thyroid goitres, especially in benign cases.