Abstract
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.
Highlights
As natural orifice transluminal endoscopic surgery (NOTES) technology has developed in recent years, NOTES has been the subject of increasing interest in thyroid surgery [1,2,3,4]
The concept of the transoral endoscopic thyroidectomy vestibular approach (TOETVA) applied in thyroid surgery was first reported by Richmon et al And nowadays, the TOETVA has been widely appreciated in thyroid surgery [5,6,7,8,9,10]
In the past two years, we developed and performed a novel gasless TOETVA method that used novel trocars and a new suspension system designed by our team for thyroid cancer
Summary
As natural orifice transluminal endoscopic surgery (NOTES) technology has developed in recent years, NOTES has been the subject of increasing interest in thyroid surgery [1,2,3,4]. The inherent limitation of CO2 insufflation should be recognition It does increase the risk of CO2-related complications, such as CO2 embolism, pneumothorax, pneumomediastinum, and subcutaneous emphysema [13]. It may cause tumor implantation and metastasis during the surgery [14]. Since 2008, gasless trans-axillary endoscopic thyroid surgery has been reported, and there have been numerous studies regarding its safety and efficacy [15, 16]. Only a few studies with small samples supported the safety and efficacy of gasless TOETVA [5, 18, 19]
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