Abstract
Open thyroidectomy; is the gold standard surgical procedure for thyroid diseases, but the incision scar in the anterior aspect of the neck due to this approach cannot be avoided and may results in a permanent cosmetic defect. Therefore, there is a need to improve postoperative quality of life, including cosmetics. Recently, transoral endoscopic thyroidectomy has been developed; it is a natural orifice thyroid surgery, minimally invasive and completely scar free. This study aimed to describe the outcome, patient’s satisfaction, and complications after hemithyroidectomy for benign thyroid nodules by transoral endoscopic vestibular approach in comparison with open approach. This study was conducted in Al-Shiffa General hospital, Basrah, Iraq from August 2017 to June 2019 and was approved by a local ethical committee.Fifty patients with benign thyroid nodules who are candidate for hemithyroidectomy were included in the study; they were divided into two groups according to the method for thyroidectomy which was either conventional open or transoral endoscopic thyroidectomy vestibular approach based on the patients’ preferences. All operations were performed by the same surgical team. The results of this study showed that 24 (48%) of them operated upon by transoral endoscopic thyroidectomy vestibular approach, while the remaining 26 (52%) patients have been operated upon by open thyroidectomy approach. Transoral endoscopic thyroidectomy vestibular approach reported significant longer operative time, has comparable rate of complications with an excellent cosmetic outcome and better postoperative patients’ satisfaction in comparison to open thyroidectomy.In conclusion, transoral endoscopic thyroidectomy vestibular approach is a safe and feasible procedure with an excellent cosmetic outcome and better patients’ satisfaction. At present, it is a relatively time-consuming procedure and, therefore, candidate patients with a strong motivation for scar free surgery are recommended.Key words: Thyroidectomy; Endoscopic thyroidectomy; Transoral thyroidectomy; Benign, Nodule
Highlights
Thyroid nodules are common in general population with 3-7% prevalence[1]
In a systemic review of 15 studies; thyroidectomy vestibular approach (TOETVA) have a comparable rate of complications to that of conventional open thyroidectomy, but this new approach may be associated with new complications; mental nerve palsy, cervical and/or mediastinal emphysema, conversion to open thyroidectomy, and because it is a clean contaminated surgery, it may be associated with an increase rate of deepseated neck infection, the reported incidence of these complications was rare, they are considered as an additional complications added to the field of thyroid surgery[17]
Fifty patients with benign thyroid nodules who are candidates for hemithyroidectomy were included in the study and were divided into two groups according to the method of thyroidectomy which was either conventional open
Summary
Thyroid nodules are common in general population with 3-7% prevalence[1]. The prevalence increases to19-67% by using high-resolution ultrasonography among randomly selected individuals[2]. A number of techniques simultaneously started being called as minimally invasive thyroid surgery These can be classified as pure endoscopic techniques and video-assisted techniques. Transoral endoscopic thyroidectomy has been developed; it is a natural orifice thyroid surgery, minimally invasive and completely scar free[12,13,14,15]. The refinement of this transoral thyroidectomy technique was wellestablished and described by Anuwong A, as the transoral endoscopic thyroidectomy vestibular approach (TOETVA) with excellent clinical results[16]. Accepted patient selection criteria for TOETVA are; strong motivation for scar free surgery, thyroid gland diameter ≤10 cm or dominant nodule diameter ≤5 cm in ultrasonography, a benign disease as (thyroid cyst or nodular goiter), follicular neoplasm, micropapillary thyroid cancer or differentiated thyroid cancer ≤ 2cm without lymph node metastasis or extrathyroidal extension[18,19]
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