TransOral Endoscopic Thyroidectomy via Submental and Vestibular Approach: A Preliminary Report.

Yilong Fu,Jiyu Chen,Zhengfu Song,Penghao Kuang,Yezhe Luo,Ende Lin,Mengwei Wu,Suqiong Lin,Jinbo Fu,Guoyang Wu,Wei Yan,Xiaoquan Hong,Fusheng Lin

doi:10.3389/fsurg.2020.591522

Abstract

Purpose: Transoral endoscopic thyroidectomy via vestibular approach (TOETVA), with its excellent cosmetic effect, has become increasingly popular worldwide. Nonetheless, anatomic obstacles have limited its development to a certain extent. Here, we present our preliminary outcomes of transoral endoscopic thyroidectomy via submental and vestibular approach (TOETSMVA), which can overcome those limitations.Methods: From November 2019 to March 2020, we performed TOETSMVA in 21 consecutive patients with thyroid carcinoma at Zhongshan Hospital, Xiamen University. A 1.5-cm lateral incision was made at two fingers below the mandible; two 5-mm incisions were made in the vestibule near the first molars; TOETSMVA was completed through these incisions. The demographic data and surgical outcomes of the patients were retrospectively reviewed.Results: Twenty-one patients with a mean age of 37.5 ± 10.4 years were incorporated into this study. Fourteen patients had papillary thyroid micro-carcinomas, two had papillary thyroid carcinomas, and five had benign nodules. Eight patients had lymph node metastases. All surgeries were performed successfully without conversion to open thyroidectomy. The mean operation time was 138.8 ± 33.2 min; the average hospital stay was 3.3 ± 0.8 days. No patients developed cutaneous paralysis in the midline chin region. Transient recurrent laryngeal nerve paralysis was observed in one patient. There was no evidence of postoperative bleeding, infection, tetany, or other complications.Conclusion: TOETSMVA was shown to be a safe and advisable alternative for selected patients. This approach can overcome the limitations of TOETVA without sacrificing cosmetic results.

Highlights

Over the past two decades, the global morbidity rate of thyroid carcinoma has sharply increased, and endoscopic thyroid surgery has gained universal favor
The patients who intended to seek for the cosmetic effect of surgery were informed of all the advantages and disadvantages of the following techniques: [1] Thyroidectomy via Breast Approach; [2] Transoral Endoscopic Thyroidectomy via Vestibular Approach, [3] SubMental and Vestibular Approach, and [4] SubLingual and Vestibular Approach
The postoperative pathology results indicated that 14 patients had papillary thyroid micro-carcinomas, 2 had papillary thyroid cancers, and 5 had benign nodules

Summary

Introduction

Over the past two decades, the global morbidity rate of thyroid carcinoma has sharply increased, and endoscopic thyroid surgery has gained universal favor. The first endoscopic thyroid surgery was performed by Hüscher et al [1] in 1997. Transoral endoscopic thyroidectomy via vestibular approach (TOETVA) is the most popular approach, as it provides a short and direct surgical route for thyroid dissection. There are some inescapable weaknesses of TOETVA, such as the limitation of large tumor extractions or cutaneous paralysis of the midline chin due to the anatomic obstacles. We started to perform transOral endoscopic thyroidectomy via submental and vestibular approach (TOETSMVA). The purpose of this article is to determine the feasibility of TOETSMVA, while evaluating whether TOETSMVA can avoid the limitations of TOETVA

Objectives

Methods

Results

Conclusion