Transoral thyroid and parathyroid surgery: still experimental!

Abstract

It was with great interest that we read the report by Karakas et al. [1] on transoral thyroid and parathyroid surgery. By using a modified rigid rectoscope (oraloscope) hemithyroidectomies as well as resection of parathyroid glands could be performed in ten porcine cadavers, then in 10 living and orally intubated pigs, and finally in five human corpses. Because unfortunately many claims and statements in their report are misleading, we believe that rectifications are needed. Karakas et al. stated in the ‘‘Introduction’’ of their article that ‘‘For the first time, we describe an entirely transoral access, which allows for a hemithyroidectomy and parathyroidectomy without an accessorial incision of the skin in pigs and human cadavers.’’ Later, in the ‘‘Results’’ section, they affirm that ‘‘This is the first study to demonstrate that transoral resection of thyroid and parathyroid glands is feasible using an entirely transoral access to the thyroid region.’’ Both statements are wrong. Transoral thyroid surgery is an innovative project that was initiated in September 2007 by the New European Surgical Academy (NESA) and developed in cooperation with the Department of Neuroscience Anatomy at the Erasmus MC University in Rotterdam, The Netherlands. It is a part of the NESA’s Natural Orifice Surgery (NOS) project that includes investigation of transvaginal and transoral access for various surgical procedures [2–4]. Transoral thyroidectomy is based on the hybrid technique invented by our member Kai Witzel, who was the first to describe transoral access to the thyroid [5]. Our main goal was the investigation and introduction of a technique of totally endoscopic thyroid resection that is minimally invasive and safe for the patient and also cosmetically optimal (scarless). The first step of this project consisted of anatomic studies with instrument development performed on three human cadavers. Following these detailed studies, safety and reproducibility to reach and resect the thyroid gland were assessed according to a defined road map in two cadavers. On 14 May 2008 we succeeded in performing a totally transoral video-assisted thyroidectomy that we named TOVAT. On 31 August 2008 this method was successfully used in five living pigs. On 13 September 2008 we submitted a video paper to Surgical Endoscopy that was accepted on 8 January 2009 and published online on 5 March 2009 [6]. Karakas et al. submitted their manuscript to Surgical Endoscopy on 12 June 2009, 3 months after the online publication of our video paper in the same journal, long after our paper was available on PubMed and other search engines. Moreover, we presented TOVAT as early as 30 August 2008 at the 20th International Conference of the Society for Medical Innovation and Technology (SMIT) in Vienna [7]. The abstract of this oral presentation was also published at that time in Minimally Invasive Therapy and Allied Technologies [8]. All this makes it legitimate to raise serious concerns over Karakas’ literature search before starting their T. Benhidjeb (&) O. Mann Department of General-, Visceraland Thoracic-Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany e-mail: t.benhidjeb@uke.de