Abstract
Transoral endoscopic thyroidectomy vestibular approach (TOETVA) is an upcoming surgical technique with the aim to optimize cosmetic outcome avoiding visible scars in the neck. However, the transoral access bears the risk of contamination and microbial allocation from the mouth into the thyroid region. Therefore, some authors recommend extended antibiotic therapy up to 7 days after surgery. Our aim was to evaluate infection rates and parameters before and after transoral surgery and to suggest a viable and safe routine in transoral surgery. Prospectively collected data of patients who were eligible for transoral surgery in Austria and Germany between June 2017 and July 2020 were retrospectively evaluated focussing on clinical and laboratory infection signs pre and postoperatively. White blood cell count (WBC) and C-reactive protein levels (CRP) were estimated before and after surgery. Patients` characteristics, surgical outcome and complications were also determined and compared to the current results reported in the literature. 113 transoral operations were performed in 108 patients. In 37 of 108 (36%) patients an additional retroauricular incision in the hairline and in two patients a submental skin incision was performed to extract thyroid specimen of more than 40 ml. Intravenous antibiotic prophylaxis and enoral mucosal disinfection were used in all patients before surgery. WBC and CRP levels were available in 75 patients. Median WBC was 5800/µl (range 3500–10,500/µl) before and significantly higher (median 8900/µl, range 4500–18,800 µl; p < 0.01) at day one after surgery. WBC returned to normal range (4500–11,500/µl) in all patients within the first 7 days postoperatively (median 5300/µl, range 3400–8700/µl). CRP levels were normal before (< 0.5 mg/dl) and slightly elevated within the first two days after surgery (Median 2.0 mg/dl, range 0.5–6.4 mg/dl, n.s.). In one patient oral antibiotic therapy was necessary due to transient erythema in the chin region which occurred 10 days after surgery and resolved completely without surgical intervention. Despite a transient increase in WBC transoral thyroid and parathyroid surgery via the vestibular approach does not seem to be associated with a significant number of wound infections in our patients. Intravenous antibiotic prophylaxis and enoral mucosal disinfection might be reasonable procedures to avoid microbial allocation from the mouth into the thyroid region. However, further investigations are required to finally estimate the need of antibiotics in transoral surgery.
Highlights
Conventional thyroid and parathyroid surgery are clean with rates of surgical site infections (SSI) reported to be between 0.5 and 3% at most [1,2,3,4,5].Specific risk factors have been identified to be associated with a higher rate of SSI in thyroid surgery like central lymph node dissection with thyroidectomy compared with thyroidectomy alone [3], total thyroidectomy compared with lobectomy [4] or obesity [6]
All patients were included because the transoral approach was established in all being at risk for contamination and microbial allocation from the mouth into the thyroid region
White blood cell count (WBC) and C-reactive protein levels (CRP) levels were available in 75 patients (69%, Table 1)
Summary
Conventional thyroid and parathyroid surgery are clean with rates of surgical site infections (SSI) reported to be between 0.5 and 3% at most [1,2,3,4,5].Specific risk factors have been identified to be associated with a higher rate of SSI in thyroid surgery like central lymph node dissection with thyroidectomy compared with thyroidectomy alone [3], total thyroidectomy compared with lobectomy [4] or obesity [6]. Over the past two decades various techniques of minimally invasive thyroidectomy like transcervical video assisted surgery, transaxillary, breast or postauricular (EndoCATS) have been developed because many patients were concerned about the scar in the visible part of the neck. Though, these techniques are associated with new, intervention specific complications, none of these procedures is susceptible to be associated with infection rates higher than conventional thyroid surgery [9, 10]. TOETVA as well as its modifications, like the combined transoral and retroauricular approach (TOVARA) that allows for retrieving specimen of more than 40 ml volume show excellent cosmetical results by avoiding visible scars with low complication rates [11, 12]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
