Abstract
Simple SummaryTransoral thyroidectomy accesses the thyroid gland through three incisions in the oral vestibule. The cosmetic outcome was excellent since no scar was observed on the body surface. However, it is challenging to create a working space using this new approach. Unconventional but severe complications can also occur. Our review summarizes the tips regarding working space creation in transoral thyroidectomy and tricks for preventing complications.Transoral thyroidectomy is a novel technique that uses three small incisions hidden in the oral vestibule to remove the thyroid gland. It provides excellent cosmetic results and outcomes comparable to the open approach. One of the main obstacles for this technique is the creation of a working space from the lip and chin to the neck. The anatomy of the perioral region and the top-down surgical view are both unfamiliar to general surgeons. As a result, inadequate manipulation might easily occur and would lead to several unconventional complications, such as mental nerve injury, carbon dioxide embolism, and skin perforation, which are rarely observed in open surgery. Herein, we summarize the basic concepts, techniques, and rationales behind working space creation in transoral thyroidectomy to assist surgeons in obtaining an adequate surgical field while eliminating preventable complications.
Highlights
Transoral thyroidectomy via the vestibular approach leaves no visible scar on the body surface while adhering to the minimally invasive concept by dissecting far smaller areas than other remote access thyroidectomies, such as transaxillary, retroauricular, or bilateral axillo-breast approaches
Growing evidence shows that transoral thyroidectomy has equivalent and even superior surgical outcomes compared with the open approach and other extracervical accesses [1,2,3,4]
Hypotension and even asystole have been reported in patients who develop CO2 embolism during transoral thyroidectomy and parathyroidectomy [55,61]
Summary
Transoral thyroidectomy via the vestibular approach leaves no visible scar on the body surface while adhering to the minimally invasive concept by dissecting far smaller areas than other remote access thyroidectomies, such as transaxillary, retroauricular, or bilateral axillo-breast approaches. Growing evidence shows that transoral thyroidectomy has equivalent and even superior surgical outcomes compared with the open approach and other extracervical accesses [1,2,3,4]. This procedure became popular worldwide [5]. In transoral thyroidectomy, developing a working space through three small incisions in the oral vestibule is the core feature of this procedure and is the most challenging part for beginner surgeons who are trying to learn this technique. This review aims to present the current approach and evidence on each step of working space creation in transoral thyroidectomy. To the best of our knowledge, a comprehensive review focusing on working space creation in transoral thyroidectomy has not yet been reported
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