Endoscopic Thyroidectomy Vestibular Approach Research Articles

Comparison of clinical and patient-reported outcomes in patients with benign euthyroid solitary nodules after ultrasound-guided percutaneous microwave ablation and endoscopic thyroidectomy.

Percutaneous ultrasound-guided microwave ablation (MWA) for benign solid thyroid nodules is the newest modality for treatment. However, the differences in treatment outcomes between MWA and endoscopic thyroidectomy vestibular approach (TOETVA) for patients with benign euthyroid solitary nodules remain unknown. We are sharing initial results from our prospective study. Prospective study between January 2022 and December 2023 was conducted and data were noted at 3 time points in patients planned for treatment (Preoperative, 1week, and 12months). Main outcome measures were clinical outcome and comparison of thyroid-related quality of life using the ThyPRO-39hin and swallowing-related quality of life using the SWAL-QoL. Of the 36 included patients, 20 patients underwent TOETVA and 16 underwent MWA. Both the groups were comparable in terms of demographic and clinicopathological profiles. The nodule volume reduction rate of patients at 12months after MWA was 75.10% and 100% for TOETVA. The mean preoperative ThyPRO-39hin and SWAL-QoL scores were comparable in all domains between the two groups. Mean ThyPRO-39hin and SWAL-QoL scores on postoperative day 7 were significantly better in the MWA group in domains impaired social life (p<0.0001) and impaired daily life (p=0.0002). However, at the end of 12months, mean ThyPRO-39hin and SWAL-QoL scores became significantly better in the TOETVA group as compared to the MWA group. Our findings suggest that transoral endoscopic thyroidectomy results in significant superior clinical outcome, thyroid-related quality of life, and swallowing-related quality of life in the long term.

Dr. Victoria Banuchi: my thoughts on starting a program of endoscopic transoral thyroidectomy vestibular approach

Dr. Victoria Banuchi: my thoughts on starting a program of endoscopic transoral thyroidectomy vestibular approach

Bilateral superficial cervical plexus block for transoral endoscopic thyroidectomy (vestibular approach): a randomized controlled study

Background Transoral endoscopic thyroidectomy is one of the scarless approaches for thyroid surgery. The aim of this study was to assess analgesic efficacy of cervical plexus block after general anesthesia for transoral thyroidectomy. The secondary goals are hospital stay, total analgesic consumption, and adverse effects of either anesthesia or surgery. Patients and methods This study was carried out in Mansoura Oncology Hospital. After informed consent, patients undergoing transoral thyroidectomy were randomized into two groups: the first group received general anesthesia (group G) and the second group received bilateral superficial cervical plexus block with ropivacaine 0.5% after induction of general anesthesia (group GB). Analgesic efficiency was our primary concern. Secondary outcomes included patient satisfaction, hospital stay, rescue analgesic, and adverse effects. Results After applying the exclusion criteria, 40 patients were randomized into two groups in this study. The postanesthesia care unit time, pain score for 8 h postoperatively, postoperative opioid requirement, and hospital stay were statistically significantly less in group GB than in the control group. Patient satisfaction is more observed in group GB. Conclusion Bilateral superficial cervical plexus block provided effective analgesia after transoral endoscopic thyroidectomy. Moreover, it results in more patient satisfaction and less hospital stay.

Indications and contraindications to transoral thyroidectomy.

Patient motivation to avoid neck scarring has been a strong impetus in the development of remote access approaches to the thyroid, including transoral robotic or endoscopic thyroidectomy vestibular approach (TOR/ETVA). TOR/ETVA continues to become more prevalent given its early success in North America and the demonstration of its safety and efficacy in Asia. As more surgeons perform this procedure, it is important that specific and uniform indications and contraindications exist to prevent surgical complications due to poor patient selection. In this article, we review the existing English literature regarding TOR/ETVA and compile the inclusion and exclusion criteria of individual authors for both robotic and endoscopic techniques to date. We then resolve differences in the existing literature to provide recommended indications and contraindications to TOR/ETVA based on both our review and our own experience with TOR/ETVA to date. The following are our resultant recommended indications for TOR/ETVA: patient history of hypertrophic scarring or motivation to avoid a cervical neck incision with a maximal thyroid diameter ≤ 10 cm and dominant nodule ≤6 cm, with one of the following pathologic criteria; benign lesion, multinodular goiter, indeterminate nodule, or suspicious lesions/well-differentiated thyroid carcinomas ≤ 2 cm. Recommended contraindications to TOR/ETVA are as follows: history of head & neck surgery, history of head, neck, or upper mediastinal irradiation, inability to tolerate general anesthesia, evidence of clinical hyperthyroidism, preoperative recurrent laryngeal nerve palsy, lymph node metastasis, extrathyroidal extension including tracheal or esophageal invasion, oral abscesses, substernal thyroidal extension, or failure to meet inclusion criteria as above. Relative contraindications include smoking and other oral pathology, and surgeons should be aware that morbid obesity may make it difficult to raise skin flaps.