Transoral Vestibular Approach Research Articles

Feasibility and Safety of transoral robotic parathyroidectomy: Initial experience with a new approach for parathyroid surgery

BackgroundWe present the initial outcomes of transoral robotic parathyroidectomy (TORP) using the transoral vestibular approach in patients with primary hyperparathyroidism (PHPT). MethodA retrospective case series analysis was performed on patients diagnosed with PHPT between October 2016 and July 2019 who underwent transoral robotic surgery for parathyroidectomy. ResultsThirteen patients (five males and eight females) successfully underwent TORP at our institution from October 2016 to July 2019. Eight patients underwent TORP alone, and five underwent TORP combined with transoral robotic thyroidectomy for papillary thyroid carcinoma. No intra- or postoperative complications were observed. Serum levels of parathyroid hormone, total calcium, and ionized calcium decreased to normal postoperatively and continued to decrease during the follow-up period. ConclusionThis study suggests that TORP holds promise for the treatment of patients with PHPT with the advantages of the robotic procedure, including dynamic visualization and meticulous dissection.

Transoral endoscopic vestibular approach Sistrunk procedure (TEVAS)-case report and scoping review.

Thyroglossal duct cyst (TGDC) is the most common congenital neck mass among the pediatric population. Less than 10% of the cases occur in adults. The standard of care for TGDC is surgical treatment with the Sistrunk procedure via a traditional transverse cervicotomy. This technique involves the resection of the cyst with its tract and the central portion of the hyoid bone body to avoid recurrence. The transoral vestibular approach has gained popularity as an alternative approach to open neck surgery in order to eliminate the transcervical scar associated with these procedures. We describe a case of an endoscopic Sistrunk procedure performed by the transoral vestibular approach. A scoping review of the transoral endoscopic vestibular approach Sistrunk procedure (TEVAS) was performed. The PubMed, Medline, Cochrane, Lilacs, Scielo, Mary Ann Libert and Scopus databases were systematically searched by using a Medical Subject Heading (MeSH)-optimized search strategy. The selection of papers followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines after setting inclusion and exclusion criteria. The case was successful and without complications. Five studies were included in the final analysis for this review. This novel approach to the Sistrunk procedure is an effective alternative way to treat TGDC in selected patients who are motivated to avoid a visible neck scar.

Completion thyroidectomy via robotic transoral vestibular approach - preliminary outcome report

Completion thyroidectomy via robotic transoral vestibular approach - preliminary outcome report

A retrospective comparative study between robotic thyroidectomy through transoral vestibular approach and bilateral breast-axillary approach

Objective: To compare the surgical outcome of robotic thyroidectomy through transoral approach and the bilateral breast-axillary approach. Methods: Retrospective analysis was made on the clinical data of patients who performed transoral robotic thyroidectomy (TORT group) or bilateral breast-axillary approach (BABA group) in the Department of Thyroid and Breast Surgery, the 960th Hospital of People's Liberation Army from July 2020 to May 2022. Both groups received lobectomy with lymph node dissection of the central region. A total of 100 cases were included in the study, including 48 cases in the TORT group and 52 cases in the BABA group. The propensity score matching method was used for 1∶1 matching of patients between the 2 groups, with a match tolerance of 0.03. There were 31 patients in each group successfully matched. In the TORT group, there were 5 males and 26 females, aged (33.2±7.9) years (range: 21 to 53 years). While there were 4 males and 27 females in the BABA group, aged (34.6±9.2) years (range: 19 to 58 years). The t test, Mann-Whitney U test, χ2 test or Fisher exact test were used to compare the clinical efficacy between the two groups. Results: All the patients successfully completed robotic thyroid surgery without conversion to open surgery. Compared with BABA group, the TORT group had longer operation time ((211.3±57.2) minutes vs. (126.2±37.8) minutes, t=6.915, P<0.01), shorter drainage tube retention time ((5.4±1.0) days vs. (6.4±1.2) days, t=-3.544, P=0.001), shorter total hospital stay ((6.6±1.2) days vs. (7.4±1.3) days, t=-2.353, P=0.022), and higher cosmetic score (9.46±0.25 vs. 9.27±0.26, t=2.925, P=0.005). There was no significant difference between the two groups in the number of lymph nodes dissection, metastasis in the central compartment, and the incidence of postoperative complications (all P>0.05). Conclusions: Compared with the bilateral breast-axillary approach, the transoral vestibular approach of robotic thyroidectomy is also safe and effective. It shows similar surgical results to the bilateral breast-axillary approach in strictly selected patients, but the postoperative recovery speed is much faster, and the hospital stay is shorter. Transoral robotic thyroidectomy is a more recommended surgical method for patients with high aesthetic demand.

Transoral thyroid and parathyroid surgery in Brazil: where are we?

thyroid surgery through the transoral vestibular approach is a reality in many countries. While several competing remote access techniques have been developed in the last 20 years, many were not reproducible. Transoral Endoscopic Neck Surgery (TNS) has been shown to be reproducible in different centers around the world, and approximately five years after its description it has been adopted relatively quickly for various reasons. To date, there are at least 7 Brazilian studies published, including a series of more than 400 cases. The aim of this work is to study the progression of Transoral Neck Surgery in Brazil and describe the profile of surgeons involved in this new approach. this is a retrospective study with descriptive statistics. A REDCap based survey about transoral endoscopic thyroidectomy and parathyroidectomy vestibular approach (TOETVA/TOEPVA) was done with 66 Brazilian surgeons regarding surgeon profile, numbers of cases performed by geographic region, what kind of training was necessary prior to the first case and behavior of the surgeon proposing these new approaches. response rate of this survey was 53%. To date, 1275 TOETVA/TOEPVA cases had been performed in Brazil, 1229 thyroidectomies (96.4%), 42 parathyroidectomies (3.3%) and 4 combined procedures (0.3%). Most of the cases were done in the southeast region (821, 64.4%), 538 (42.2%) cases in the State of São Paulo and 283 (22.2%) cases in the State of Rio de Janeiro. TOETVA is becoming popular in Brazil. Younger surgeons, especially those between 30 and 50 years old were more likely to adopt this approach.

Retracted: Discussion on the Transoral Vestibular Approach Endoscopy for TC Patients and the Significance of Serum 25-Hydroxyvitamin D Classification.

[This retracts the article DOI: 10.1155/2022/3425225.].

Transoral Endoscopic Vestibular Approach Sistrunk Procedure: Surgery Video

Introduction: Thyroglossal duct cyst (TGDC) is a congenital malformation and it is usually found in children <10 years old (>90%).1–4 It is the most common neck cyst and congenital neck mass in the pediatric population and a smaller number of cases occur in adulthood.1–5 The diagnosis is confirmed with imaging and it can be done with a simple ultrasound scan, CT scan, or MRI. The definitive treatment is surgical removal and the gold standard surgery is called Sistrunk procedure,6 which involves excision of the whole cyst and the body of the hyoid bone, because of the embryologic origin of the malformation. This technique described in 19206 was a game changer in the treatment of TGDC as it reduced recurrence rates from 40% to <3%,7 however, it has not changed since then. More recently, the transoral vestibular approach technique for accessing the central neck made possible a total endoscopic safe technique for thyroid and parathyroid removal—TOETVA/TOEPVA.8,9 As TGDCs are located in the same field, the same technique has been shown to give good access for treating TGDC without leaving a neck scar.1–3 Other authors already published two case reports2,3 and a case series1 about effective excision of TGDC transorally. They named the technique transoral endoscopic vestibular approach Sistrunk (TEVAS) procedure.1 The aim of this video is to describe, step-by-step, a case of TEVAS. Materials and Methods: We recorded this video of TEVAS in a woman. The patient involved in the case gave written informed consent to participate in this study. Case: A 47-year-old woman with no medical history presented with a long-term midline neck mass with recent enlargement associated with neck discomfort and sensation of compression. Clinical examination showed a midline mass located on the level of the hyoid bone measuring ~5 cm. Sistrunk sign was positive. The patient underwent a CT scan that showed a 4.5 cm TGDC. Surgery was indicated and endoscopic approach was chosen. The surgery began with the confection of three endoscopic portals through the oral vestibule. After that, the working space was made with an ultrasonic scalpel while running CO2 insufflation. The midline was opened and TGDC was observed. The soft tissue around the cyst was dissected with an ultrasonic scalpel and the hyoid bone was exposed, cutting the insertions of the strep muscles. The bone was cut using the ultrasonic scalpel with an open jaw, touching it with the active blade and making some pressure. The thyroglossal duct was ligated with hemolocks and after that it was sectioned, releasing the specimen, which was removed through the central port using an endobag. Conclusion: This video illustrates the application of TEVAS for treating TGDC. Experience with TOETVA/TOEPVA made possible the execution of this surgery. The most important aspect to choose this novel approach was the patient's motivation to avoid a neck scar. Cutting the hyoid bone was the most challenging step. Using a harmonic scalpel to do the osteotomies was efficient and we recommend it. No competing financial interests exist. Authors have received and archived patient consent for video recording/publication in advance of video recording of procedure. No funding was received for this article. Runtime of video: 11 mins 58 secs

Scarless Neck Feminization: Chondrolaryngoplasty Through Endoscopic Transoral Vestibular Approach.

We present in this paper a novel approach to perform endoscopic chondrolaryngoplasty without any external visible scars. The technique involves utilizing the endoscopic transoral vestibular approach. We have modified the technique by using the placement of a suture immediately above the anterior commissure, which provides a marker for the inferior extent of cartilage resection. Laryngoscope, 133:1099-1102, 2023.

Hypoparathyroidism Risk After Total Endoscopic Thyroidectomy for Papillary Thyroid Cancer: A Comparison of the Transoral Vestibular and Breast Approaches.

BackgroundThis study aimed to compare the risk of hypoparathyroidism between the transoral vestibular approach (TOVA) and the breast approach (BA) in patients undergoing total endoscopic thyroidectomy (TET) for papillary thyroid carcinoma (PTC).MethodsThe medical records of 121 PTC patients (all women) who underwent total TET from January 2015 to January 2021 were retrospectively analyzed. Patients were grouped according to surgical approach (BA or TOVA). Clinical status and concentrations of parathyroid hormone (PTH) and calcium were monitored in the perioperative period and 1, 6, and 12 months after surgery.ResultsThe BA and TOVA groups comprised 101 and 20 patients, respectively. Clinicopathologic and characteristics and surgical data were comparable between the groups. Incidence of transient hypoparathyroidism was significantly lower in the TOVA group than the BA group (10% vs 63.4%; p <0.01). Incidence of permanent hypoparathyroidism was comparable (5% vs 6.9%). Two days after TET, mean PTH concentration was significantly higher and incidence of abnormal PTH was significantly lower in the TOVA group. The incidence of abnormal calcium concentration 2 days after surgery was significantly lower in the TOVA group. One month after surgery, the mean calcium concentration was significantly higher in the TOVA group. Univariate and multivariate Cox regression analysis suggested that patients who underwent TOVA had a lower risk of transient hypoparathyroidism (hazard ratio 0.05, 95% confidence interval, 0.01–0.23; p<0.01). No clinicopathological factors examined were significantly associated with permanent hypoparathyroidism.ConclusionIn patients undergoing TET for PTC, the incidence of transient hypoparathyroidism may be lower with the TOVA than the BA. Surgeons should be aware of the relatively high risk of transient hypoparathyroidism when performing the BA.

Comparative Study of Gasless Transaxillary, Bilateral Axillo-Breast, Unilateral Axillo-Breast With Carbon Dioxide Insufflation, Retroauricular, and Transoral Vestibular Endoscopic Thyroidectomy Approaches at a Single Institution: A Retrospective Analysis and Lessons Learned.

ObjectivesThis study aimed to present our experiences with various approaches for endoscopic thyroidectomy (ET) and to offer lessons for choosing an approach.MethodsThe medical records of 701 patients who underwent ET via the transaxillary (TA), bilateral axillo-breast (BABA), unilateral axillo-breast with carbon dioxide insufflation (UABA), retroauricular (RA), or transoral vestibular (TO) approach between May 2008 and March 2020 were retrospectively reviewed. Postoperative pain and cosmetic outcomes were evaluated using visual analog scales.ResultsThe mean operative time of UABA was the shortest among the five approaches (TA, 194.65±51.13 minutes; BABA, 189.11±61.53 minutes; UABA, 118.62±30.23 minutes; RA, 168.22±45.63 minutes; TO, 196.10±40.19 minutes; P=0.02). BABA was the most painful approach, while TO was the least painful on postoperative day 1 (TA, 3.09±0.96; BABA, 3.59±0.92; UABA, 2.39±0.54; RA, 3.49±0.93; TO, 2.01±0.37; P=0.04) and day 3 (TA, 2.10±0.77; BABA, 2.59±0.88; UABA, 1.84±0.37; RA, 3.01±0.67; TO, 1.49±0.45; P=0.04). The TO group had the best cosmetic outcomes at 3 months (TA, 3.91±1.21; BABA, 4.52±1.13; UABA, 4.49±0.74; RA, 4.28±0.74; TO, 4.81±0.48; P=0.04).ConclusionWe present a single-surgeon experience of five distinctive ET approaches and the lessons from each approach, together with a literature review. This data may aid endoscopic thyroid surgeons in choosing from various ET approaches.

Discussion on the Transoral Vestibular Approach Endoscopy for TC Patients and the Significance of Serum 25-Hydroxyvitamin D Classification.

In order to discuss the transoral vestibular approach endoscopy through oral vestibular approach in TC and the efficacy of 25(OH)D classification, a total of 110 TC patients from January 2020 to June 2021 are selected. The endoscopic group and the control group are respectively established according to different surgical approaches, with 55 cases in each group. The control group received conventional TC resection, while the endoscopic group received endoscopic assisted TC resection through oral vestibular approach. The differences of intraoperative and postoperative indicators, clinical efficacy, incidence of adverse complications, VAS score, and total satisfaction are observed. TC resection assisted by endoscopy through oral vestibular approach can effectively improve all intraoperative indicators and reduce postoperative pain and has high safety in clinical application. In addition, this study conducted in-depth analysis and classification of serum 25(OH)D index level in postoperative TC patients, indicating that the serum 25(OH)D index level is closely related to prognosis, providing a basis for follow-up clinical monitoring of TC patients' signs and optimization of diagnosis and treatment plans.

Transoral Vestibular Approach Was Combined with the Nursing Care of Patients with Thoracoscopic Thyroidectomy

Transoral Vestibular Approach Was Combined with the Nursing Care of Patients with Thoracoscopic Thyroidectomy

The Year in Surgical Thyroidology: Recent Technological Developments and Future Challenges.

Background: The field of surgical and interventional thyroidology is rapidly evolving. In the past few years, we have seen the introduction and establishment of many novel surgical adjuncts, techniques, and disruptive ablative technologies that have impacted the field. Methods: We identified the most influential articles on technological developments in surgical and interventional thyroidology that were published from September 1, 2020, to August 1, 2021. We searched three electronic databases and consulted experts. Results: Major findings are summarized. Continuous intraoperative nerve monitoring (cIONM) lowered the risk of early postoperative vocal cord palsy 1.8-fold and permanent palsy 29 · 4-fold compared with intermittent intraoperative nerve monitoring. Parathyroid autofluorescence yielded a diagnostic odds ratio (OR) of 228.9 for detection of parathyroid glands over visualization, with 96% sensitivity and 92% specificity. There was no significant difference in the incidence of major complications between the transoral endoscopic thyroidectomy vestibular approach (TOETVA) and transcervical thyroidectomy (1.5% vs. 2.1%, p = 0.75), and a higher body mass index did not lead to a significant increase in the odds of cumulative complication with TOETVA for the overweight (OR = 0.52 [95% confidence interval {CI} 0.17-1.58]) and obese groups (OR = 1.69 [CI 0.74-3.88]). Radiofrequency ablation (RFA) for benign thyroid nodules typically resulted in a 50-85% volume reduction with faster recovery times, less pain levels, and higher social and psychological well-being compared with conventional thyroidectomy at 15 months post-treatment, although physical well-being levels were higher in the conventional thyroidectomy group at this time. RFA for papillary thyroid microcarcinoma showed no significant difference in local tumor progression (1.8% vs. 3.3%, p = 0.209), lymph node metastasis (0.6% vs. 0.6%, p = 1.000), recurrence (1.2% vs. 2.4%, p = 0.244), and 4-year recurrence-free survival rates (98.2% vs. 97.0%, p = 0.223) when compared with transcervical lobectomy. Conclusions: cIONM, parathyroid autofluorescence, transoral vestibular approach thyroid surgery, and RFA for benign and malignant thyroid nodules are some of the latest additions to the surgeon's and interventionalist's armamentarium to manage thyroid disease. These technological advancements demonstrate promise to improve outcomes, decrease complications, and enhance a patient's quality of life, but further rigorous studies are needed to define their utility and value.

One hundred and one consecutive transoral endoscopic parathyroidectomies via the vestibular approach for PHPTH: a worldwide multi-institutional experience.

The transoral vestibular approach for thyroid and parathyroid surgery is being adopted rapidly world-wide. Currently there is a paucity of information on this approach for primary hyperparathyroidism (PHPTH). If this approach is safe and efficacious it would provide patients a completely scarless option for parathyroidectomy. To determine whether parathyroidectomy via the transoral vestibular approach can be successfully done in a safe and efficient manner. Consecutive case series of 101 transoral parathyroidectomies performed over a two-year period. Multi-institutional, academic, high-volume transoral thyroidectomy centers from the USA, Israel, and Thailand. A consecutive series of adult patients with a biochemical diagnosis of classic PHPTH and who met criteria for parathyroidectomy based on established international consensus for surgery for PHPTH. All patients also had well-localized single adenomas on at least two preoperative imaging studies. Transoral endoscopic parathyroidectomy vestibular approach. Surgical success rate defined by immediate intra or post-operative return to normal PTH values. Surgical complications including recurrent laryngeal nerve injury, permanent hypoparathyroidism, and infection. Of the 101 consecutive transoral parathyroidectomy patients 84% were female with an average age of 54.23 ± 11.0years and an average BMI of 27.35 ± 6.19. Ninety-nine out of the 101 patients had immediate return to normal PTH after resection for a surgical success rate of 98%. There were no permanent recurrent laryngeal nerve injuries, one temporary nerve palsy, and no permanent hypoparathyroidism. The median operative time dropped from 130.5min (IQR 86) to 66.5min (IQR 56) between the first- and second-half of cases. Transoral endoscopic parathyroidectomy via the vestibular approach is a scarless method of removing parathyroids that is clinically feasible, safe, and efficacious and is a reasonable option for focused minimally invasive parathyroidectomy that can be offered to select patients with PHPTH.

Current indications for neck remote approaches

Objective To summarize the most commonly used remote surgical accesses to the neck, current indications, and contraindications of the different surgical procedures. Findings The trans-oral vestibular approach has been used to perform thyroid and parathyroid surgery. The retro-auricular approach represents the known approach to perform a comprehensive or selective neck dissection, but it may also be used for thyroid surgery. The trans-axillary approach also may be used to perform both thyroid surgery and neck dissection. Conclusion Remote and minimally-invasive approaches to the neck facilitate various surgical procedures. In addition, surgeons' enhanced experience and the technological advancement of robotic and endoscopic equipment may encourage more centers to adopt these approaches in the future. To summarize the most commonly used remote surgical accesses to the neck, current indications, and contraindications of the different surgical procedures. The trans-oral vestibular approach has been used to perform thyroid and parathyroid surgery. The retro-auricular approach represents the known approach to perform a comprehensive or selective neck dissection, but it may also be used for thyroid surgery. The trans-axillary approach also may be used to perform both thyroid surgery and neck dissection. Remote and minimally-invasive approaches to the neck facilitate various surgical procedures. In addition, surgeons' enhanced experience and the technological advancement of robotic and endoscopic equipment may encourage more centers to adopt these approaches in the future.

Remote access endoscopic parathyroidectomy: a study of 17 cases from Central India

&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;It has been debated that "remote access endoscopic parathyroidectomy" requires extensive dissection, thereby, increasing the risk of complications. Hence, the aim of this study is to assess the feasibility and safety of remote access endoscopic parathyroidectomy via the unilateral axilla-breast approach (ABA) and transoral vestibular approach (TOEPVA). &lt;/p&gt;&lt;p&gt;&lt;strong&gt;Method: &lt;/strong&gt;The study includes 17 patients with primary hyperparathyroidism undergoing endoscopic parathyroidectomy from January 2016 to December 2020. Of these, 11 patients underwent parathyroidectomy via unilateral ABA and 6 had TOEPVA. Preoperatively, ultrasonography of neck, sestamibi scan and CT scan neck were done to localise the diseased gland. Post operatively, Serum calcium and parathyroid hormone levels were monitored.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results&lt;/strong&gt;: The mean age of patients was 35.6±10.5 years. Except one, all the patients were females. The mean operative time of the unilateral ABA and TOEPVA group was 93.67±28.64 minutes and 138.6±31 minutes respectively. Except for three patients, in all the patients, the parathormone levels normalised. One patient had hungry bone syndrome postoperatively. The mean hospital stay of the unilateral ABA and TOEPVA group was 3±1.5 days and 4±3.09 days respectively. One patient had post-operative transient recurrent laryngeal nerve paresis. Seroma and surgical emphysema were seen in two patients each. &lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions&lt;/strong&gt;: Remote Access Endoscopic parathyroidectomy may be considered safe in treatment of parathyroid tumours. Precise preoperative localisation is mandatory. In addition to a magnified view and a better illumination, the potential advantages of endoscopic techniques are better cosmetic results, decreased hospital stay and better patient comfort.&lt;/p&gt;

Tracheal Injury during Endoscopic Transoral Vestibular Approach Thyroidectomy: A Case Report

This report describes the intraoperative course of endoscopic thyroidectomy by oral vestibular approach in a female patient. This operation is new, and its perioperative management is not yet mature. In this case, the surgery resulted in trachea injury that could not be detected easily. As a result, the patient suddenly developed acute dyspnea and circulatory disorder. This procedure requires caution in surgical execution and anesthesia management.

Lateral Vestibular Approach to the Central Neck for Thyroid and Parathyroid Surgery: A Cadaveric Study.

Background: The transoral endoscopic approach to the central neck has rapidly become one of the most widely utilized remote-access approaches for thyroid and parathyroid surgery in the world. The approach involves three small incisions inside the lower lip and has an optimal cosmetic outcome with no visible scar. However, the technique is quite difficult and poses several challenges that limit its widespread adoption. To overcome these issues, a novel lateral vestibular approach (LaVA) was explored in cadavers. Methods: Study using 7 fresh human cadavers that were dissected using open and endoscopic techniques to explore the feasibility of a transoral vestibular approach to the central neck without gas insufflation. Results: This novel approach resulted in wide access to the central neck and allowed for a total thyroidectomy and central neck dissection while preserving the marginal mandibular and mental nerves. Conclusions: LaVA permits excellent access to the central neck with a wide working space without the need for gas insufflation and overcomes many of the limitations of current transoral endoscopic approaches to the central neck.

A comparative study on the efficacy of transoral vestibular approach, via bilateral areola approach endoscopic and open thyroidectomy on stage T1b papillary thyroid carcinoma

Objective: To compare the surgical efficacy and cosmetic satisfaction of the transoral endoscopic thyroidectomy by vestibular approach (TOETVA), endoscopic thyroidectomy via bilateral areola approach (BAA), and open thyroidectomy (OT) in the treatment of papillary thyroid carcinoma (PTC) in stage T1b. Methods: A total of 178 patients with PTC in stages pT1bN0M0 and pT1bN1aM0 treated from January 2017 to December 2018 were divided into TOETVA group (n=59), BAA group (n=43), and OT group (n=76). The baseline characteristics, relevant indexes of surgical efficacy and follow-up data were compared between the three groups, and also the surgical efficacy indexes were compared between unilateral lobectomy + central lymph node dissection (unilateral lobectomy subgroup) and bilateral lobectomy + central lymph nodes dissection (total resection subgroup). SPSS 19.0 statistical software was used for data analysis. Results: The mean ages of patients in TOETVA group and BAA group were significantly younger than those in OT group, and the proportion of women in TOETVA group and BAA group was significantly higher than that in OT group, all P<0.05. None of patients in TOETVA and BAA groups were converted to open surgery. Among TOETVA, BAA and OT groups, there were significant differences in the mean operation time [unilateral lobectomy subgroup: (198.0±45.2) min, (162.0±36.9) min and (79.4±28.6) min, P<0.05; total resection subgroup: (230.0±36.0) min, (219.8±68.1) min and (102.8±40.0) min, P<0.05], in total drainage volume [unilateral lobectomy subgroup: (195.0±55.6) ml, (178.1±50.4) ml and (127.0±30.1) ml, P<0.05; total resection subgroup: (221.1±46.7) ml, (245.3±71.2) ml and (137.7±41.6) ml, P<0.05], and the incidence of subcutaneous ecchymosis in TOETVA group or BAA group was higher than that in the OT group [5.1% (3/59), 11.6% (5/43) vs. 0, χ(2)=3.952 and 9.225 respectively, both P<0.05]. The mean level of C-reactive protein in TOETVA group was higher than that in OT group [(16.8±10.7) vs. (9.5±6.9), P<0.05]. Following-up in the third month after surgery between three groups in cosmetic satisfaction scores [(2.7±0.5) vs. (2.6±0.7) vs. (1.7±0.8)], scar self-consciousness scores (0[0,1] vs. 1[0,2] vs. 2[1,2]), and quality of life scores [(9.1±1.1) vs. (8.9±1.1) vs. (7.5±0.8)], cosmetic satisfaction and quality of life in TOETVA and BAA group were better than that in OT group, in terms of scar self-consciousness: TOETVA<BAA<OT (all P<0.05). But there were no significant differences in the levels of Tg or TgAb between three groups for total resection subgroup (all P>0.05). The median follow-up time of the three groups was 25 months (TOETVA group), 28 months (BAA group), and 32 months (OT group) respectively, without disease progression. Conclusion: TOETVA and BAA are optional surgical methods for PTC in stages pT1bN0M0 and pT1bN1aM0, with good safety and patient's cosmetic satisfaction.

Initial Experience of Endoscopic Thyroidectomy Using Bilateral Axillary Breast and Transoral Vestibular Approach in Georgia.

PurposeRemote access thyroid surgery using a bilateral axillary breast approach (BABA) or a transoral endoscopic thyroidectomy vestibular approach (TOETVA) are increasingly performed worldwide. In the Caucasus, these methods were first applied in the Republic of Georgia. This study compares these two methods of endoscopic thyroid surgery performed on patients in a tertiary hospital in Tbilisi, Georgia.MethodsBetween December 2015 and January 2018, 41 patients underwent endoscopic thyroid surgery at the Aversi Clinic, including 32 who underwent BABA endoscopic thyroidectomy for benign nodules and nine who underwent TOETVA for thyroid cancers. Patients’ medical records were retrospectively reviewed.ResultsTumors were significantly larger (2.38±0.38 cm versus 1.70±0.31 cm, p value <0.001), operation time was significantly longer (177.66±21.02 min versus 116.66±5.59 min, p value <0.001), and blood loss was significantly greater (149.07±28.10 ml versus 102.22±8.33 ml, p value <0.001) in patients who underwent BABA than TOETVA. There were no significant differences in postoperative complications between the two groups.ConclusionRemote access thyroid surgery, either BABA or TOETVA, was successfully started, without harmful complications, at the Aversi Clinic in Tbilisi, Georgia. BABA is suitable for large sized benign nodules and TOETVA for thyroid cancers with central lymph node dissection.