Ann Surg Treat Res.  2018 Aug;95(2):73-79. 10.4174/astr.2018.95.2.73.

Transoral endoscopic surgery for papillary thyroid carcinoma: initial experiences of a single surgeon in South Korea

• Yi JW
• Yoon SG
• Kim HS
• Yu HW
• Kim SJ
• Chai YJ
• Choi JY
• Lee KE

• KMID: 2417772
• DOI: http://doi.org/10.4174/astr.2018.95.2.73

Abstract

PURPOSE
The transoral endoscopic thyroid surgery vestibular approach (TOETVA) is one of the newest techniques which do not result in an anterior neck scar. We report herein our initial experience with TOETVA and its short-term outcomes in patients with papillary thyroid carcinoma (PTC).
METHODS
This case series consisted of all consecutive patients who underwent TOETVA in our institution between August 2016 and June 2017. Indications for TOETVA were an fine needle aspiration-confirmed PTC or follicular neoplasm, an intrathyroidal tumor with a diameter of less than 2 cm, and no clinical evidence of central or lateral lymph node metastasis. A total of 20 patients underwent TOETVA and we retrospectively reviewed clinicopathologic data and short-term postoperative outcomes.
RESULTS
Among the 20 TOETVA cases, 7 were total thyroidectomy, 12 were lobectomy and 1 was wide isthmusectomy. Mean age was 50.8 years and mean operation time was 152 ± 51.4 minutes. Tumor size ranged from 0.2-1.4 cm and the mean size of harvested central lymph nodes was 2.8 (range, 0-10). Neither mental nerve injury nor surgical site infection occurred. One patient had transient vocal cord palsy and 1 patient developed a neck seroma. Among 7 total thyroidectomy patients, 3 patients developed transient hypocalcemia.
CONCLUSION
Transoral thyroid surgery could be an alternative surgical option for some PTC patients.

Keyword

Endoscopy; Thyroidectomy; Thyroid neoplasms

MeSH Terms

Cicatrix
Endoscopy
Humans
Hypocalcemia
Korea*
Lymph Nodes
Neck
Needles
Neoplasm Metastasis
Retrospective Studies
Seroma
Surgical Wound Infection
Thyroid Gland*
Thyroid Neoplasms*
Thyroidectomy
Vocal Cord Paralysis

Figure

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  Fig. 1 Incision and trocar placement in the transoral endoscopic thyroidectomy vestibular approach. (A) Vestibular incisions (yellow lines). (B) Placement of the trocars.

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  Fig. 2 Thyroidectomy procedures in TOETVA. Representative images were taken from a single patient's transoral endoscopic right lobectomy procedure. (A) Strap muscle was divided on the midline and (B) isthmus was cut from the superior aspect. (C) After right lobe mobilization, the middle thyroid vein was ligated. (D) Dissection and division of the superior pole was performed using an ultrasonic device. After that, (E) the right upper parathyroid was identified and saved. (F) Right recurrent laryngeal nerve was identified and (G) Berrys ligament dissection with en bloc central node dissection was done. (H) The recurrent laryngeal nerve signal was checked using a nerve stimulator after thyroidectomy. T, trachea; I, isthmus; SN, sternal notch; RT, right thyroid; MTV, middle thyroid vein; SP, superior pole; CTM, cricothyroid muscle; UP, upper parathyroid; LP, lower parathyroid; RLN, recurrent laryngeal nerve; B, ligament of Berry; VI, level VI central node area; NS, nerve stimulator.

• 

  Fig. 3 Postoperative surgical field after right lobectomy. T, trachea; CTM, cricothyroid muscle; UP, upper parathyroid; LP, lower parathyroid; RLN, recurrent laryngeal nerve.

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  Fig. 4 Cosmetic outcomes at 2 weeks after surgery. (A) Anterior view of the patient's neck with neck extension. (B) The oral vestibule wounds healed without complications.

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