Trans-oral endoscopic endocrine surgery vestibular approach: Pioneering the technique in the Gulf Cooperation Council Countries - A case series

Affiliations

23 November 2021

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doi: 10.1016/j.amsu.2021.103114


Abstract

Background: We present our experience with the first five thyroidectomies and parathyroidectomy in Kuwait performed via the transoral endoscopic vestibular approach.

Methods: Retrospective data collection for all trans-oral endoscopic vestibular approach endocrine surgeries performed at a single institution in Kuwait between November 2019 and February 2021. Information on patient demographics, perioperative management and complications were collected and reviewed.

Outcomes: All 5 cases were completed successfully; the intended specimen was extracted successfully via the trans-oral endoscopic vestibular approach and conversion to traditional trans-cervical approach (TCA) was not required. Operative time for the parathyroidectomy case was 225 min and the average operative time for the remaining 4 cases, thyroidectomies, was 151 min. Blood loss was minimal, and length of hospital stay was between 24 and 48 h. One patient had a transient mental nerve injury, and one patient experienced a postoperative seroma which required aspiration. One case required completion thyroidectomy as histopathology revealed papillary thyroid carcinoma.

Conclusion: Transoral vestibular approach is a scar free and safe approach to thyroidectomies and parathyroidectomies. Careful patient selection and counselling with regards to risk versus benefit is required. It is an excellent alternative to the traditional transcervical approach and offers great cosmetic results.

Keywords: Case series; Endocrine surgery; Parathyroidectomy; Thyroidectomy; Transoral vestibular approach.


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References

  1.  
    1. Kocher E.T. Ueber Kropfexstirpation und ihre Folgen. Arch Klin Chir. 1883;29:254–337.
  2.  
    1. Russell J.O., Razavi C.R., Shaear M., Liu R.H., Chen L.W., Pace-Asciak P., Tanavde V., Tai K.Y., Ali K., Fondong A., Kim H.Y., Tufano R.P. Transoral thyroidectomy: safety and outcomes of 200 consecutive north American cases. World J. Surg. 2021 Mar;45(3):774–781. - PubMed
  3.  
    1. Russell J.O., Clark J., Noureldine S.I., Anuwong A., Al Khadem M.G., Yub Kim H., Dhillon V.K., Dionigi G., Tufano R.P., Richmon J.D. Transoral thyroidectomy and parathyroidectomy - a North American series of robotic and endoscopic transoral approaches to the central neck. Oral Oncol. 2017 Aug;71:75–80. - PubMed
  4.  
    1. Richmon J.D., Holsinger F.C., Kandil E., Moore M.W., Garcia J.A., Tufano R.P. Transoral robotic-assisted thyroidectomy with central neck dissection: preclinical cadaver feasibility study and proposed surgical technique. J. Robot Surg. 2011;5:279–282. - PMC - PubMed
  5.  
    1. Witzel K., Von Rahden B.H.A., Kaminski C., Stein H.J. Transoral access for endoscopic thyroid resection. Surg. Endosc. Other Interv. Tech. 2008;22:1871–1875.
  6.  
    1. Benhidjeb T., Wilhelm T., Harlaar J., Kleinrensink G.J., Schneider T.A.J., Stark M. Natural orifice surgery on thyroid gland: totally transoral video-assisted thyroidectomy (TOVAT): report of first experimental results of a new surgical method. Surg. Endosc. 2009;23:1119–1120. - PubMed
  7.  
    1. Karakas E., Steinfeldt T., Gockel A., Schlosshauer T., Dietz C., Jäger J., Westermann R., Sommer F., Richard H.R., Exner C., Sesterhenn A.M., Bartsch D.K. Transoral thyroid and parathyroid surgery–development of a new transoral technique. Surgery. 2011 Jul;150(1):108–115. - PubMed
  8.  
    1. Dinç1 B., Turan M., Gündüzl U., Belen N. Transoral endoscopic thyroidectomy vestibular approach (TOETVA): our outcomes from Turkey. Turk. J. Surg. 2020;36(4):340–346. - PMC - PubMed
  9.  
    1. Anuwong A., Ketwong K., Jitpratoom P., Sasanakietkul T., Duh Q.Y. Safety and outcomes of the transoral endoscopic thyroidectomy vestibular approach. JAMA Surg. 2018;153:21–27. - PMC - PubMed
  10.  
    1. Al Bisher H., Khidr A., Alkhudair B., Alammadi F., Ibrahim A. Transoral endoscopic thyroidectomy via vestibular approach: first case in Saudi Arabia. Int. J. Surg. Case Rep. 2020;70:75–77. - PMC - PubMed
  11.  
    1. Anuwong A. Transoral endoscopic thyroidectomy vestibular approach: a series of the first 60 human cases. World J. Surg. 2016;40(3):491–497. - PubMed
  12.  
    1. Sasanakietkul T., Jitpratoom P., Anuwong A. Transoral endoscopic parathyroidectomy vestibular approach: a novel scarless parathyroid surgery. Surg. Endosc. 2017 Sep;31(9):3755–3763. - PubMed
  13.  
    1. https://www.researchregistry.com/register-now#home/registrationdetails/6...
  14.  
    1. Agha R.A., Sohrabi C., Mathew G., Franchi T., Kerwan A., O'Neill N for the PROCESS Group The PROCESS 2020 guideline: updating consensus preferred reporting of CasE series in surgery (PROCESS) guidelines. Int. J. Surg. 2020;84:231–235. - PubMed
  15.  
    1. Russell J.O., Sahli Z.T., Shaear M., Razavi C., Ali K., Tufano R.P. Transoral thyroid and parathyroid surgery via the vestibular approach-a 2020 update. Gland Surg. 2020 Apr;9(2):409–416. - PMC - PubMed
  16.  
    1. Camenzuli C., Schembri Wismayer P., Calleja Agius J. Transoral endoscopic thyroidectomy: a systematic review of the practice so far. J. Soc. Laparoendosc. Surg. 2018;22(3) e2018.00026.
  17.  
    1. Razavi C.R., Russell J.O. Indications and contraindications to transoral thyroidectomy. Ann. Thyroid. 2017;2(5):12. - PMC - PubMed
  18.  
    1. Dionigi G., Lavazza M., Bacuzzi A., Inversini D., Pappalardo V., Tufano R.P., Kim H.Y., Anuwong A. Transoral endoscopic thyroidectomy vestibular approach (TOETVA): from A to Z. Surg. Technol. Int. 2017 Feb 7;30:103. 2. - PubMed
  19.  
    1. Sasanakietkul T., Jitpratoom P., Anuwong A. Transoral endoscopic parathyroidectomy vestibular approach: a novel scarless parathyroid surgery. Surg. Endosc. 2017 Sep;31(9):3755–3763. - PubMed
  20.  
    1. Kasemsiri P., Trakulkajornsak S., Bamroong P., Mahawerawat K., Pirmochai P., Ratanaanekchai T. Comparison of quality of life between patients undergoing trans-oral endoscopic thyroid surgery and conventional open surgery. BMC Surg. 2020;20:18. - PMC - PubMed
  21.  
    1. Zhang D., Park D., Sun H., Anuwong A., Tufano R., Kim H.Y., Dionigi G. Indications, benefits and risks of transoral thyroidectomy. Best Pract. Res. Clin. Endocrinol. Metabol. 2019 Aug;33(4):101280. - PubMed
  22.  
    1. Bakkar S., Al Hyari M., Naghawi M., Corsini C., Miccoli P. Transoral thyroidectomy: a viable surgical option with unprecedented complications-a case series. J. Endocrinol. Invest. 2018 Jul;41(7):809–813. - PubMed
  23.  
    1. Grogan R.H., Suh I., Chomsky-Higgins K., Alsafran S., Vasiliou E., Razavi C.R., Chen L.W., Tufano R.P., Duh Q.Y., Angelos P., Russell J.O. Patient eligibility for transoral endocrine surgery procedures in the United States. JAMA Netw. Open. 2019 May 3;2(5) - PMC - PubMed
  24.  
    1. Shan L., Liu J. A systemic review of transoral thyroidectomy. Surg. Laparosc. Endosc. Percutaneous Tech. 2018 Jun;28(3):135–138. - PubMed
  25.  
    1. Suh I., Viscardi C., Chen Y., Nwaogu I., Sukpanich R., Gosnell J.E., Shen W.T., Seib C.D., Duh Q.Y. Technical innovation in transoral endoscopic endocrine surgery: a modified “scarless” technique. J. Surg. Res. 2019 Nov;243:123–129. - PubMed
  26.  
    1. Nguyen J., Duong H. StatPearls Publishing; 2021. Anatomy, Head and Neck, Mental Nerve.https://www.ncbi.nlm.nih.gov/books/NBK546630/ [Updated 2020 Aug 10]. In: StatPearls [Internet]. Treasure Island (FL)
  27.  
    1. Anuwong A., Sasanakietkul T., Jitpratoom P., Ketwong K., Kim H.Y., Dionigi G., Richmon J.D. Transoral endoscopic thyroidectomy vestibular approach (TOETVA): indications, techniques and results. Surg. Endosc. 2018 Jan;32(1):456–465. - PubMed
  28.  
    1. Kim K.N., Lee D.W., Kim J.Y., Han K.H., Tae K. Carbon dioxide embolism during transoral robotic thyroidectomy: a case report. Head Neck. 2018 Mar;40(3):E25–E28. - PubMed
  29.  
    1. Calò P.G., Pisano G., Medas F., et al. Identification alone versus intraoperative neuromonitoring of the recurrent laryngeal nerve during thyroid surgery: experience of 2034 consecutive patients. J. Otolaryngol. Head Neck Surg. 2014;43:16. - PMC - PubMed
  30.  
    1. Zhang D., Sun H., Tufano R., Caruso E., Dionigi G., Kim H.Y. Recurrent laryngeal nerve management in transoral endoscopic thyroidectomy. Oral Oncol. 2020 Sep;108:104755. - PubMed