Ann Surg Treat Res.  2017 Aug;93(2):70-75. 10.4174/astr.2017.93.2.70.

Transoral endoscopic thyroidectomy for papillary thyroid microcarcinoma: initial experience of a single surgeon

Affiliations
  • 1Department of Surgery, Seoul Metropolitan Government - Seoul National University Boramae Medical Center, Seoul, Korea. kevinjoon@naver.com
  • 2Minimally Invasive and Endocrine Surgery Division, Department of Surgery, Police General Hospital, Bangkok, Thailand.
  • 3Division for Endocrine Surgery, Department of Human Pathology in Adulthood and Childhood “G. Barresi”, University Hospital G. Martino, University of Messina, Messina, Italy.
  • 4Department of Surgery, KUMC Thyroid Center, Korea University Hospital, Korea University College of Medicine, Seoul, Korea.
  • 5Department of Internal Medicine, Seoul Metropolitan Government - Seoul National University Boramae Medical Center, Seoul, Korea.
  • 6Department of Surgery, Seoul National University Hospital and College of Medicine, Seoul, Korea.

Abstract

PURPOSE
Recently, transoral endoscopic thyroidectomy (TOET) is receiving attention because it is regarded as a true minimally invasive surgery in that it does not leave scars on any part of the body and the area of flap dissection is similar to that of open surgery. In this study, we present the surgical procedures and initial outcomes of TOET in the treatment of papillary thyroid microcarcinoma (PTMC) patients.
METHODS
The medical records of patients who underwent TOET for PTMC between July 2016 and February 2017 were retrospectively reviewed. Indication of TOET was PTMC without capsular invasion or lymph node metastasis on preoperative imaging studies.
RESULTS
Ten female patients were enrolled. Seven patients underwent thyroid lobectomy and three patients underwent isthmusectomy. The mean age and tumor size was 43.3 ± 11.5 years and 0.6 ± 0.2 cm, respectively. Operation time for lobectomy and isthmusectomy was 121.1 ± 30.7 (range, 65-148) and 90.0 ± 9.2 minutes (range, 82-100 minutes), respectively. The mean number of retrieved lymph nodes was 2.7 ± 1.7. Two patients had transient vocal cord palsy, which recovered in three months. There was no case with subcutaneous emphysema, surgical site infection, postoperative bleeding, or mental nerve injury.
CONCLUSION
TOET was feasible and could be performed safely for PTMC. TOET might become a new treatment option for the patients who do not want to leave visible scars on the body.

Keyword

Natural orifice endoscopic surgery; Thyroidectomy; Papillary thyroid cancer; Papillary thyroid microcarcinoma

MeSH Terms

Cicatrix
Female
Hemorrhage
Humans
Lymph Nodes
Medical Records
Minimally Invasive Surgical Procedures
Natural Orifice Endoscopic Surgery
Neoplasm Metastasis
Retrospective Studies
Subcutaneous Emphysema
Surgical Wound Infection
Thyroid Gland*
Thyroidectomy*
Vocal Cord Paralysis

Figure

  • Fig. 1 Patient position and incisions of transoral endoscopic thyroidectomy. (A) Patients were placed in supine position with slight neck extension and (B) incisions were made at midline (2-cm length) and 1 cm medial to mouth angle (5-mm length).

  • Fig. 2 Procedures of transoral endoscopic thyroidectomy. (A) Isthmus was divided at the midline. (B) Strap muscles were retracted using external hanging suture. (C) Identification of the right recurrent laryngeal nerve (white arrowheads). Common carotid artery is demonstrated (black arrow).


Cited by  3 articles

Robotic transoral thyroidectomy for papillary thyroid carcinoma
Hong Kyu Kim, Dawon Park, Hoon Yub Kim
Ann Surg Treat Res. 2019;96(5):266-268.    doi: 10.4174/astr.2019.96.5.266.

Transoral Endoscopic Thyroid Surgery: Indication, Preparation and Surgical Technique
Jun-Ook Park
Korean J Otorhinolaryngol-Head Neck Surg. 2018;61(3):121-126.    doi: 10.3342/kjorl-hns.2018.00038.

Complications of Transoral Thyroidectomy: Overview and Update
Kyung Tae
Clin Exp Otorhinolaryngol. 2021;14(2):169-178.    doi: 10.21053/ceo.2020.02110.


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