Clin Exp Otorhinolaryngol.  2021 May;14(2):169-178. 10.21053/ceo.2020.02110.

Complications of Transoral Thyroidectomy: Overview and Update

• Tae K

• KMID: 2515429
• DOI: http://doi.org/10.21053/ceo.2020.02110

Abstract

Transoral thyroidectomy via the vestibular approach has become popular worldwide, with advantages including less surgical morbidity, excellent postoperative cosmesis, and superior functional voice outcomes. Several studies have reported that the surgical outcomes of the transoral approach were comparable to those of the conventional transcervical approach in selected patients. However, unusual complications, such as CO₂ embolism, mental nerve injury, surgical space infection, skin perforation, burns, and trauma have been noted in transoral thyroidectomy. This paper aims to review and provide updated information on these complications and their management. Routine intraoperative neural monitoring is required to avoid laryngeal nerve palsy in the transoral approach. To prevent CO₂ embolism, surgeons need to be careful not to injure the anterior jugular vein, and the CO₂ insufflation pressure should be set as low as 4–6 mmHg. To avoid mental nerve injury, vestibular incisions should be placed in the safety zone, and dissection of the vestibular area and chin should be minimized. In conclusion, recognizing the possibility of complications and understanding their prevention and management are important for patient safety and the success of the transoral approach.

Keyword

CO Embolism; Complications; Mental Nerve Injuries; Vocal Cord Paralysis; Surgical Site Infection; Transoral Thyroidectomy

Figure

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  Fig. 1 Oral vestibular incisions in transoral thyroidectomy. A 1.5- to 2-cm central incision was made near the base of the lower lip frenulum, and two lateral incisions were made close to the oral commissure to avoid mental nerve injury.

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  Fig. 2 Surgical space infection after transoral robotic thyroidectomy showing skin redness, swelling, and tenderness. The infection resolved with appropriate antibiotics and aspiration.

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  Fig. 3 Surgical view of skin perforation and trauma, which resulted in skin necrosis. A local flap was used to cover it.

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  Fig. 4 Skin burn and trauma after transoral thyroidectomy, which resolved without any sequelae.

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  Fig. 5 Skin ecchymosis and bruising after transoral thyroidectomy.

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