Skip to main content

Advertisement

SpringerLink
Log in

Transoral endoscopic thyroidectomy for thyroid carcinoma: outcomes and surgical completeness in 150 single-surgeon cases

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

A Correction to this article was published on 05 June 2019

This article has been updated

Abstract

Background

Transoral endoscopic thyroid surgery vestibular approach (TOETVA) is a promising technique involving no skin incision. Since its first use in 60 patients in 2015, TOETVA has been adopted by several hospitals worldwide. However, reports of TOETVA for thyroid cancer are scarce.

Methods

Between August 2016 and March 2019, 150 and 125 thyroid cancer patients underwent TOETVA and open thyroidectomy (OT), respectively, by a single endocrine surgeon. Comparative analyses were performed on clinical and pathological findings, complications, and surgical completeness in total thyroidectomy cases, as indicated by the serum thyroglobulin (Tg) level. Data were collected prospectively and analyzed retrospectively.

Results

Mean age was younger in the TOETVA than in the OT group (43.06 ± 10.90 vs. 51.02 ± 12.42). The percentage of females was 96.7% in the TOETVA group. Total thyroidectomy was higher in the OT group (26.7% vs. 65.0%). Operation time (min) was longer in the TOETVA group for lobectomy (102.12 ± 32.59 vs. 76.38 ± 21.24) and total thyroidectomy (132.65 ± 34.79 vs. 90.71 ± 25.09). The largest tumor diameter was 0.91 (± 1.00) in the TOETVA group and 1.19 (± 1.07) in the OT group. The harvested lymph node number was not significantly different between the two groups for lobectomy (3.19 ± 2.89 vs. 3.49 ± 2.41, p = 0.319) and total thyroidectomy (4.98 ± 3.12 vs. 5.70 ± 4.35, p = 0.714). The thyroid-stimulating hormone stimulated Tg level before administration of the first dose of radioactive iodine was also not different (3.38 ± 10.87 vs. 3.44 ± 11.51, p = 0.595). Percentage of stimulated Tg below 1.0 ng/ml was 80.0% in the TOETVA group.

Conclusions

TOETVA is feasible in selected thyroid cancer patients, not only because it is cosmetically advantageous but also because it is oncologically safe. A large prospective cohort study including recurrence surveillance is needed to consolidate the feasibility of TOETVA.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Change history

  • 05 June 2019

    The Acknowledgment was omitted from this article and appears below.

References

  1. La Vecchia C, Malvezzi M, Bosetti C, Garavello W, Bertuccio P, Levi F et al (2015) Thyroid cancer mortality and incidence: a global overview. Int J Cancer 136(9):2187–2195

    Article  Google Scholar 

  2. Ferlay J, Soerjomataram I, Dikshit R, Eser S, Mathers C, Rebelo M et al (2015) Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer 136(5):E359–E386

    Article  CAS  Google Scholar 

  3. Oh CM, Jung KW, Won YJ, Shin A, Kong HJ, Lee JS (2015) Age-period-cohort analysis of thyroid cancer incidence in Korea. Cancer Res Treat 47(3):362–369

    Article  CAS  Google Scholar 

  4. Brown BC, McKenna SP, Siddhi K, McGrouther DA, Bayat A (2008) The hidden cost of skin scars: quality of life after skin scarring. J Plast Reconstr Aesthet Surg 61(9):1049–1058

    Article  CAS  Google Scholar 

  5. Ikeda Y, Takami H, Niimi M, Kan S, Sasaki Y, Takayama J (2001) Endoscopic thyroidectomy by the axillary approach. Surg Endosc 15(11):1362–1364

    Article  CAS  Google Scholar 

  6. Choe JH, Kim SW, Chung KW, Park KS, Han W, Noh DY et al (2007) Endoscopic thyroidectomy using a new bilateral axillo-breast approach. World J Surg 31(3):601–606

    Article  Google Scholar 

  7. Singer MC, Seybt MW, Terris DJ (2011) Robotic facelift thyroidectomy: I Preclinical simulation and morphometric assessment. Laryngoscope 121(8):1631–1635

    Article  Google Scholar 

  8. Kim MJ, Nam KH, Lee SG, Choi JB, Kim TH, Lee CR et al (2018) Yonsei experience of 5000 gasless transaxillary robotic thyroidectomies. World J Surg 42(2):393–401

    Article  Google Scholar 

  9. Lee KE, Kim E, Koo DH, Choi JY, Kim KH, Youn YK (2013) Robotic thyroidectomy by bilateral axillo-breast approach: review of 1026 cases and surgical completeness. Surg Endosc 27(8):2955–2962

    Article  Google Scholar 

  10. Berber E, Bernet V, Fahey TJ 3rd, Kebebew E, Shaha A, Stack BC Jr et al (2016) American thyroid association statement on remote-access thyroid surgery. Thyroid 26(3):331–337

    Article  Google Scholar 

  11. Nakajo A, Arima H, Hirata M, Mizoguchi T, Kijima Y, Mori S et al (2013) Trans-oral video-assisted neck surgery (TOVANS). A new transoral technique of endoscopic thyroidectomy with gasless premandible approach. Surg Endosc 27(4):1105–1110

    Article  Google Scholar 

  12. Wilhelm T, Metzig A (2011) Endoscopic minimally invasive thyroidectomy (eMIT): a prospective proof-of-concept study in humans. World J Surg 35(3):543–551

    Article  Google Scholar 

  13. Anuwong A (2016) Transoral endoscopic thyroidectomy vestibular approach: a series of the first 60 human cases. World J Surg 40(3):491–497

    Article  Google Scholar 

  14. Udelsman R, Anuwong A, Oprea AD, Rhodes A, Prasad M, Sansone M et al (2016) Trans-oral vestibular endocrine surgery: a new technique in the United States. Ann Surg 264(6):e13–e16

    Article  Google Scholar 

  15. Dionigi G, Bacuzzi A, Lavazza M, Inversini D, Boni L, Rausei S et al (2017) Transoral endoscopic thyroidectomy: preliminary experience in Italy. Updates Surg 69(2):225–234

    Article  Google Scholar 

  16. Pan JH, Zhou H, Zhao XX, Ding H, Wei L, Qin L et al (2017) Robotic thyroidectomy versus conventional open thyroidectomy for thyroid cancer: a systematic review and meta-analysis. Surg Endosc 31(10):3985–4001

    Article  Google Scholar 

  17. Yi JW, Yoon SG, Kim HS, Yu HW, Kim SJ, Chai YJ et al (2018) Transoral endoscopic surgery for papillary thyroid carcinoma: initial experiences of a single surgeon in South Korea. Ann Surg Treat Res 95(2):73–79

    Article  Google Scholar 

  18. Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE et al (2016) 2015 American thyroid association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: the American thyroid association guidelines task force on thyroid nodules and differentiated thyroid cancer. Thyroid 26(1):1–133

    Article  Google Scholar 

  19. Cibas ES, Ali SZ (2017) The 2017 bethesda system for reporting thyroid cytopathology. Thyroid 27(11):1341–1346

    Article  Google Scholar 

  20. Inabnet WB 3rd, Fernandez-Ranvier G, Suh H (2018) Transoral endoscopic thyroidectomy-an emerging remote access technique for thyroid excision. JAMA Surg 153(4):376–377

    Article  Google Scholar 

  21. Chai YJ, Chung JK, Anuwong A, Dionigi G, Kim HY, Hwang KT et al (2017) Transoral endoscopic thyroidectomy for papillary thyroid microcarcinoma: initial experience of a single surgeon. Ann Surg Treat Res 93(2):70–75

    Article  Google Scholar 

  22. Fu J, Luo Y, Chen Q, Lin F, Hong X, Kuang P et al (2018) Transoral endoscopic thyroidectomy: review of 81 Cases in a Single Institute. J Laparoendosc Adv Surg Tech A 28(3):286–291

    Article  Google Scholar 

  23. Jitpratoom P, Ketwong K, Sasanakietkul T, Anuwong A (2016) Transoral endoscopic thyroidectomy vestibular approach (TOETVA) for Graves’ disease: a comparison of surgical results with open thyroidectomy. Gland Surg 5(6):546–552

    Article  Google Scholar 

  24. Peng W, Peng XW, Li Z (2018) Application of transoral endoscopic thyroidectomy for benign thyroid nodule. Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 32(13):972–975

    CAS  PubMed  Google Scholar 

  25. Razavi CR, Khadem MGA, Fondong A, Clark JH, Richmon JD, Tufano RP et al (2018) Early outcomes in transoral vestibular thyroidectomy: robotic versus endoscopic techniques. Head Neck 40(10):2246–2253

    Article  Google Scholar 

  26. Shan L, Liu J (2018) A systemic review of transoral thyroidectomy. Surg Laparosc Endosc Percutan Tech 28(3):135–138

    PubMed  Google Scholar 

  27. Anuwong A, Ketwong K, Jitpratoom P, Sasanakietkul T, Duh QY (2018) Safety and outcomes of the transoral endoscopic thyroidectomy vestibular approach. JAMA Surg 153(1):21–27

    Article  Google Scholar 

  28. Park JO, Sun DI (2017) Transoral endoscopic thyroidectomy: our initial experience using a new endoscopic technique. Surg Endosc 31(12):5436–5443

    Article  Google Scholar 

  29. Anuwong A (2017) Strategy to prevent subcutaneous emphysema and gas insufflation-related complications in transoral endoscopic thyroidectomy vestibular approach: reply. World J Surg 41(10):2649–2650

    Article  Google Scholar 

  30. Chen CM, Hung IY, Liu WC, Wang LK, Lan KM, Lin YT et al (2017) A great variation in the reported incidence of postoperative subcutaneous emphysema in trans-oral vestibular endoscopic thyroidectomy. World J Surg 41(10):2647–2648

    Article  Google Scholar 

  31. Lee KE, Koo DH, Kim SJ, Lee J, Park KS, Oh SK et al (2010) Outcomes of 109 patients with papillary thyroid carcinoma who underwent robotic total thyroidectomy with central node dissection via the bilateral axillo-breast approach. Surgery 148(6):1207–1213

    Article  Google Scholar 

Download references

Funding

The authors declare no sources of funding for this research.

Author information

Authors and Affiliations

  1. Department of Surgery, Inha University Hospital, 27, Inhang-ro, Jung-gu, Incheon, Republic of Korea

    Jong-hyuk Ahn & Jin Wook Yi

  2. Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea

    Jin Wook Yi

Authors
  1. Jong-hyuk Ahn
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jin Wook Yi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jin Wook Yi.

Ethics declarations

Disclosures

Dr. Jong-hyuk Ahn and Professor Jin Wook Yi have no conflicts of interest or financial ties to disclose.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ahn, Jh., Yi, J.W. Transoral endoscopic thyroidectomy for thyroid carcinoma: outcomes and surgical completeness in 150 single-surgeon cases. Surg Endosc 34, 861–867 (2020). https://doi.org/10.1007/s00464-019-06841-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-019-06841-8

Keywords

Search

Navigation