Natural orifice transluminal endoscopic surgery thyroidectomy is a novel approach to avoid surgical scars.To compare the safety and outcomes of the transoral endoscopic thyroidectomy vestibular approach (TOETVA) with those of open thyroidectomy (OT).This study retrospectively reviewed all TOETVA and OT operations performed from April 1, 2014, through August 31, 2016, at Police General Hospital, Bangkok, Thailand. All patients who underwent TOETVA and patients who underwent OT were included. Exclusion criteria were (1) previous neck surgery, (2) substernal goiter, (3) lymph node or distance metastasis, and (4) suspicious invasion to the adjacent organs. Propensity score matching was conducted to reduce selective bias.Operative time, blood loss, and complications related to thyroid surgery.Of the 425 patients who underwent transoral endoscopic thyroidectomy (mean age, 35.3 [12.1] years; age range, 16-81 years; 389 [92.2%] female), 422 successfully were treated with the TOETVA; 3 patients were converted to a conventional operation because of bleeding. Twenty-five patients (5.9%) had transient recurrent laryngeal nerve palsy, and 46 (10.9%) had transient hypoparathyroidism. None had permanent recurrent laryngeal nerve palsy or permanent hypoparathyroidism. Three patients (0.7%) had transient mental nerve injury; all cases resolved by 4 months. One patient developed postoperative hematoma treated by OT. Twenty patients (4.7%) had seroma treated by simple aspiration. Operative time was longer for the TOETVA compared with the OT group (100.8 [39.7] vs 79.4 [32.1] minutes, P = 1.61 × 10-10). The mean (SD) visual analog scale score for pain was lower in the TOETVA group (1.1 [1.2] vs 2.8 [1.2], P = 2.52 × 10-38). Estimated mean (SD) blood loss (36.9 [32.4] vs 37.6 [23.1] mL, P = .43) and rate of complications (45 of 216 [20.8%] vs 38 of 216 [17.6%], P = .41) were not significantly different in the TOETVA vs OT group.The TOETVA was performed as safely as OT, requires only conventional laparoscopic instruments, and avoids incisional scars; thus, the approach may be an option for select patients.

Transoral endoscopic thyroidectomy vestibular approach is the natural orifice surgery to avoid surgical scars. However, mental nerve injury is a characteristic complication. Herein, we report the development of a novel method to dissect the mental nerve proactively during surgery to minimize the morbidity from mental nerve injury.In this study, a total of 105 patients from June 2016 to February 2018 were categorized as the mental nerve dissection group (MND) or not mental nerve dissection group (NMND). We analyzed the demographics, operative data, hospital stay, pathologic results, and postoperative complications between the two groups.There were no significant differences with respect to age, gender, tumor size, extent of surgery, the amount of bleeding, or postoperative hospitalization between groups. The specimen removal time was shorter in the MND group. The average operation time in both groups was similar, but the operation time for a hemithyroidectomy with CND in the MND group was shorter than in the NMND group. The VAS pain scores and complication rates that included transient hypocalcemia, seroma, subcutaneous emphysema, transient, and permanent recurrent laryngeal nerve palsy did not differ significantly between groups. In terms of mental nerve injury, the morbidity rate in the MND group was lower than in the NMND group.The modified endoscopic thyroidectomy involving dissection of the mental nerve via the oral vestibular approach is safe and feasible. It is beneficial to protect the mental nerve and for specimen removal which is worth clinical promotion.

The transoral endoscopic thyroidectomy vestibular approach (TOETVA) has been increasingly used to treat patients with papillary thyroid cancer (PTC) with improved cosmetic outcomes. This study aimed to explore the safety and efficacy of TOETVA in patients with PTC.This retrospective study included TOETVA patients from Yantai Yuhuangding and Xiamen Zhongshan Hospitals. Among the 297 patients studied, 84 had benign nodules (28.3%), 208 had PTC (70.0%), and five had follicular thyroid cancer (1.7%).The incidence of transient and permanent recurrent laryngeal nerve injury was 1.3%, while that of transient hypoparathyroidism was 1.0%. Mental nerve paraesthesia was observed in 241 cases (81.1%), while permanent mental nerve paraesthesia was noted in seven cases (2.4%). Abnormal motor function of the lower lip and chin was observed in 12 cases (4.0%). Ten of the 208 patients with PTC (4.8%) underwent total thyroidectomy (TT) and bilateral central neck dissection (CND). A mean 6.6 ± 4.1 and 10.9 ± 4.0 lymph nodes were removed in the unilateral and bilateral surgeries, respectively, with a metastasis rate of 49.0%; a mean 2.7 ± 2.3 and 3.2 ± 2.6 lymph nodes were metastatic, respectively. The parathyroid gland was inadvertently removed in 6.6% and auto-transplanted in 10.6% of patients with unilateral PTC. The non-stimulated thyroglobulin level in the TT and bilateral CND patients was below 1 ng/mL at the 6-month follow-up.TOETVA is safe in well-selected patients with unilateral PTC. However, its safety remains unclear in patients treated with TT and bilateral CND.Copyright © 2021 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.

To investigate the clinical efficacy and safety of endoscopic thyroidectomy through the oral vestibular approach and the breast approach. Retrospective analysis was done on clinical data of 80 patients who received an endoscopic thyroidectomy from April 2018 to March 2019. The research group had endoscopic thyroidectomy through the oral vestibular approach, whereas the control group had endoscopic thyroidectomy through the areola breast approach. Comparison between the two groups including intraoperative bleeding, operation time, total postoperative drainage, drainage time, postoperative sustained pain time, recovery feeding time, postoperative hospitalization duration, satisfactory esthetic outcomes of incision, central lymph node clearance, skin injury, infection incidence, and complications such as facial hematoma, subcutaneous emphysema, abnormal feeling of the neck and chest, and pleural injury was recorded. There was no significant difference between the two groups in the amount of intraoperative bleeding, operation time, total postoperative drainage, drainage time, postoperative sustained pain time, recovery feeding time, and postoperative hospitalization time (> .05). The incidence of complications such as skin injury, infection, wound hematoma, subcutaneous emphysema, abnormal feeling of the neck and chest, and pleural injury was not statistically different between the two groups (> .05). There was no significant difference in the number of lymph nodes cleaned in the central area between the two groups (> .05). The overall satisfaction of the patients with the cosmetic effects of the incision (100.00%) was higher than that of the control group (90.00%). The clinical treatment effect and safety in the two groups were similar, but the transoral group had better cosmetic effects.

To report the clinical implications of an initial experience with transoral endoscopic thyroidectomy vestibular approach (TOETVA).From March to November 2017, five cases of TOETVA were performed. Data reported include patient demographics, indication for surgery, extent of surgery, operative time, the need to convert to cervicotomy, the length of hospital stay and post-operative pain and morbidity. Unconventional complications regarded as specific for TOETVA were reported. The burden of surgery on the patient's quality of life was evaluated using the 36-item short form (SF-36) health survey 1 month after surgery.All patients were females with a mean age of 36 years. They all underwent a right-sided hemithyroidectomy for a solitary thyroid nodule measuring on average 3.5 cm in size. The nodule was reported as Bethesda category II (n = 3), III (n = 1), and IV (n = 1) on fine needle aspiration cytology. The mean operative time was 122 min. Conversion to a transverse cervicotomy was required in one case. None of the patients developed post-operative bleeding, and none experienced vocal fold or mental nerve palsy. Surgical site infection did not occur. All patients developed subcutaneous emphysema that resolved within 12-48 h. All patients reported a long-standing bothersome pulling sensation along the surgical track that resulted in a poor outcome in some scales of the SF-36 survey. Flap perforation occurred in one case. The median VAS score was 3.Patients strongly motivated to undergo a novel surgical procedure tailored to their needs and desires should be properly counselled particularly regarding unconventional procedure-related complications.

Transoral thyroidectomy is a kind of "natural orifice transluminal endoscopic surgery (NOTES)" which is now being performed in increasing frequency. However, the safety and feasibility have not been concluded yet.A systemic literature search was performed in Pubmed, Cochrane, and Embase databases to identify all studies written in English and published up to April 2017. The keywords used were "transoral endoscopic," "transoral robotic," "oral vestibular endoscopic," and "oral vestibular robotic" combined with "thyroidectomy" or "thyroid surgery."Ten articles containing 211 cases matched the review criteria. The weighted average operative time was 119.9 minutes with an average intraoperative blood loss of 35.5 mL while the weighted average length of hospital stay was 4.0 days. The overall conversion rate to open surgery was 1.9%. An overall incidence rate of temporary hypoparathyroidism was 7.1%, temporary recurrent laryngeal nerve injury was 4.3%, whereas of mental nerve palsy was 4.3%.According to those reviewed literatures, we can conclude that transoral thyroidectomy is safe and feasible in well-selected patients and offers good perioperative and postoperative outcomes.