Transoral endoscopic thyroid surgery: – new introduction device for producing operative field: a feasibility cadaver study and first clinical series

Objectives:

Today, minimally invasive thyroid and parathyroid resections for both benign and malignant tumors are rarely performed. Recently, promising new endoscopic transoral approaches to the anterior neck (Transoral endoscopic thyroidectomy vestibular approach; TOETVA) have been described with good results and few complications. A new device is proposed to allow the safe entrance of trocars in the subplatysmal space. This study evaluates the blunt dissection device in performing TOETVA in a cadaver model.

Methods:

The technique was performed for 4 unilateral thyroidectomies in female cadavers with no preexisting neck operations. The technical steps consisted of a 10 mm incision made at the center of the oral vestibule, followed by subplatysmal hydrodissection. Then the blunt dissector stick was inserted creating a space below the platysma to the anterior neck and the strap muscles. The blunt dissector is a metallic stick with an olive at the end and promotes progressive gain in subplatysmal space enlarging the operative field. Three trocars were inserted in the vestibular area. For better exposure, strap muscles were retracted laterally by external sutures. The isthmus was dissected and transected. Anatomical structures as the superior thyroid artery, parathyroid glands and the recurrent laryngeal nerve could be easily identified with magnified vision.

Results:

Preliminary clinical experience with transoral thyroidectomy after cadaver study showed optimal operative field due to subplatysmal dissection by the device allowed for exposition of thyroid and parathyroid glands in all cases. Unilateral thyroidectomy was performed in a mean of 54 min. The device allowed for good exposure in the clinical and cadaverexperience. The cosmetic results were excellent.

Conclusions:

The new device is a promising feature to allow feasibility of transoral thyroid and parathyroid surgery through the vestibular approach in a cadaver model. Further studies in clinical series are needed to evaluate the broad application of this technique.