The new era of transoral endoscopic thyroid surgery: tips and tricks from first clinical series (Video)

Einleitung:

Promising new endoscopic transoral approaches to the anterior neck (TOETVA) have been described with good results and few complications, and the first access is key. A new device is proposed to allow the safe entrance of trocars in the subplatysmal space.

Ziele:

This video describes the key steps in performing transoral thyroidectomy in clinical series.

Methodik:

The video shows the technique performed for unilateral thyroidectomies. The technical steps consisted of a 10 mm incision made at the center of the oral vestibule, followed by subplatysmal hydrodissection. 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.

Ergebnis:

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. The cosmetic results were excellent.

Schlussfolgerung:

Transoral thyroid and parathyroid surgery through the vestibular approach is a growing promissing technique for benign indications. Further studies in clinical series are needed to evaluate the broad indication of this technique.