Novel suspension system for gasless transoral vestibular thyroidectomy

Safety and outcomes of gasless transoral endoscopic thyroidectomy and lateral neck dissection for papillary thyroid cancer

PURPOSE

Entirely endoscopic surgery via an oral approach is a novel surgical procedure that results in favorable cosmetic outcomes for papillary thyroid cancer (PTC) patients. However, technical constraints have limited the utilization of a single approach for neck lymph node dissection. The aim of this study was to report the safety and outcomes of a novel gasless transoral endoscopic thyroidectomy and lateral neck dissection (LND) procedure for papillary thyroid cancer patients with lateral lymph node metastases.

METHODS

This study reported a newly designed suspension system and trocars for a novel surgical procedure of gasless transoral endoscopic thyroidectomy and LND. Patients who underwent gasless transoral endoscopic thyroidectomy and LND at the Department of Thyroid Surgery, the First Affiliated Hospital of the University of Science and Technology of China, between January 2022 and December 2023 were included. This study documented the demographic information, operative details, postoperative outcomes, and rates of postoperative complications among the patients included in the analysis.

RESULTS

A total of 43 PTC patients, including 6 male patients and 37 female patients with an average age of 30.53 years, were included in the study. The average number of examined lymph nodes was 33.81, including an average of 5.21 examined lymph nodes at level II. The mean operative time was 293.05 min, with an average postoperative hospital stay of 5.21 days. One patient had a history of chyle leakage, three had transient recurrent laryngeal nerve injury, and four experienced transient hypoparathyroidism after surgery.

CONCLUSION

Our innovative design of gasless transoral endoscopic thyroidectomy and LND surgery prevents incisional scars and shows promising safety and outcomes in papillary thyroid cancer patients with lateral lymph node metastases. This entirely endoscopic approach represents a viable alternative surgical option for selected cases.

A suspension surgical space construction method involving a gasless transoral endoscopic thyroidectomy vestibular approach: a single-center experience

OBJECTIVE

This study aimed to summarize and explore how to establish a good surgical space via a gasless transoral endoscopic thyroidectomy vestibular approach (TOETVA) to facilitate smooth surgical progress.

METHODS

This study was conducted between January 2022 and December 2023. The study involved 281 patients with papillary thyroid carcinoma who underwent gasless TOETVA at The First Affiliated Hospital of the University of Science and Technology of China. The suspension method was used to establish the surgical space during the operation. The key steps and difficulties of surgical space construction were summarized, and the clinicopathological characteristics and surgical complications of the patients were analyzed.

RESULTS

The mean surgical duration was 167.86 ± 25.38 min, and the time needed to create the surgical space (from incision of the lip mucosa to incision of the anterior border of the neck) was 17.82 ± 9.44 min. During the construction of the surgical space, there was 1 case of thermal skin burn and 2 cases of bleeding from the anterior jugular vein, with no permanent injury to the mental nerve.

CONCLUSION

In the gasless TOETVA, the suspension method of surgical space construction was employed to rapidly establish a stable three-dimensional operating space that was less prone to collapse, thus facilitating the smooth implementation of subsequent surgical procedures.

Single-incision gasless trans-subclavian endoscopic approach thyroidectomy

The main purpose of the reported endoscopic thyroidectomy with the several incisions on the chest wall or other approaches was to meet the cosmetic demands of patients, but they had inherent technical disadvantages. To solve these problems, we developed a single-incision gasless trans-subclavian approach endoscopic thyroidectomy and evaluated its feasibility. We reviewed clinical data from 243 consecutive patients who underwent gasless trans-subclavian approach endoscopic thyroidectomy with a single incision at our centre from January 2021 to March 2022. Patients' basic information, the extent of surgery, the duration of surgery, the number of lymph node dissection, postoperative hospital stay, complications, and follow-up outcomes were collected and analysed. No cases converted to open surgery. The mean time for lobectomy + central neck dissection was 84.9 ± 29.9 min and 95.0 ± 24.3 min for lobectomy. The mean number of lymph node dissection in the central compartment was 5.6 ± 3.9, with a mean number of metastatic lymph nodes of 0.8 ± 1.6. Temporary recurrent laryngeal nerve (RLN) injury occurred in eigth patients, and minor lymphatic fistula occurred in one patient. During at least 6 months of follow-up, one patient was found to have a recurrence of lateral neck lymph nodes by ultrasound 6 months after surgery. The single-incision gasless trans-subclavian approach endoscopic thyroidectomy is a feasible and truly minimally invasive procedure for selected patients, providing a scarless cervical appearance. Given the simplicity and ease of learning, this surgical technique is well-suited for widespread clinical application.

Progress in gasless endoscopic thyroidectomy

Gasless endoscopic thyroidectomy obviates the necessity for carbon dioxide insufflation to establish a surgical workspace, thus mitigating the potential complications associated with this practice. This technique presents several benefits, such as the maintenance of neck functionality, minimal scarring, and enhanced visibility of the surgical field, which contribute to its extensive adoption in clinical settings. The objective of this study is to synthesize the current methodologies of gasless endoscopic thyroidectomy and to evaluate the advantages and disadvantages inherent to each technique. It aims to offer theoretical insights to assist surgeons in determining the most suitable approach for gasless endoscopic thyroidectomy in their clinical practice.

Patient-reported oral function and psychological well-being outcomes of papillary thyroid cancer patients (PTC) after surgery: a cross-sectional study

BACKGROUND

This study was performed to evaluate the differences in oral function and psychological well-being between patients with PTC after the gasless transoral endoscopic thyroidectomy vestibular approach (gasless-TOETVA) and patients with PTC after open surgery.

METHODS

PTC patients who underwent radical surgery from May 2021 to August 2022 were included in this study. Postoperative data on oral function and psychological well-being, including the Oral Health Impact profile-14 (OHIP-14) and State-Trait Anxiety Inventory Form Y, were collected and analyzed.

RESULTS

212 patients were included in the analysis. Among them, 102 patients who received gasless-TOETVA were assigned to the gasless-TOETVA group, while the remaining 110 patients who underwent open surgery were categorized as the open group. Although the OHIP-14 score in the gasless-TOETVA group was higher than that of the open group from 6 months to 1 year after surgery (p = 0.012), the difference in OHIP-14 scores between the two groups disappeared 1 year after surgery (p = 0.155). There were no differences between the gasless-TOETVA group and the open group in state-anxiety scores. However, the gasless-TOETVA group had significantly lower trait-anxiety scores than the open group at all follow-up time periods. Furthermore, within the gasless-TOETVA group, patients who were more than 1 year post-surgery showed significantly increased trait-anxiety scores compared to those of patients who were less than 1 year post-surgery (Δ = 3.4; p = 0.032). In contrast, the open group showed a decreasing trend in trait-anxiety scores, but there was no statistically significant difference between patients who had surgery less than 1 year ago and those who had surgery more than 1 year ago (Δ = - 2.2; p = 0.094).

CONCLUSION

Gasless TOETVA had a temporary impact on oral function, but it did not alleviate the state of anxiety. Furthermore, we observed a significant increase in trait-anxiety scores among PTC patients who underwent gasless-TOETVA after 1 year.

Gasless submental-transoral combined approach endoscopic thyroidectomy: a new surgical technique

Background

The development of transoral endoscopic vestibular approach thyroidectomy (TOETVA) has been limited by inherent defects, such as mental nerve injury and carbon dioxide (CO₂)-related complications. Herein, we proposed a new technique without CO₂ called gasless submental-transoral combined approach endoscopic thyroidectomy (STET) to solve the problems in TOETVA.

Methods

We reviewed 75 patients who successfully underwent gasless STET using novel instruments at our institution from November 2020 to November 2021. A main incision of approximately 2 cm was made in the natural submental crease line and then combined with two vestibule incisions to complete the procedure. Demographic data, surgical technique and perioperative outcomes were retrospectively recorded.

Results

Thirteen male and sixty-two female patients with a mean age of 34.0 ± 8.1 years were enrolled in this study. Sixty-eight patients had papillary thyroid carcinomas and seven had benign nodules. We successfully performed all gasless STET without conversion to open surgery. The average postoperative hospital stay was 4.2 ± 1.8 days. One transient recurrent laryngeal nerve injury and two transient hypoparathyroidisms were observed. Three patients complained of slight lower lip numbness on the first postoperative day. One case of lymphatic fistula, subcutaneous effusion, and incision swelling occurred each, all of which were conservatively cured. One patient developed a recurrence six months after surgery.

Conclusions

Gasless STET using our own designed suspension system is technically safe and feasible with reasonable operative and oncologic results.