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Ngo DQ, Le DT, Ngo QX, Van Le Q. Transoral endoscopic thyroidectomy vestibular approach as a novel technique for pediatric populations: Results from a single surgeon. Front Endocrinol (Lausanne) 2023; 14:1177633. [PMID: 37334309 PMCID: PMC10272734 DOI: 10.3389/fendo.2023.1177633] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 05/23/2023] [Indexed: 06/20/2023] Open
Abstract
Background The transoral endoscopic thyroidectomy vestibular approach (TOETVA) is increasingly being adopted worldwide because of its many advantages. However, there are few reports on the effectiveness and safety of TOETVA in children. In this study, we report the results of the application of TOETVA on 27 pediatric patients in Vietnam. To the best of our knowledge, this is also the largest sample size of the TOETVA technique performed by a single surgeon on pediatric patients worldwide. Patients and methods: From June 2020 to February 2022, we performed TOETVA on 27 pediatric patients (≤ 18 years old). The outcomes of the procedure were retrospectively reviewed. Results Our study was conducted on 27 pediatric patients, of whom 24 were female (88.9%). The mean age was 16.3 ± 2 (range 10-18). Fifteen patients had benign thyroid nodules with a mean nodule size of 31.6 ± 7.1 (range 20-50mm), and 12 patients had papillary thyroid carcinoma with a mean nodule size of 10.2 ± 5.6 (range 4-19mm). All 27 patients underwent successful TOETVA without any conversion to open surgery. The 15 patients with benign thyroid nodules had lobectomies with a mean operative time of 83.3 ± 10.5 (range 60-105 minutes). Among the 12 patients diagnosed with thyroid cancer, ten had a lobectomy, isthmusectomy, and central neck dissection, with a mean operative time of 89.8 ± 5.7 (range 80-100 minutes). The other two underwent total thyroidectomy with central lymph node dissection with a mean operative time of 132.5 minutes. The mean hospital stay was 4.7 ± 0.9 (range 3-7 days). No patient had permanent complications, such as hypocalcemia, recurrent laryngeal nerve injury, or mental nerve injury. The rates of temporary recurrent laryngeal nerve injury and mental nerve injury were 3.7% and 11.1% respectively. Conclusions TOETVA may be a feasible and safe surgical method for children with thyroid disease. However, we recommend that only high-volume thyroid surgeons with experience in TOETVA should perform TOETVA on the pediatric population.
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Affiliation(s)
- Duy Quoc Ngo
- Department of Head and Neck Surgery, Vietnam National Cancer Hospital, Hanoi, Vietnam
- Department of Oncology, Hanoi Medical University, Hanoi, Vietnam
| | - Duong The Le
- Department of Head and Neck Surgery, Vietnam National Cancer Hospital, Hanoi, Vietnam
| | - Quy Xuan Ngo
- Department of Head and Neck Surgery, Vietnam National Cancer Hospital, Hanoi, Vietnam
| | - Quang Van Le
- Department of Head and Neck Surgery, Vietnam National Cancer Hospital, Hanoi, Vietnam
- Department of Oncology, Hanoi Medical University, Hanoi, Vietnam
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Cohen O, Mäkitie AA, Khafif A, Shaha AR, Randolph G, Coca-Pelaz A, Ferlito A. Remote-Access Thyroidectomy in the Pediatric Population: a Systematic Review. Adv Ther 2023; 40:1560-1570. [PMID: 36746825 DOI: 10.1007/s12325-023-02429-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 01/06/2023] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Remote-access thyroidectomy has been reported in the pediatric population in a limited fashion. METHODS This was a systematic review in PubMed and Scopus for pediatric remote-access thyroidectomy. RESULTS Seventy-eight articles were identified and screened, of which 13 met the inclusion criteria, including 231 patients; 70% of publications reported six or fewer patients. The mean age was 15.3 years (range 5-19). Sixty percent of surgeries were total thyroidectomy. Transaxillary robotic approach was most commonly performed (48.9%). Sixty-seven percent of the cases were operated on for a malignancy. Tumor size ranged between 0.4 and 1.8 cm. Recurrent laryngeal nerve injury rate was 1.9%. Transient and permanent hypocalcemia rates were 23.9% and 2.2%, respectively. CONCLUSION Pediatric remote-access thyroidectomy is not widely employed currently. Comparative studies with better quality are needed to establish its safety. Among selected pediatric patients, it can provide an alternative to open approaches, especially when neck scar is of major concern.
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Affiliation(s)
- Oded Cohen
- Department of Otorhinolaryngology - Head and Neck Surgery, Soroka Medical Center, Affiliated with Ben-Gurion University of the Negev, Be'er Sheva, Israel.
| | - Antti A Mäkitie
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Avi Khafif
- A.R.M. Center of Otolaryngology Head and Neck Surgery, Assuta Medical Center, Affiliated with Ben-Gurion University of the Negev, Tel Aviv, Israel
| | - Ashok R Shaha
- Head and Neck Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Gregory Randolph
- Division of Otolaryngology - Endocrine Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard University, Boston, MA, USA
| | - Andrés Coca-Pelaz
- Department of Otolaryngology, Hospital Universitario Central de Asturias, University of Oviedo, ISPA, IUOPA, CIBERONC, Oviedo, Spain
| | - Alfio Ferlito
- Coordinator of the International Head and Neck Scientific Group, Padua, Italy
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Panaseykin Y, Polkin V, Severskaya N, Isaev P, Iliyn A, Plugar A, Kupriyanova E, Ivanov S, Kaprin A. Preventive Transoral Endoscopic Thyroidectomy by Vestibular Approach in 6-Year-Old Patient with the High-Risk RET C634R Germline Mutation. Case Rep Oncol 2023; 16:963-971. [PMID: 37900832 PMCID: PMC10601771 DOI: 10.1159/000533570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 08/08/2023] [Indexed: 10/31/2023] Open
Abstract
Aggressiveness and age of manifestation of medullary thyroid cancer depend on the risk level of germline RET mutations. For high-risk mutations, preventive thyroidectomy is recommended at young age. In recent years, endoscopic operations for thyroid cancer were introduced in clinical practice. But such experience in pediatrics is very limited. We present a case report of a male patient, 6-year-old with the high-risk germline mutation С634R in RET gene. Close relatives (mother, cousin, and native sister) of the proband, were treated for medullary thyroid cancer. Also, his grandmother on the maternal line and her native brother died at the age of 38 and 37 years because of medullary thyroid cancer progression. Since 3 years old, our patient was under regular exams. At the age of six, calcitonin level was 8 ng/mL, and no evidence of pathology on ultrasound. According to recommendations of American Thyroid Association from 2015 (ATA 2015), preventive thyroidectomy was planned. This operation was performed by transoral vestibular approach. Oral nutrition started on the first day after the operation and the patient was discharged from the hospital. No major complications were observed. Transitory paresthesia and slight edema of the submental compartment were noticed. Consider this, endoscopic operation on the thyroid gland can be performed, as a preventive procedure, for RET gene germline mutation carriers in young age. This method helps avoid scars on the skin of the anterior neck.
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Affiliation(s)
- Yury Panaseykin
- National Medical Research Radiological Center of the Ministry of Health of the Russian Federation, Obninsk, Russian Federation
| | - Vyacheslav Polkin
- National Medical Research Radiological Center of the Ministry of Health of the Russian Federation, Obninsk, Russian Federation
| | - Nataliya Severskaya
- National Medical Research Radiological Center of the Ministry of Health of the Russian Federation, Obninsk, Russian Federation
| | - Pavel Isaev
- National Medical Research Radiological Center of the Ministry of Health of the Russian Federation, Obninsk, Russian Federation
| | - Aleksey Iliyn
- National Medical Research Radiological Center of the Ministry of Health of the Russian Federation, Obninsk, Russian Federation
| | - Alisa Plugar
- National Medical Research Radiological Center of the Ministry of Health of the Russian Federation, Obninsk, Russian Federation
| | - Ekaterina Kupriyanova
- National Medical Research Radiological Center of the Ministry of Health of the Russian Federation, Obninsk, Russian Federation
| | - Sergey Ivanov
- National Medical Research Radiological Center of the Ministry of Health of the Russian Federation, Obninsk, Russian Federation
| | - Andrey Kaprin
- National Medical Research Radiological Center of the Ministry of Health of the Russian Federation, Obninsk, Russian Federation
- Peoples Friendship University of Russia (RUDN University), Moscow, Russian Federation
- Hertsen Moscow Oncology Research Institute – branch of the National Medical Research, Moscow, Russian Federation
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Li C, Gao Y, Zhou P, Yue T, Xu J, Shao C, Liu Y, Zhuang D, He Q, Li X. Comparison of the Robotic Bilateral Axillo-Breast Approach and Conventional Open Thyroidectomy in Pediatric Patients: A Retrospective Cohort Study. Thyroid 2022; 32:1211-1219. [PMID: 35943878 DOI: 10.1089/thy.2022.0242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Background: Operations for pediatric thyroid nodules are more complicated, and usually lead to longer scars, which may impair life quality in the long term. Bilateral axillo-breast approach robotic thyroidectomy (BABA RT) may provide a better alternative to conventional open thyroidectomy (COT) for pediatric thyroid nodules. Our study aimed at comparing the surgical and oncological outcomes of BABA RT and COT in pediatric patients. Methods: The data of 49 pediatric patients who consecutively underwent BABA RT or COT (20:29) between July 1998 and November 2021 in our center were retrospectively analyzed, including demographics, surgery extent, surgical outcomes, pathological characteristics, and oncological outcomes. Results: All BABA RT procedures were completed successfully without conversion to open operation. The BABA RT group consisted of 5 benign and 15 malignant cases, while the COT group consisted of 19 benign and 10 malignant cases. The operation time, drain removal time, and number of lymph nodes harvested by central lymph node dissection or lateral lymph node dissection were equivalent in the BABA RT and COT groups. Notably, the postoperative hospital stay of the BABA RT group was shorter than that of the COT group (8.5 [interquartile ranges (IQRs): 3] vs. 11 [IQR: 8] days, p = 0.008). The aesthetic score of the BABA RT group was much higher than that of the COT group (9 [IQR: 1] vs. 6 [IQR: 1], p < 0.001). There was no significant difference between the BABA RT and COT groups in hypoparathyroidism rate (transient, 5 vs. 4; permanent, 1 vs. 0). There was one case of chyle leakage in the COT group and no other complications in any group, such as recurrent laryngeal nerve injury. With a median follow-up of 101 (IQR: 189) months, one case of local relapse and one case of pulmonary metastasis in the COT group were documented. Conclusion: In the hands of experienced surgeons, robotic BABA thyroidectomy can be a safe and effective option for both benign and malignant thyroid nodules in children, including those with lymph node metastasis. Robotic BABA thyroidectomy can offer a better and faster postoperative course and a much better cosmetic result, which is crucial for pediatric thyroid patients.
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Affiliation(s)
- Chenyu Li
- Jinzhou Medical University, Jinzhou, Liaoning, China
- Department of Thyroid and Breast Surgery, the 960th Hospital of People's Liberation Army, Jinan, China
| | - Yuan Gao
- Department of Thyroid and Breast Surgery, the 960th Hospital of People's Liberation Army, Jinan, China
- Department of General Surgery, the 963rd Hospital of People's Liberation Army, Jiamusi, China
- Department of Hepatobiliary Surgery, Xi-Jing Hospital, Fourth Military Medical University, Xi'an, China
| | - Peng Zhou
- Department of Thyroid and Breast Surgery, the 960th Hospital of People's Liberation Army, Jinan, China
| | - Tao Yue
- Department of Thyroid and Breast Surgery, the 960th Hospital of People's Liberation Army, Jinan, China
| | - Jing Xu
- Department of Thyroid and Breast Surgery, the 960th Hospital of People's Liberation Army, Jinan, China
| | - Changxiu Shao
- Jinzhou Medical University, Jinzhou, Liaoning, China
| | - Yongxiang Liu
- Jinzhou Medical University, Jinzhou, Liaoning, China
| | - Dayong Zhuang
- Department of Thyroid and Breast Surgery, the 960th Hospital of People's Liberation Army, Jinan, China
| | - Qingqing He
- Department of Thyroid and Breast Surgery, the 960th Hospital of People's Liberation Army, Jinan, China
| | - Xiaolei Li
- Department of Thyroid and Breast Surgery, the 960th Hospital of People's Liberation Army, Jinan, China
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