Scarless total thyroidectomy via transoral endoscopic vestibular approach: initial case series in a developing Asian country

Comparison of the degree of patient satisfaction between transoral thyroidectomy and open thyroidectomy: a survey-based study

BACKGROUND

Recent advances in thyroid surgery techniques have increased the number of patients undergoing transoral thyroidectomy, and many patients are concerned about post-thyroidectomy cosmetic effects. This study aimed to compare patient satisfaction after transoral versus conventional thyroidectomy.

METHODS

This study was conducted from August 2021 to January 2022 at Gangnam Severance Hospital (Seoul, South Korea). A total of 91 patients underwent transoral endoscopic thyroidectomy (TOET) or open thyroidectomy performed by a single surgeon. The Hospital Anxiety and Depression Scale (HADS), Pain Catastrophizing Scale (PCS), and 15-Item Quality of Recovery (QoR-15) postoperative day (POD)#-1 surveys were administered before the surgery. The QoR-15 POD#1 and #2 surveys were administered after the surgery. The Post-traumatic Stress Disorder Checklist surveys were administered on the first day of the outpatient visit after discharge. The survey results were compared to determine the differences between both groups.

RESULTS

Only the HADS-Depression survey scores differed significantly between the TOET and open thyroidectomy groups (4.22 ± 0.781 and 5.52 ± 0.84, respectively; P = .039). Multivariable analysis, adjusted for age and weight differences between the conventional and TOET groups, revealed no differences in any of the survey scores, including the HADS-Depression scores. Therefore, no differences were observed in the survey scores between the TOET and open thyroidectomy groups.

CONCLUSIONS

The subjective postoperative stress about pain and the degree of recovery after surgery were similar between the two groups. Thus, there would be no difference in the patient's satisfaction for surgery between the two groups.

A comparison between transoral endoscopic thyroidectomy vestibular approach and transareolar thyroidectomy regarding postoperative pain and cosmetic outcomes: A systematic review and meta-analysis

OBJECTIVES

Remote scarless surgeries have been developed for cosmetic reasons; literature showed that remote endoscopic surgeries were superior to conventional thyroidectomy. However, no researchers have compared the transoral thyroidectomy vestibular approach and transareolar approach regarding cosmetic outcomes and postoperative pain score. This meta-analysis assessed the same among patients with papillary microcarcinoma, thyroid disease, and small-size papillary carcinoma.

METHODS

We searched PubMed MEDLINE, Web of Science, SCOPUS, and Cochrane Library from the date of the first inception up to January 2024. The general keywords used are trans-areolar thyroidectomy, trans-oral thyroidectomy vestibular approach, scar-less thyroidectomy, remote thyroidectomy, pain score, and cosmetic effects. The MeSH terms "mouth", "areola", "nipples", "vestibular", "oral", "endoscopes", "endoscopic", and "thyroid" were used. Out of the 389 studies and 114 remained after the removal of duplication, from them, 22 full texts were screened, and only 10 studies were included in the final meta-analysis.

RESULTS

The tansoral thyroidectomy vestibular approach showed better cosmetic outcomes compared to the trans-areolar approach, odd ratio, 1.26, 95% CI, 0.53-1.99. However, no significant statistical difference was found regarding postoperative pain score, odd ratio, -0.11, 95% CI, -0.26-0.04, and central lymph node dissection, odd ration, 1.52, 95% CI, -0.14-3.17.

CONCLUSION

The transoral endoscopic thyroidectomy vestibular approach was better compared to the trans-areolar approach in terms of cosmetic outcomes, no differences were evident regarding pain score and central lymph node dissection. Further larger well-controlled studies assessing operative and postoperative outcomes are needed.

Carbon dioxide embolism during transoral endoscopic thyroidectomy: A case report and literature review

The creation of the surgical space in transoral endoscopic thyroid surgery may put the anterior jugular vein at risk for injury and possibly lead to carbon dioxide (CO2 ) embolism. Although rare, CO2 embolism is potentially fatal. We report a case of a 67-year-old female who underwent transoral endoscopic thyroidectomy vestibular approach (TOETVA) for a benign thyroid disease. Intraoperatively, the anterior jugular vein was inadvertently lacerated. The end-tidal (Et)CO2 , O2 saturation, heart rate, and blood pressure suddenly decreased. The patient eventually became asystole. Cardiopulmonary resuscitation was performed with a return of spontaneous circulation (ROSC). We successfully ligated the injured vessel and terminated the procedure. A literature review of CO2 embolism during transoral thyroid surgery is presented, focusing on presentation, management, and prevention. Since TOETVA is still in preliminary clinical application, especially in developing countries, CO2 embolism may not be uncommon during the initial phase of the learning curve. Surgeons and anesthesiologist should be aware of this possibility.

Prophylactic antibiotics may not be necessary for transoral endoscopic thyroidectomy

Background

With the recent advances in thyroid cancer surgery techniques and the increasing number of patients concerned about cosmetics, the use of transoral endoscopic thyroidectomy is increasing globally. The aim of this study was to determine whether transoral endoscopic thyroidectomy is truly a clean-contaminated surgery.

Methods

From September 2016 to April 2018, 20 patients with thyroid cancer underwent transoral endoscopic thyroidectomy performed by a single surgeon at Gangnam Severance Hospital. Before and after surgery, the oral cavity was swabbed to obtain culture samples, and antibiotics were administered before and after surgery each once.

Results

Of the total 20 patients, no bacteria were identified before or after surgery in eight (40%) patients. Bacteria were identified both before and after surgery in seven patients (35%). In four patients (20%), bacteria were not identified before surgery, but bacteria were identified after surgery. Bacteria were identified before surgery but not after surgery in one patient (5%). No surgical site infection was observed. All the bacteria identified were normal flora of the oral cavity and skin.

Conclusions

There was no difference between the preoperative culture and postoperative culture of the oral cavity in patients undergoing TOET, and there were no postoperative surgical site infection with prophylactic pre & post-operative antibiotics use. Considering the patient's position and surgical extent in TOET, it appears to be difficult for non-indigenous bacteria to invade the surgical site in oral cavity.