En bloc resection of total thyroid and bilateral central compartment lymph nodes via a gasless transoral approach in papillary thyroid carcinoma

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.

Application of deep-learning to the automatic segmentation and classification of lateral lymph nodes on ultrasound images of papillary thyroid carcinoma

PURPOSE

It is crucial to preoperatively diagnose lateral cervical lymph node (LN) metastases (LNMs) in papillary thyroid carcinoma (PTC) patients. This study aims to develop deep-learning models for the automatic segmentation and classification of LNM on original ultrasound images.

METHODS

This study included 1000 lateral cervical LN ultrasound images (consisting of 512 benign and 558 metastatic LNs) collected from 728 patients at the Chongqing General Hospital between March 2022 and July 2023. Three instance segmentation models (MaskRCNN, SOLO and Mask2Former) were constructed to segment and classify ultrasound images of lateral cervical LNs by recognizing each object individually and in a pixel-by-pixel manner. The segmentation and classification results of the three models were compared with an experienced sonographer in the test set.

RESULTS

Upon completion of a 200-epoch learning cycle, the loss among the three unique models became negligible. To evaluate the performance of the deep-learning models, the intersection over union threshold was set at 0.75. The mean average precision scores for MaskRCNN, SOLO and Mask2Former were 88.8%, 86.7% and 89.5%, respectively. The segmentation accuracies of the MaskRCNN, SOLO, Mask2Former models and sonographer were 85.6%, 88.0%, 89.5% and 82.3%, respectively. The classification AUCs of the MaskRCNN, SOLO, Mask2Former models and sonographer were 0.886, 0.869, 0.90.2 and 0.852 in the test set, respectively.

CONCLUSIONS

The deep learning models could automatically segment and classify lateral cervical LNs with an AUC of 0.92. This approach may serve as a promising tool to assist sonographers in diagnosing lateral cervical LNMs among patients with PTC.

Feasibility and safety of modified en-bloc resection in endoscopic thyroid surgery via bilateral areolar approach - long-term institutional analysis ten years after surgery

Purpose

This study aimed to introduce a new modified en-bloc resection method and evaluate its feasibility and safety in endoscopic thyroid surgery via bilateral areolar approach (BAA).

Methods

Papillary thyroid carcinoma (PTC) patients who underwent lobectomy and ipsilateral central node dissection (CND) via the BAA approach were retrospectively reviewed. Their clinical characteristics and outcomes were evaluated, including operative duration, lymph node yield (LNY), surgical complications, recurrence rate, and metastasis rate, over a ten-year follow-up period. Simultaneous lobectomy and CND were performed in the modified en-bloc group, whereas lobectomy was performed first, followed by CND in the conventional group.

Results

The study included 108 patients in the modified en-bloc group and 213 in the conventional group. There were no significant differences in gender, age, tumor locations, tumor dominant nodule size, or the incidence of concomitant Hashimoto thyroiditis when comparing clinicopathologic characteristics. The comparison of operative duration (P = 0.14), blood loss (P = 0.13), postoperative hospital stay (P = 0.58), incidence of transient vocal cord paralysis (P = 0.90) and hypocalcemia (P = 0.60) did not show any differences. The mean LNY achieved in the central compartment of the modified en-bloc group (7.5 ± 4.5) was significantly higher than that in the conventional group (5.6 ± 3.6). Two patients in the modified en-bloc group and two in the conventional group experienced metastasis after surgery during the ten-year follow-up (1.8% vs. 0.9%, P = 0.60). The learning curve analysis showed a significant decrease in operative duration after the 25-35th cases for modified en-bloc resection.

Conclusions

The modified en-bloc resection method in endoscopic thyroid surgery via BAA is a technically feasible and safe procedure with excellent cosmetic outcomes for selective PTC patients.