Hybrid techniques and patients' safety in implementing transoral sublingual thyroidectomy.

PURPOSE: Cosmetic advantages and minimally invasive aspects become more and more important for patients undergoing thyroidectomy. We report on our personal experience and conceptual design in dealing with approaches to the thyroid gland, which we were the first to describe. We report on ideas and experiences concerning its implementation. METHODS: Our own experiences and considerations in the process of finding an endoscopic minimally invasive access in thyroidectomy are compared in a systematic review with the available literature on minimally invasive or endoscopic thyroid surgery. We describe our failures and risk assessment. RESULTS: Our analysis of the literature on minimally invasive thyroidectomy and our own experiences lead us to the conclusion that using different hybrid technologies during the implementation of endoscopic procedures in thyroid surgery can be helpful and could improve patients' safety. A combination of transoral endoscopic and non-transoral techniques might be a useful safer, but more traumatizing alternative for implementation. Several studies show the feasibility of the transoral access in thyroid surgery. We believe that the implementation of these new procedures as routine surgery in specialized centers must be carefully considered and discussed. CONCLUSIONS: The transoral access seems to be less invasive than other extracollar endoscopic accesses in thyroid surgery. For a sublingual single-access routine surgery, better instruments are needed. The vestibular access is possible with standard instruments. Using hybrid technologies for implementation should not be considered as a failure. The transoral thyroidectomy can be a safe method in the hand of experienced surgeons. We expect this hybrid technique to play a major part in further spreading endoscopic transoral thyroid surgery.

Minimally invasive endoscopic thyroid surgery using a collar access: experience in 246 cases with the CEViTS technique.

BACKGROUND: The arguments for applying minimally invasive techniques are, besides cosmetic results, reduced access trauma and less postoperative pain. In thyroid surgery, cosmetic aspects are gaining importance. Whether minimally invasive endoscopic thyroid surgery is less painful has not been shown yet. METHOD: In this study, we analyse the outcome of 246 patients who underwent cervical endoscopic video-assisted thyroid surgery (CEViTS) regarding the surgery itself, their postoperative pain and satisfaction with the procedure. RESULTS: CEViTS is routinely performed in our hospital. In this study, no postoperative bleedings that would have made a reoperation necessary occurred. All lobectomies could be completed endoscopically. In two cases, conversions (enlargement of the 5-mm incision to 25 mm) were necessary. Transient nerve palsy was registered in three patients (1.22%). One patient (0.41%) had a permanent palsy of the recurrent laryngeal nerve. In comparison to open surgery (n = 173 patients), the 246 CEViTS patients had a significantly lower pain level (p = 0.047). CONCLUSIONS: Cervical endoscopic video-assisted thyroid surgery (CEViTS) can be considered a safe, less traumatizing and useful minimally invasive procedure in endoscopic thyroid surgery.

Transoral thyroidectomy: limitations, patients' safety, and own experiences.

For patients undergoing thyroidectomy, the minimally invasive aspect and the cosmetic advantage of the procedure seem to be important factors in surgery. Studies in cadaver and animals have shown that different endoscopic techniques can be performed in a safe and successful way. In the evolution of thyroid surgery, for many endocrine surgeons, the transoral approach seems to be the next step. Even if such procedures are more and more frequently applied in patients, these procedures are far from being generally implemented in routine surgery. In this study, we report on our own experience and considerations in the process of finding a sublingual endoscopic transoral way to the endoscopic transoral thyroidectomy. We describe our failures, risk assessment and compare that with the available literature on transoral sublingual and vestibular thyroid surgery. The access itself needs to be further refined, and even more suitable and better adapted instruments need to be developed, so that optimal and safe results that meet all requirements on endocrine surgery can be achieved. A learning curve at the risk of patients' lives should be avoided. Furthermore, a combination of transoral endoscopic non-transoral techniques might be a useful safer, but more traumatising alternative for implementation. The sublingual access seems to be less invasive than the vestibular access. For a sublingual single-access routine surgery, better instruments are needed. Only in highly specialized centres for endocrine and endoscopic surgery, transoral thyroidectomy should be performed.