Safety and Outcomes of the Transoral Endoscopic Thyroidectomy Vestibular Approach

Abstract

Importance: Natural orifice transluminal endoscopic surgery thyroidectomy is a novel approach to avoid surgical scars.

Objective: To compare the safety and outcomes of the transoral endoscopic thyroidectomy vestibular approach (TOETVA) with those of open thyroidectomy (OT).

Design, setting, and participants: This study retrospectively reviewed all TOETVA and OT operations performed from April 1, 2014, through August 31, 2016, at Police General Hospital, Bangkok, Thailand. All patients who underwent TOETVA and patients who underwent OT were included. Exclusion criteria were (1) previous neck surgery, (2) substernal goiter, (3) lymph node or distance metastasis, and (4) suspicious invasion to the adjacent organs. Propensity score matching was conducted to reduce selective bias.

Main outcomes and measures: Operative time, blood loss, and complications related to thyroid surgery.

Results: Of the 425 patients who underwent transoral endoscopic thyroidectomy (mean age, 35.3 [12.1] years; age range, 16-81 years; 389 [92.2%] female), 422 successfully were treated with the TOETVA; 3 patients were converted to a conventional operation because of bleeding. Twenty-five patients (5.9%) had transient recurrent laryngeal nerve palsy, and 46 (10.9%) had transient hypoparathyroidism. None had permanent recurrent laryngeal nerve palsy or permanent hypoparathyroidism. Three patients (0.7%) had transient mental nerve injury; all cases resolved by 4 months. One patient developed postoperative hematoma treated by OT. Twenty patients (4.7%) had seroma treated by simple aspiration. Operative time was longer for the TOETVA compared with the OT group (100.8 [39.7] vs 79.4 [32.1] minutes, P = 1.61 × 10-10). The mean (SD) visual analog scale score for pain was lower in the TOETVA group (1.1 [1.2] vs 2.8 [1.2], P = 2.52 × 10-38). Estimated mean (SD) blood loss (36.9 [32.4] vs 37.6 [23.1] mL, P = .43) and rate of complications (45 of 216 [20.8%] vs 38 of 216 [17.6%], P = .41) were not significantly different in the TOETVA vs OT group.

Conclusions and relevance: The TOETVA was performed as safely as OT, requires only conventional laparoscopic instruments, and avoids incisional scars; thus, the approach may be an option for select patients.

Conflict of interest statement

Conflict of Interest Disclosures: None reported.

Figures

Figure.. Endoscopic View During the Transoral Endoscopic Thyroidectomy Vestibular Approach Demonstrated a Top-down Anatomy After Right Thyroidectomy

White arrowhead indicates the right recurrent laryngeal nerve. CA indicates right common carotid artery; CT, cricoid cartilage; LT, left thyroid lobe; RLP, right lower parathyroid gland; RUP, right upper parathyroid gland; and TA, trachea.