Journal of Otolaryngology and Ophthalmology of Shandong University ›› 2020, Vol. 34 ›› Issue (3): 13-18.doi: 10.6040/j.issn.1673-3770.1.2019.019

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Progress and controversy of the transoral endoscopic thyroidectomy vestibular approach

WU Zhen1,2, FANG Jugao1   

  1. 1. Department of Otorhinolaryngology & Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China2. Department of Thyroid and Breast Surgery, Liaocheng People's Hospital, Liaocheng Hospital affiliated to Shandong First Medical University, Liaocheng 252000, Shandong, China
  • Published:2019-08-07

Abstract: On the premise of ensuring disease treatment and surgical safety, endoscopic thyroid surgery via the vestibular approach has become a new technique in thyroid surgery, which has achieved good results in disease treatment and cosmetic appearance as a minimally invasive procedure. Domestic experts have reached a consensus on this operation, but as a new surgical method with great technical difficulty, transoral endoscopic thyroidectomy is still highly controversial. On the basis of the literature and our own clinical experience, we reviewed the progress and controversies of this operation. The purpose was to promote the operation and allow more patients with a thyroid tumor to benefit from the treatment.

Key words: Thyroid, Tumor, Endoscopic thyroid surgery, Vestibular approach

CLC Number: 

  • R736.2
[1] Witzel K, von Rahden BH, Kaminski C, et al. Transoral access for endoscopic thyroid resection[J]. Surg Endosc, 2008, 22(8): 1871-1875. doi:10.1007/s00464-007-9734-6.
[2] Benhidjeb T, Wilhelm T, Harlaar J, et al. Natural orifice surgery on thyroid gland: totally transoral video-assisted thyroidectomy(TOVAT): report of first experimental results of a new surgical method[J]. Surg Endosc, 2009, 23(5): 1119-1120. doi:10.1007/s00464-009-0347-0.
[3] Nakajo A, Arima H, Hirata M, et al. Trans-Oral Video-Assisted Neck Surgery(TOVANS). A new transoral technique of endoscopic thyroidectomy with gasless premandible approach[J]. Surg Endosc, 2013, 27(4): 1105-1110. doi:10.1007/s00464-012-2588-6.
[4] Wang CC, Zhai HN, Liu WJ, et al. Thyroidectomy: a novel endoscopic oral vestibular approach[J]. Surgery, 2014, 155(1): 33-38. doi:10.1016/j.surg.2013.06.010.
[5] 王勇, 谢秋萍, 俞星, 等. 经口腔前庭入路腔镜甲状腺手术150例临床分析[J]. 中华外科杂志, 2017, 55(8): 587-591. doi:10.3760/cma.j.issn.0529-5815.2017.08.007. WANG Yong, XIE Qiuping, YU Xing, et al. Preliminary experience with transoral endoscopic thyroidectomy via vestibular approach: a report of 150 cases in a single center[J]. Chinese Journal of Surgery, 2017, 55(8): 587-591. doi:10.3760/cma.j.issn.0529-5815.2017.08.007.
[6] 王平, 吴国洋, 田文, 等. 经口腔前庭入路腔镜甲状腺手术专家共识(2018版)[J]. 中国实用外科杂志, 2018, 38(10): 1104-1107. doi:10.19538/j.cjps.issn1005-2208.2018.10.02.
[7] Karakas E, Klein G, Schopf S. Transoral thyroid surgery vestibular approach: does size matter anymore?[J]. J Endocrinol Invest, 2020,43(5):615-622. doi:10.1007/s40618-019-01149-9.
[8] Razavi CR, Tufano RP, Russell JO. Starting a transoral thyroid and parathyroid surgery program[J]. Curr Otorhinolaryngol Rep, 2019, 7(3): 204-208. doi:10.1007/s40136-019-00246-w.
[9] Terris DJ, Chin E. Clinical implementation of endoscopic thyroidectomy in selected patients[J]. Laryngoscope, 2006, 116(10): 1745-1748. doi:10.1097/01.mlg.0000233243.28872.26.
[10] Razavi CR, Vasiliou E, Tufano RP, et al. Learning curve for transoral endoscopic thyroid lobectomy[J]. Otolaryngol Head Neck Surg, 2018, 159(4): 625-629. doi:10.1177/0194599818795881.
[11] 黄晓明, 梁发雅, 余诗桐. 内镜下甲状腺乳头状腺癌的手术[J]. 山东大学耳鼻喉眼学报, 2016, 30(2): 13-16. doi:10.6040/j.issn.1673-3770.1.2016.04. HUANG Xiaoming, LIANG Faya, YU Shitong. Surgical treatment of papillary thyroid carcinoma under endoscopy[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2016, 30(2): 13-16. doi:10.6040/j.issn.1673-3770.1.2016.04.
[12] 许志亮, 史曼曼, 廖仕翀, 等. 两种常用腔镜技术在甲状腺微小乳头状癌中央组淋巴结清扫中的运用[J]. 武汉大学学报(医学版), 2019, 40(4): 613-616. doi:10.14188/j.1671-8852.2019.0087. XU Zhiliang, SHI Manman, LIAO Shichong, et al. A comparison between two common endoscopic techniques in central lymph node dissection of thyroid micropapillary carcinoma[J]. Medical Journal of Wuhan University, 2019, 40(4): 613-616. doi:10.14188/j.1671-8852.2019.0087.
[13] Russell JO, Razavi CR, Shaear M, et al. Transoral vestibular thyroidectomy: current state of affairs and considerations for the future[J]. J Clin Endocrinol Metab, 2019: jc.2019-jc.00116. doi:10.1210/jc.2019-00116.
[14] 王存川, 王晨曦, 许朋, 等. 经乳晕入路腔镜甲状腺大部切除治疗原发性甲状腺功能亢进61例经验[J]. 外科理论与实践, 2004, 9(6): 473-475. doi:10.3969/j.issn.1007-9610.2004.06.012. WANG Cunchuan, WANG Chenxi, XU Peng, et al. Experience in the treatment of primary hyperthyroidism with endoscopic subtotal thyroidectomy via the nipple areola in 61 cases[J]. Journal of Surgery Concepts & Practice, 2004, 9(6): 473-475. doi:10.3969/j.issn.1007-9610.2004.06.012.
[15] Jitpratoom P, Ketwong K, Sasanakietkul T, et al. Transoral endoscopic thyroidectomy vestibular approach(TOETVA)for Graves'disease: a comparison of surgical results with open thyroidectomy[J]. Gland Surg, 2016, 5(6): 546-552. doi:10.21037/gs.2016.11.04.
[16] Anuwong A. Transoral endoscopic thyroidectomy vestibular approach: a series of the first 60 human cases[J]. World J Surg, 2016, 40(3): 491-497. doi:10.1007/s00268-015-3320-1.
[17] Anuwong A, Kim HY, Dionigi G. Transoral endoscopic thyroidectomy using vestibular approach: updates and evidences[J]. Gland Surg, 2017, 6(3): 277-284. doi:10.21037/gs.2017.03.16.
[18] Chen C, Huang SM, Huang AH, et al. Total endoscopic thyroidectomy versus conventional open thyroidectomy in thyroid cancer: a systematic review and meta-analysis[J]. Ther Clin Risk Manag, 2018, 14: 2349-2361. doi:10.2147/TCRM.S183612.
[19] Shao L, Sun W, Zhang H, et al. Risk factors for right paraesophageal lymph node metastasis in papillary thyroid carcinoma: a meta-analysis[J]. Surg Oncol, 2020, 32: 90-98. doi:10.1016/j.suronc.2019.11.007.
[20] Fama F, Zhang DQ, Pontin A, et al. Patient and surgeon candidacy for transoral endoscopic thyroid surgery[J]. Turk Arch Otorhinolaryngol, 2019, 57(2): 105-108. doi:10.5152/tao.2019.18191.
[21] Kahramangil B, Mohsin K, Alzahrani H, et al. Robotic and endoscopic transoral thyroidectomy: feasibility and description of the technique in the cadaveric model[J]. Gland Surg, 2017, 6(6): 611-619. doi:10.21037/gs.2017.10.03.
[22] 中华人民共和国国家卫生健康委员会. 甲状腺癌诊疗规范(2018年版)[J]. 中华普通外科学文献(电子版), 2019, 13(1): 1-15. doi:10.3877/cma.j.issn.1674-0793.2019.01.001.
[23] 郭方东, 王文瑞, 王平. 胸乳入路腔镜颈侧区淋巴结清扫术的疗效分析[J]. 腹腔镜外科杂志, 2019, 24(12): 881-884. doi:10.13499/j.cnki.fqjwkzz.2019.12.881. GUO Fangdong, WANG Wenrui, WANG Ping. Therapeutic effect analysis of endoscopic neck dissection via chest and breast approach[J]. Journal of Laparoscopic Surgery, 2019, 24(12): 881-884. doi:10.13499/j.cnki.fqjwkzz.2019.12.881.
[24] 吴国洋, 傅锦波, 严威, 等. 经胸经口联合入路腔镜下行甲状腺癌中央区淋巴结清扫术[J]. 中华外科杂志, 2016, 54(4): 297-298. doi:10.3760/cma.j.issn.0529-5815.2016.04.011.
[25] 吴国洋, 林福生. 经口腔前庭入路腔镜甲状腺手术专家共识解读及争议[J]. 外科理论与实践, 2019, 24(6): 495-497. doi:10.16139/j.1007-9610.2019.06.005. WU Guoyang, LIN Fusheng. Interpretation and controversy of expert consensus on transoral endoscopic thyoidectomy[J]. Journal of Surgery Concepts & Practice, 2019, 24(6): 495-497. doi:10.16139/j.1007-9610.2019.06.005.
[26] Park JH, Bilegsaikhan SE, Suh YJ. A novel technique for performing transoral endoscopic thyroidectomy vestibular approach(TOETVA): a single-port platform[J]. Surg Laparosc Endosc Percutan Tech, 2020, 30(1): e4-e7. doi:10.1097/SLE.0000000000000739.
[27] Anuwong A, Sasanakietkul T, Jitpratoom P, et al. Transoral endoscopic thyroidectomy vestibular approach(TOETVA): indications, techniques and results[J]. Surg Endosc, 2018, 32(1): 456-465. doi:10.1007/s00464-017-5705-8.
[28] Zhang DQ, Fu YT, Dionigi G, et al. Human cadaveric model for studying the preservation of mental nerve during transoral endoscopic thyroidectomy[J]. Surg Radiol Anat, 2020, 42(1): 55-62. doi:10.1007/s00276-019-02306-8.
[29] 彭文, 彭小伟, 李赞, 等. 经口入路腔镜手术在较大甲状腺良性肿瘤中的应用[J]. 临床耳鼻咽喉头颈外科杂志, 2018, 32(13): 972-975. doi:10.13201/j.issn.1001-1781.2018.13.003. PENG Wen, PENG Xiaowei, LI Zan, et al. Application of transoral endoscopic thyroidectomy for benign thyroid nodule[J]. Journal of Clinical Otorhinolaryngology Head and Neck Surgery, 2018, 32(13): 972-975. doi:10.13201/j.issn.1001-1781.2018.13.003.
[30] Anuwong A, Ketwong K, Jitpratoom P, et al. Safety and outcomes of the transoral endoscopic thyroidectomy vestibular approach[J]. JAMA Surg, 2018, 153(1): 21-27. doi:10.1001/jamasurg.2017.3366.
[31] Zhang DQ, Park D, Sun H, et al. Indications, benefits and risks of transoral thyroidectomy[J]. Best Pract Res Clin Endocrinol Metab, 2019, 33(4): 101280. doi:10.1016/j.beem.2019.05.004.
[32] Yeh YT, Chen JY, Kuo PC, et al. Printing a three-dimensional patient-specific safety device for reducing the potential risk of mental nerve injury during transoral thyroidectomy[J]. World J Surg, 2020, 44(2): 371-377. doi:10.1007/s00268-019-05155-z.
[33] 贺青卿,朱见,王丹.机器人甲状腺及甲状旁腺手术中神经电生理监测临床操作专家共识(2019版)[J]. 中国实用外科杂志,2019,12:1248-1253. doi:10.19538/j.cjps.issn1005-2208.2019.12.02.
[34] 孙辉, 田文. 甲状腺及甲状旁腺术中喉上神经外支保护与监测专家共识(2017版)[J]. 中国实用外科杂志, 2017, 37(11): 1243-1249. doi:10.19538/j.cjps.issn1005-2208.2017.11.14.
[35] Henry LR, Solomon NP, Howard R, et al. The functional impact on voice of sternothyroid muscle Division during thyroidectomy[J]. Ann Surg Oncol, 2008, 15(7): 2027-2033. doi:10.1245/s10434-008-9936-8.
[36] 斯岩, 蔡晶昇, 张浩, 等. 下位甲状旁腺原位保留新探索——胸甲韧带精细解剖法[J]. 中华内分泌外科杂志, 2019,13(4):278-282. doi:10.3760/cma.j.issn.1674-6090.2019.04.004. SI Yan, CAI Jingsheng, Zhang Hao, et al. A new protecting method for the inferior parathyroid gland in situ: the meticulous thyrothymic ligament dissection technique[J]. Journal of Endocrine Surgery, 2019,13(4):278-282. doi:10.3760/cma.j.issn.1674-6090.2019.04.004.
[37] Berber E, Bernet V, Fahey T J, et al. American Thyroid Association Statement on Remote-Access Thyroid Surgery[J]. Thyroid, 2016, 26(3): 331-337. doi:10.1089/thy.2015.0407
[38] Lee HY, You JY, Woo SU, et al. Transoral periosteal thyroidectomy: cadaver to human[J]. Surg Endosc, 2015, 29(4): 898-904. doi:10.1007/s00464-014-3749-6.
[39] 张彬, 韩宗辉, Bikash Rai. 经口腔达芬奇机器人甲状腺手术初步经验[J]. 中华腔镜外科杂志(电子版), 2018, 11(4): 234-237. doi:10.3877/cma.j.issn.1674-6899.2018.04.011. ZHANG Bin, HAN Zonghui, RAI B. Transoral robotic thyroidectomy: a preliminary report of 5 cases in China[J]. Chinese Journal of Laparoscopic Surgery(Electronic Edition), 2018, 11(4): 234-237. doi:10.3877/cma.j.issn.1674-6899.2018.04.011.
[40] You JY, Kim HY, Park DW, et al. Transoral robotic thyroidectomy versus conventional open thyroidectomy: comparative analysis of surgical outcomes using propensity score matching[J]. Surg Endosc, 2020,10. doi:10.1007/s00464-020-07369-y.
[41] Camenzuli C, Schembri Wismayer P, Calleja Agius J. Transoral endoscopic thyroidectomy: a systematic review of the practice so far[J]. J Soc Laparoendosc Surg, 2018, 22(3): e2018.00026. doi:10.4293/jsls.2018.00026.
[42] 张彬. 经口腔达芬奇机器人甲状腺手术[J]. 外科理论与实践, 2019, 24(6): 503-506. doi:10.16139/j.1007-9610.2019.06.007. ZHANG Bin. Transoral robotic thyoidectomy[J]. Journal of Surgery Concepts & Practice, 2019, 24(6): 503-506. doi:10.16139/j.1007-9610.2019.06.007.
[43] Liu ZY, Peng XW, Li Z, et al. Postoperative drain after transoral endoscopic thyroidectomy vestibular approach(TOETVA)with single incision[J]. Surg Endosc, 2020,7. doi:10.1007/s00464-020-07408-8.
[44] Rubino F, Pamoukian VN, Zhu JF, et al. Endoscopic endocrine neck surgery with carbon dioxide insufflation: the effect on intracranial pressure in a large animal model[J]. Surgery, 2000, 128(6): 1035-1042. doi:10.1067/msy.2000.110238.
[45] Park JO, Park YJ, Kim MR, et al. Gasless transoral endoscopic thyroidectomy vestibular approach(gasless TOETVA)[J]. Surg Endosc, 2019, 33(9): 3034-3039. doi:10.1007/s00464-019-06826-7.
[46] 冯志起, 王存川, 王小忠, 等. 经口腔前庭腔镜甲状腺手术通道的解剖研究及临床应用效果[J]. 腹腔镜外科杂志, 2016, 21(4): 251-254. doi:10.13499/j.cnki.fqjwkzz.2016.04.251. FENG Zhiqi, WANG Cunchuan, WANG Xiaozhong, et al. The anatomical study and its clinical application result of the surgery channels of endoscopic thyroidectomy via oral vestibular approach[J]. Journal of Laparoscopic Surgery, 2016, 21(4): 251-254. doi:10.13499/j.cnki.fqjwkzz.2016.04.251.
[47] 肖丽玲, 王存川, 陈鋆, 等. 皮下间隙分离法在150例腔镜甲状腺切除术中的应用[J]. 暨南大学学报(自然科学与医学版), 2003, 24(4): 72-73. doi:10.3969/j.issn.1000-9965.2003.04.019. XIAO Liling, WANG Cunchuan, CHEN(Jun|Yun), et al. The use of subcutaneous dissection method in laparoscopic thyroidectomy:150 cases [J]. Journal of Jinan University(Natural Science & Medicine Edition), 2003, 24(4): 72-73. doi:10.3969/j.issn.1000-9965.2003.04.019.
[48] Xie QP, Xiang C, Wang Y, et al. The patterns and treatment of postoperative hemorrhage and hematoma in total endoscopic thyroidectomy via breast approach: experience of 1932 cases[J]. Endocrine, 2019, 63(3): 422-429. doi:10.1007/s12020-018-01837-1.
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