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 Table of Contents  
CASE REPORT
Year : 2017  |  Volume : 14  |  Issue : 2  |  Page : 75-76

Transoral thyroidectomy, vestibular approach using two ports: A novel technique


1 Department of Endocrine Surgery, Maharaja Agrasen Hospital, New Delhi, India
2 Department of Surgery, Maharaja Agrasen Hospital, New Delhi, India
3 Department of Radiology, Maharaja Agrasen Hospital, New Delhi, India
4 Department of Endocrinology, Maharaja Agrasen Hospital, New Delhi, India

Date of Web Publication26-May-2017

Correspondence Address:
Deepak Khandelwal
Department of Endocrinology, Maharaja Agrasen Hospital, Punjabi Bagh, New Delhi - 110 026
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/trp.trp_12_17

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  Abstract 


Cosmesis is a prime concern for many patients undergoing thyroid surgery. Postthyroidectomy scar-related apprehension among patients has forced the surgeons to develop techniques to reduce the scar or even without scar. We report a case of a young female with thyroid nodule who underwent transoral endoscopic thyroidectomy done through a novel technique (transoral vestibular approach using two ports) at our center as potentially scarless thyroid surgery.

Keywords: Endoscopic thyroidectomy, thyroid nodule, thyroidectomy, transoral thyroidectomy


How to cite this article:
Aggarwal V, Kiran RB, Garg M, Khandelwal D. Transoral thyroidectomy, vestibular approach using two ports: A novel technique. Thyroid Res Pract 2017;14:75-6

How to cite this URL:
Aggarwal V, Kiran RB, Garg M, Khandelwal D. Transoral thyroidectomy, vestibular approach using two ports: A novel technique. Thyroid Res Pract [serial online] 2017 [cited 2019 Oct 15];14:75-6. Available from: http://www.thetrp.net/text.asp?2017/14/2/75/207128




  Introduction Top


Endoscopic procedures for thyroid surgery have evolved significantly in last few years. Transoral thyroidectomy is potentially scar free thyroid surgery offered for selected patients primarily for cosmetic reason. There are limited reports of such procedures in the literature. Herein, we report a case of transoral endoscopic thyroidectomy done via a novel technique at our centre.


  Case Report Top


A young female patient presented to our hospital with chief complaints of swelling in the right side of the neck and difficulty in breathing on lying down position. Examination revealed a large mobile thyroid nodule on the right side of the neck with slight tracheal deviation. Ultrasonography confirmed 4 cm × 3.5 cm thyroid mixed nodule with predominant cystic component, and fine-needle aspiration cytology revealed it as a colloid nodule.

The patient was planned for transoral right hemithyroidectomy after written informed consent. Nasotracheal intubation was done for better oral access. The first port of 10 mm was introduced through vestibular access 1 cm lateral to midline, and subplatysmal plane was created using a balloon inflated with saline. CO2 insufflation was done and another 5 mm port was introduced 2 cm away from the first port [Figure 1]. Using one port for camera and one for dissection, deep cervical fascia was incised, superficial strap muscles were separated, and thyroid nodule was exposed. A 2-0 Silk suture was passed percutaneously through the nodule for traction and stabilization, thus avoiding the third port. Superior thyroid pedicle, middle thyroid vein, and inferior thyroid pedicles were separated and cauterized using harmonic scalpel. Thyroid was then dissected from thyroid bed. Thyroid swelling was aspirated and removed through 10 mm port. Hemostasis was achieved and a minivac was placed and port sites were closed with 2-0 Vicryl suture. The patient was discharged on the 2nd postoperative day; there were no postoperative complications.
Figure 1: Transoral vestibular approach using two ports

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  Discussion Top


Cosmesis is a prime concern for many patients undergoing thyroid surgery, especially young females who are afraid of having a scar particularly in exposed parts of the body such as neck. Postthyroidectomy scar-related apprehension among patients has forced the surgeons to develop techniques to reduce the scar and place it distantly at less visible areas. Endoscopic procedures for thyroid surgery were introduced since 1998; however, these procedures have not gained popularity because of lack of clear demonstrable benefits. The routes of endoscopic thyroidectomy are through the chest, breast, axillary, or a combination of these.[1] Neck surgery is one of the newest fields for application of minimally invasive surgery.[2] The technique of minimally invasive video-assisted thyroidectomy developed by Miccoli is the method that has so far become most widespread.[3] However, all these procedures will have some external scar. Recently, natural orifice transluminal endoscopic surgery has generated interest among surgeons as a potentially scar-free surgery.[4],[5] There are very limited reports of transoral thyroidectomy in the literature. All of previously reported cases have used three port accesses.[6],[7] However, in our patient, we performed this procedure using only two ports access. A percutaneous suture was passed for traction, avoiding an extra port. All dissection and hemostasis was done by single port using harmonic scalpel. To the best of our knowledge, this is the first report of this novel technique as a scar-free thyroid surgery using only two ports through natural orifice.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Tan CT, Cheah WK, Delbridge L. “Scarless” (in the neck) endoscopic thyroidectomy (SET): An evidence-based review of published techniques. World J Surg 2008;32:1349-57.  Back to cited text no. 1
    
2.
Wilhelm T, Metzig A. Video. Endoscopic minimally invasive thyroidectomy:First clinical experience. Surg Endosc 2010;24:1757-8.  Back to cited text no. 2
    
3.
Miccoli P. Minimally invasive surgery for thyroid and parathyroid diseases. Surg Endosc 2002;16:3-6.  Back to cited text no. 3
    
4.
Benhidjeb T, Wilhelm T, Harlaar J, Kleinrensink GJ, Schneider TA, Stark M. Natural orifice surgery on thyroid gland: Totally transoral video-assisted thyroidectomy (TOVAT): Report of first experimental results of a new surgical method. Surg Endosc 2009;23:1119-20.  Back to cited text no. 4
    
5.
Nakajo A, Arima H, Hirata M, Mizoguchi T, Kijima Y, Mori S, et al. Trans-Oral Video-Assisted Neck Surgery (TOVANS). A new transoral technique of endoscopic thyroidectomy with gasless premandible approach. Surg Endosc 2013;27:1105-10.  Back to cited text no. 5
    
6.
Pai VM, Muthukumar P, Prathap A, Leo J, Rekha A. Transoral endoscopic thyroidectomy: A case report. Int J Surg Case Rep 2015;12:99-101.  Back to cited text no. 6
    
7.
Anuwong A. Transoral endoscopic thyroidectomy vestibular approach: A series of the first 60 human cases. World J Surg 2016;40:491-7.  Back to cited text no. 7
    


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