Four-Trocar Approach for Transoral Endoscopic Thyroidectomy Through Vestibular Area: A Novel Technique

Abstract

Abstract

Introduction:

Recently, the transoral endoscopic thyroidectomy vestibular approach (TOETVA) has widely been applied thanks to its promising advantages.^1–4 Nevertheless, from our prospective of view, there are certain limitations with three trocars to perform thyroidectomy. Therefore, we improve the technique by placing four trocars to carry out the procedure easily. The objective of this study was to report the feasibility and safety of a novel four-trocar approach for transoral endoscopic thyroidectomy through the vestibular. The first case was performed in our institution on February 2020 after an initial experience with TOETVA. The investigation was performed after approval by our Institutional Review Board.

Materials and Methods:

The procedure was performed based on Anuwong's technique that consists of three trocars placed in the vestibular area of the lower lip (one trocar 10–15 mm at the middle and two trocars 5-mm on both sides). ⁵ The first incision is made 1.5–2.5 cm in length transversely. The lateral 5-mm incision was made in the vestibular area of canine and first premolar teeth. After the isthmus was divided at the midline, and the posterior surface of the isthmus was detached from the trachea to the ligament of Berry, the fourth incision was made inferior and lateral to the third incision near the sixth teeth in the left oral vestibular area to insert the fourth 5-mm trocar to pull the right thyroid lobe to the opposite side and help surgeon to perform thyroidectomy easily. The instrumental collision between the same side instruments could be avoided by pushing the fourth trocar closely to main surgeon after inserting the instrument to the working space. We reported the safety and surgical feasibility of transoral endoscopic thyroidectomy using a four-trocar technique in our institute from February 2020 to April 2020. The video shows the procedure in detail.

Results:

Transoral endoscopic thyroidectomy through the vestibular approach using four trocars was operated in three patients. Mean operative time was 95 minutes. No complications such as bleeding, recurrent laryngeal nerve injury, or hypoparathyroidism were reported. All patients were completely satisfied with the cosmetic results.

Conclusions:

Transoral endoscopic thyroidectomy with four trocars through vestibular approach is an effective and feasible method. Markedly, this technique outstandingly assists surgeons to perform transoral endoscopic thyroidectomy easily.

No competing financial interests exist.

Runtime of video: 11 mins 2 secs