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Completion thyroidectomy via the transoral endoscopic vestibular approach.

ABSTRACT: The safety and efficacy of the transoral endoscopic thyroidectomy vestibular approach (TOETVA) continues to be verified with the growing literature in regards to the procedure. While early cases were thyroid lobectomies performed for benign disease, the indications for TOETVA have now expanded to include total thyroidectomy for select small well-differentiated thyroid cancers (DTCs). Oncologic efficacy of this procedure remains unproven at this time, as the procedure was described only recently. Furthermore, as many of the cases completed via TOETVA are often diagnostic lobectomies, the appropriate management for patients requiring or opting for further surgical intervention per American Thyroid Association (ATA) guidelines has not been established. Here we present a case of a diagnostic lobectomy via TOETVA followed by interval completion thyroidectomy via the same approach for minimally invasive Hurthle cell carcinoma. Postoperative ultrasound demonstrated no evidence of thyroid remnant and serum thyroglobulin without circulating anti-thyroid antibodies was 0.3 ng/mL (reference range, 1.5-38.5 ng/mL) following the patient's completion thyroidectomy.

SUBMITTER: Razavi CR

PROVIDER: S-EPMC6107595 | biostudies-literature | 2018 Aug

REPOSITORIES: biostudies-literature

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Completion thyroidectomy via the transoral endoscopic vestibular approach.

Razavi Christopher R CR Tufano Ralph P RP Russell Jonathon O JO

Gland surgery 20180801 Suppl 1

The safety and efficacy of the transoral endoscopic thyroidectomy vestibular approach (TOETVA) continues to be verified with the growing literature in regards to the procedure. While early cases were thyroid lobectomies performed for benign disease, the indications for TOETVA have now expanded to include total thyroidectomy for select small well-differentiated thyroid cancers (DTCs). Oncologic efficacy of this procedure remains unproven at this time, as the procedure was described only recently. ...[more]

PMID: 30175068

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Project description:BackgroundAmbulatory thyroid surgery has been increasingly performed in recent years. However, the feasibility of the ambulatory transoral endoscopic thyroidectomy vestibular approach (TOETVA) has not been evaluated. We aimed to evaluate the safety, economy, and mental health outcomes of ambulatory TOETVA.MethodsWe retrospectively reviewed the data of patients who underwent TOETVA between March 2019 and August 2022. The procedure was performed by a skilled surgical team from the Department of Thyroid Surgery of the affiliated Yantai Yuhuangding Hospital of Qingdao University. Patients were enrolled in the ambulatory (n=166) and conventional (n=290) groups, based on their chosen procedure. We analyzed patients' clinical characteristics, surgical outcomes, Hamilton Anxiety Rating Scale (HAM-A) scores, and hospitalization costs.ResultsOf 456 patients, 166 underwent ambulatory TOETVA and 290 underwent conventional TOETVA. No significant differences were found in clinical and surgical characteristics between the groups, including sex (P=0.363), age (P=0.077), body mass index (P=0.351), presence of internal diseases (P=0.613), presence of Hashimoto's thyroiditis (P=0.429), pathology (P=0.362), maximum tumor diameter (P=0.520), scope of surgery (P=0.850), or operative time (P=0.351). There were no significant differences in maximum tumor diameter (P=0.349), extrathyroidal tissue invasion (P=0.516), number of retrieved central lymph nodes (P=0.069), or metastatic central lymph nodes (P=0.897) between the groups. No significant differences were found in complications, including transient hypoparathyroidism (P=0.438), transient vocal cord palsy (P=0.876), transient mental nerve injury (P=0.749), permanent mental nerve injury (P=0.926), and other complications (P=1.000). Ambulatory patients had shorter hospital stays (P<0.001) and reduced hospitalization costs (P<0.001). There was no significant difference in HAM-A scores between the groups (P=0.056).ConclusionsAmbulatory TOETVA is a safe, feasible, and cost-effective procedure for selected patients. This procedure resulted in shorter hospital stays, decreased medical costs, and did not increase patient anxiety. To ensure patient safety, surgical teams must inform patients of the indications, when to seek help, and how to receive the fastest medical attention.

Dataset Information

Completion thyroidectomy via the transoral endoscopic vestibular approach.

Publications

Completion thyroidectomy via the transoral endoscopic vestibular approach.

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