Transoral endoscopic thyroidectomy vestibular approach (TOETVA): initial experience in Australia.

BACKGROUND: Thyroidectomy is traditionally an open procedure. The potential for and unpredictability of patients developing an unsightly anterior neck scar has led many investigators to develop various 'scarless' thyroidectomy techniques. Here we report on our initial experience, and to our knowledge, the first and largest series of this technique in Australia and New Zealand. METHODS: Across two centres in Western Australia, three Endocrine surgeons utilized the Transoral Endoscopic Thyroidectomy vestibular approach (TOETVA). Key endpoints such as operating time, blood loss, pain scores, recurrent laryngeal nerve injury and hypoparathyroidism was collected. Data was analysed using R statistical program. RESULTS: One hundred and two TOETVAs were performed between March 2018 and May 2021. There were 66 hemithyroidectomies, 34 total thyroidectomies (four converted to open), and two isthmusectomies. We noted a trend in median operating time decreasing over the study period. There were no cases of permanent recurrent laryngeal nerve palsy, wound infection, seroma or haematoma. We had four instances of open conversion; one temporary RLN palsy, and 12 cases of temporary hypoparathyroidism. CONCLUSION: This is the first series of TOETVA reported in Australia and New Zealand. Our results demonstrate that with appropriate surgeon experience, training, collaboration, and in well selected patients, this is a feasible and safe thyroidectomy technique. We hope that our work will build confidence in Endocrine Surgical units seeking to develop this technique in Australia.

Minimally invasive parathyroidectomy: an audit of a change in clinical practice.

BACKGROUND: Minimally invasive parathyroidectomy (MIP) for primary hyperparathyroidism is gaining acceptance as a useful tool in the armamentarium of the endocrine surgeon. METHODS: We undertook an audit of 154 consecutive cases of parathyroidectomy carried out through bilateral neck exploration as well as a minimally invasive approach. RESULTS: Bilateral neck exploration had a 100% single operation cure rate. MIP had a 90% cure rate. Sestamibi localization had a positive predictive value of 99% for identifying an abnormal parathyroid gland. However, it performed poorly in the presence of multiglandular disease, resulting in these patients being at risk of having persistent hyperparathyroidism and therefore requiring a second operation. CONCLUSION: Our results with bilateral neck exploration are favourable compared with other large series. However, we have reported a 10% reoperation rate with MIP. Although not ideal, we are confident that, as a result of improvements based on this audit and with increasing experience, the cure rate will improve to reach international benchmarks. As such we feel that this strategy is a pragmatic way to offer MIP to patients in our region.