Aesthetic Perceptions Regarding a Thyroidectomy Scar and Transvestibular Approach in Brazil.

OBJECTIVE: We investigated motivation levels across the general Brazilian population and subgroups and their willingness to spend for surgery without a cervical scar. METHODS: This random-sample survey was performed by a specialized third-party research institute. In this study, we created a hypothetical thyroidectomy scenario, and the transcervical and transoral endoscopic thyroidectomy vestibular approach (TOETVA) were used. The survey included sociocultural data and questions regarding participants' surgical preferences. RESULTS: Data were obtained from 1250 participants; 42.4% were of the opinion that a cervical scar affects social or professional life. Young and childless women were most likely to be affected (p <0.001). All respondents accepted the transoral approach to avoid cervical scarring. However, 30.7% and 31.9% of respondents maintained their preference for TOETVA despite understanding the risks of a hypothetical increase in complications and unfavorable oncological outcomes and 98.6% were of the opinion that this approach was likely associated with greater postoperative pain. Only 16.2% were unwilling to spend for TOETVA. The variable that most affected patients' willingness to spend was a salary greater than 10 Brazilian minimum wages (odds ratio 9.797, 95% confidence interval, p <0.005). Upper class respondents were 10 times more likely to spend for TOETVA than lower class patients. CONCLUSION: This study highlights patients' interest in TOETVA. Cervical scar perception is affected by concerned about appearance, particularly in certain societal subgroups. Our study population showed significant motivation to undergo TOETVA, which was emphasized by their acceptance of the complication rate, poor postoperative outcomes, greater postoperative pain, and willingness to spend on surgery with an invisible scar. LEVEL OF EVIDENCE: 4 Laryngoscope, 134:3862-3867, 2024.

Transoral endoscopic thyroidectomy vestibular approach: Experience from a multicenter national group with 412 patients.

BACKGROUND: Well-established conventional thyroidectomy has satisfactory outcomes; however, robotic and endoscopic thyroid surgery can avoid visible anterior neck scars. Transoral endoscopic thyroidectomy vestibular approach (TOETVA) is the most recent of these techniques. METHODS: This was a retrospective review of 412 patients who underwent TOETVA from 2017 to 2020 in 13 Brazilian centers. RESULTS: The study included 359 (87.1%) females and 53 (12.9%) males, with a mean age of 40 years. There were 231 (56.1%) total thyroidectomies. The conversion rate was 0.7%. The transient vocal cord palsy rate was 7.6% (30 patients). Temporary and persistent hypocalcemia rates were 4.0% and 0.8%, respectively. There were two cases of infection (0.5%). DISCUSSION: This is a large multi-institute TOETVA study, with one of the largest cohorts published to date that; despite its retrospective nature and selection bias, reached outcomes comparable to previously reported series, this study reinforced safeness, feasibility, and nationwide reproducibility for this technique.

Tiroidectomía y paratiroidectomía endoscópica transoral con abordaje vestibular(TOETVA TOEPVA): Experiencia inicial en el Hospital Universitario Austral / Transoral endoscopic thyroidectomy and parathyroidectomy vestibular approach (TOETVA TOEPVA): intial experience in Hospital Universitario Austral

RESUMEN Antecedentes: la cervicotomía de Kocher ha sido el abordaje clásico para la cirugía tiroidea y paratiroidea. El aumento en la preocupación por la cicatriz cervical ha generado un interés creciente por disminuir su tamaño o trasladarla a lugares menos visibles. Anuwong publica 60 casos de TOETVA/TOEPVA en 2016, con resultados óptimos. Objetivos: comunicar la experiencia con la tiroidectomía y paratiroidectomía transoral endoscópica con abordaje vestibular en el Hospital Universitario Austral. Material y métodos: análisis retrospetivo, sobre base prospectiva, de 18 procedimientos, entre mayo de 2019 y marzo de 2020. Se realizaron 2 paratiroidectomías, 13 lobectomías, 4 tiroidectomías totales, una con linfadenectomía central; una paciente presentó 2 patologías (adenoma paratiroideo y nódulo tiroideo). Citología según Bethesda: categoría II: 7; indeterminada: 1 y categoría VI: 9. Resultados: 18 pacientes femeninas. Mediana de edad: 41 años. Media del tamaño nodular: 30 mm. Volumen glandular medio: 24 mL. Conversión: 1 caso. Promedio de tiempo quirúrgico: lobectomía, 260 minutos; tiroidectomía total, 262 minutos. Histología definitiva: carcinoma papilar, 11; bocio nodular, 6; adenoma paratiroideo, 2. Complicaciones: equimosis leve, 12 pacientes; hipoparatiroidismo transitorio, 1 caso; paresia recurrencial transitoria, 1 caso; hiposensibilidad mentoniana transitoria, 1 caso. Dos casos de tiroidectomía total por cáncer: tiroglobulina a las 6 semanas < 0,1 μUI/mL. Conclusiones: 1) Es un abordaje seguro y ofrece resultados cosméticos excelentes. 2) Puede implementarse con equipamiento endoscópico convencional, con curva de aprendizaje corta y escasa morbilidad. 3) Alternativa para el tratamiento del carcinoma papilar de bajo riesgo. 4) Es prioritario garantizar la seguridad del paciente.

ABSTRACT Background: Kocher's cervicotomy has been the classic approach for thyroid and parathyroid surgery. The greater concern about neck scarring has generated an increasing interest in reducing scar size or leaving the scar in less visible places. In 2016 Anuwong published 60 cases of TOETVA/TOEPVA with optimal outcomes. Objectives: The aim of this study is to report the initial experience with transoral endoscopic thyroidectomy and parathyroidectomy vestibular approach in Hospital Universitario Austral. Material and methods: We conducted a retrospective analysis of 18 prospective procedures performed between May 2019 and March 2020. The procedures performed were 2 parathyroidectomies, 13 lobectomies, 4 total thyroidectomies, 1 with central lymph node dissection; one patient presented a parathyroid adenoma and a benign thyroid nodule. Cytology report according to the Bethesda system: category II in 7 cases, VI in 9 and indeterminate in 1. Results: 18 female patients. Median age: 41 years. Mean nodule size: 30 mm. Mean gland volume: 24 mL. Conversion. 1 case. Mean operative time: lobectomy, 260 minutes; total thyroidectomy, 262 minutes. Definite histology: papillary thyroid carcinoma,11; benign nodular goiter, 6; parathyroid adenoma, 2. Complications: mild ecchymosis, 12 patients; temporary hyperparathyroidism, 1 case; temporary recurrent laryngeal palsy, 1 case; temporary numbness of the mental region in 1 case. In the two cases undergoing total thyroidectomy due to cancer, thyroglobulin level 6 weeks after surgery was < 0.1 μIU/mL. Conclusions: 1) The transoral approach is a safe and feasible procedure that offers excellent cosmetic results. 2) It can be implemented using conventional endoscopic equipment, has a short learning curve and low morbidity rate. 3)It constitutes an alternative for the treatment of low-risk papillary thyroid carcinoma. 4) Patient's safety should be guaranteed.

Tiroidectomía transoral endoscópica por abordaje vestibular (TOETVA): primer caso en Perú / Transoral endoscopic thyroidectomy via vestibular approach (TOETVA): first case in Peru

RESUMEN La calidad de vida luego de la cirugía de la glándula tiroides es tan importante como el control de la enfermedad. Para mejorar los resultados cosméticos y la satisfacción del paciente se usan abordajes endoscópicos usando incisiones fuera de la región cervical. La tiroidectomía transoral endoscópica no deja ninguna cicatriz visible en la piel y es una técnica quirúrgica segura. Se presenta el caso de una paciente mujer de 29 años con una tumoración benigna de la glándula tiroides con síntomas compresivos y preocupaciones estéticas, sometida a hemitiroidectomia derecha mediante abordaje transoral vestibular endoscópico en un tiempo de 150 minutos y sangrado mínimo. Los resultados son comparables con la técnica quirúrgica abierta, con un mejor resultado estético y mejora en la calidad de vida.

ABSTRACT Quality of life after thyroid gland surgery is as important as disease control. To improve cosmetic results and patient satisfaction, endoscopic approaches are used using incisions outside the cervical region. Endoscopic transoral thyroidectomy does not leave any visible scarring on the skin. We present the case of a 29-year-old female patient with a benign thyroid gland tumor with compressive symptoms and aesthetic concerns, who underwent a right hemithyroidectomy by means of an endoscopic transoral vestibular approach in a time of 150 minutes and minimal bleeding, without complications in the postoperative period. The transoral endoscopic vestibular approach for endoscopic resection of the thyroid gland is safe and the results are comparable with the open surgical technique, with a better cosmetic result and improved quality of life.

Robotic Head and Neck Surgery: Beyond TORS.

PURPOSE OF REVIEW: To explore the advances in robotic head and neck surgery (HNS) beyond TORS. RECENT FINDINGS: Although limited, the current literature corroborates the safety of robotic neck surgery, revealing similar surgical/oncologic outcomes, except longer operative time and superior cosmesis. In most of the remote thyroid approaches, use of robotic-assisted surgery is essential. However, for the recently popularized transoral approach, endoscopic technique has been preferred by most surgeons, due to longer operative time in robotic-assisted technique. On the other hand, retroauricular approach has been considered the standard for comprehensive/selective robotic neck dissections. Robotic technology has an increasing role in HNS. Robotic neck dissection has shown encouraging results, being routinely used in some centers around the globe. Robotic thyroid surgery, although safe when well applied, has lost ground to endoscopic transoral thyroidectomy. In the future, more evolved robotic systems could improve multiple areas of HNS.

Primera tiroidectomía transoral vestibular endoscópica (TOETVA) en la Argentina / First transoral endoscopic thyroidectomy vestibular approach in Argentina

Se realizó una lobectomía transoral vestibular endoscópica (TOETVA) en una paciente femenina de 53 años interesada particularmente en su resultado cosmético, que presentaba un nódulo de 40 mm en el lóbulo tiroideo izquierdo. Mostró una excelente evolución posoperatoria. Se realizó la revisión de la bibliografía acerca de este abordaje y se informa el primer caso del país.

A 53-year-old female patient with a 40-mm nodule in the left thyroid lobe underwent surgery using the transoral endoscopic thyroidectomy vestibular approach (TOETVA) because she was particularly interested in the cosmetic results. She evolved with excellent postoperative outcome. We review the literature dealing with this approach and report the first case in our country.