Case Report: Transoral Endoscopic Thyroidectomy via Vestibular Approach in Pediatric Thyroid Cancer.

Background: Transoral endoscopic thyroidectomy via vestibular approach (TOETVA) is a new technique that has become more popular worldwide because of its many advantages. However, this novel approach for thyroid cancer treatment in children is highly challenging, even for high-volume surgeons. In our study, we report our experiences with TOETVA for pediatric patients with thyroid cancer. Patients and Methods: This study included four pediatric patients who underwent TOETVA performed by a single surgeon between June and December 2020. Patient demographics and surgical outcomes including operative time, incidence of complications, and length of hospital stay were evaluated. Results: Four patients successfully underwent TOETVA with no complications. All patients were girls, aged from 13 to 18. Three patients underwent lobectomy and isthmusectomy, plus prophylactic unilateral central neck dissection. One patient had a total thyroidectomy, plus prophylactic bilateral central neck dissection. The mean operative time was 85 min for the lobectomy and 120 min for total thyroidectomy plus central neck dissection. The median hospital stay was 4.1 days. No drains were used. The histological examination showed four cases of malignant disease (papillary thyroid carcinoma). The mean number of harvested lymph nodes was 4.2 (ranged 3 to 8). Conclusion: In the hands of a high-volume surgeon, TOETVA is a novel, feasible, and safe approach for treating selected pediatric patients with thyroid cancer.

Multiple brown tumors with primary hyperparathyroidism mimicking bone metastases [].

Multiple osteolytic lesions are usually associated with bone metastasis. However, brown tumor should also be included in the differential diagnosis. Brown tumor is a rare benign lesions in skeletal system, encountered in patients with uncontrolled primary or secondary hyperparathyroidism. In our case report, we present a 35-year-old female with multifocal brown tumor that difficultiy in differential diagnosis of metastasis of malignant parathyroid. Additionally, the treatment and follow up after parathyroidectomy are also emphasized. METHODS: The SCARE 2020 Guideline [1].

Transoral Endoscopic Thyroidectomy Vestibular Approach: An Initial Experience in Vietnam.

BACKGROUND: Transoral endoscopic thyroidectomy vestibular approach (TOETVA) can be applied to many health facilities worldwide, even in places whose medical facilities have not developed yet. To that end, our hospital is the first hospital to deploy this novel technique in Vietnam. In the study, the authors will evaluate the safety and efficacy of TOETVA, which was initially performed on patients in Vietnam. MATERIALS AND METHODS: A TOETVA research was conducted on 28 patients in hospital K from January 1, 2018 to May 31, 2019. The surgical outcomes, cosmetic results, and complications were evaluated. RESULTS: The mean operative time was 91 minutes (70 to 130 min). There were no cases with temporary and permanent hypoparathyroidism in the patients. One patient had temporary mental nerve injury recovered completely after 14-day surgery. No case used drains in patients. All patients were highly satisfied with the surgical outcome, especially, cosmetic results. CONCLUSIONS: TOETVA is a safe and feasible technique with acceptable complication rates and good outcomes. The authors will carry on this procedure for selected patients. TOETVA should not only be performed in some countries with well-developed health care systems but also be done in other developing countries worldwide.

Total nasal reconstruction for nasal defect after treatment for extranodal natural killer/T cell lymphoma, nasal-type: A case report.

INTRODUCTION: Nasal-type extranodal natural killer (NK)/T-cell lymphomas are a rare type of clinical condition. Reconstruction of the complex nasal defect after chemoradiation is extremely challenging for plastic surgeons. PRESENTATION OF CASE: Here we present the case of a 56-year old female with the condition of a nasal-type NK/T-cell lymphoma which had caused complex nasal disfigurement. The patient had undergone chemoradiotherapy. Lesions after treatment were present all over the nasal defect (nasal septum, mucosa, support frame and skin) and the left cheek medial subunit. The surgery was subdivided into 3 stages. First, we removed the infectious tissue and restored the wall of nasal cavity by the left forehead - scalp flap. Second, we used the pedicle of the left forehead flap to rebuild the nasal mucosa defect, the rotational flap to rebuild the cheek defect, and the right forehead flap to recovered skin defect of the nose. Finally, we divided the pedicle of right forehead flap. DISCUSSION: The complex nasal defect is difficult to reconstruct and has a higher risk of failure in patient who received chemoradiotherapy. It is crucial to choose the right materials and have a confident plan in order to achieve successful results for the sake of the patient. CONCLUSION: Our case report shows that the nasal defect caused by a nasal-type NK/T-cell lymphoma is complex. After our 3 stages plan for the surgery, as well as using multiple flaps for reconstruction from the forehead skin, the result was significant reduction in the disfiguration of the patient's nose.

Transoral endoscopic thyroidectomy vestibular approach (TOETVA): A case report as new technique in thyroid surgery in Vietnam.

INTRODUCTION: Transoral endoscopic thyroidectomy via vestibular approach (TOETVA) is a promising procedure with many advantages such as truly scar free healing, minimally invasive dissection, and accessible approach to both thyroid lobes. PRESENTATION OF CASE: A female patient aged 19 presented with a benign thyroid nodule 2 cm in size for a year and the patient decided to proceed with surgery. The operation with a left subtotal thyroidectomy performed by the TOETVA technique was indicated. The surgery was implemented in 110 min, the patient was discharged after three days of postoperative care without any complication except for a mild seroma and swelling in the anterior neck which resolved completely within 10 days. DISCUSSION: Endoscopic thyroidectomy is a favorable approach to treat patients with benign nodules, Grave's disease and thyroid cancer which has 1-2 cm cancer nodule without extrathyroid extension. There are direct (cervical-anterior or lateral) and extracervical endoscopic procedures to have the thyroid exposed but multiple small scars remain. However, TOETVA is an excellent choice for select patients requiring thyroid surgery who desire to avoid a neck incision. CONCLUSION: TOETVA with the potential for scar-free surgery is a safe and effective procedure which provides good cosmetic outcome. The long operative time of this approach will be shortened with experience.

Non-recurrent laryngeal nerve in thyroid surgery: A report of case series in Vietnam and literature review.

INTRODUCTION: The non-recurrent laryngeal nerve (NRLN), which is found in 0.25-0.99 of the patients who undergo thyroid surgery, is a rare embryologically-derived variant of the recurrent laryngeal nerve (RLN). Identification and prevention of injury to the laryngeal nerve is one of the main issues in thyroid surgery; thus, thyroid surgeons should have adequate knowledge of all anatomical variations of the RLN. PRESENTATION OF CASES: All four patients with the non-recurrent laryngeal nerve on the right side were performed thyroidectomy and discharged without any complications. During the procedure the surgeons found that the right laryngeal nerve was not recurrent and originated directly from the vagus nerve. Moreover, the right subclavian artery of these patients arose directly from the aortic arch. DISCUSSION: NRLN can be easily damaged during surgery and its presence is closely related to subclavian artery anomaly. There are 2 types of NRLN in terms of its origin, nonetheless, in all variations of the NRLN and RLN, the nerve travels to the larynx at the level of cricothyroid joint, close to berry ligament. CONCLUSION: The NRLN is a rare, but clinically relevant structure and is associated to an increased risk in iatrogenic injury. Thorough anatomical knowledge and cautious dissection are essential to identify variants of RLN in order to minimize the risk of injury to the patient. Additionally, in embryological terms, the presence of NRLN is closely related to subclavian artery anomaly.