title: Transoral thyroid and parathyroid surgery--development of a new transoral technique.
abstract: BACKGROUND
  Transluminal interventions via so-called natural orifices are gaining interest because they allow operative treatment without any skin incision. We previously described a transoral access for (para-)thyroid resection in pigs. To proceed with the first clinical trials, we evaluated the safety of the new technique.
  
  
  METHODS
  Transoral hemithyroidectomies were performed on 10 living pigs using a special cervicoscope and conventional laparoscopic instruments. Follow-up examinations were carried out for 14 days and followed by autopsy, which included macroscopic evaluation, microbiologic investigations, and blood testing. In addition, refinement of the new technique was achieved by developing the techniques in 10 human cadavers. Finally, transoral parathyroidectomies were performed in 2 patients with primary hyperparathyroidism and a preoperatively localized parathyroid adenoma.
  
  
  RESULTS
  All animal transoral hemithyroidectomies were performed without complications. Postoperatively, oral intake, weight gain, and white blood cell count remained normal. At autopsy, the access route, and operative field showed no signs of infection, and microbiologic swabs remained sterile. Based on these results, a transoral parathyroidectomy was performed successfully in 2 female patients with primary hyperparathyroidism; 1 patient experienced a transient palsy of the right hypoglossal nerve.
  
  
  CONCLUSIONS
  Transoral parathyroid and thyroid operation is feasible; however, additional controlled clinical studies are required to evaluate the safety and success rates of this new technique.
authors: Department of Visceral-, Thoracic and Vascular Surgery, University Hospital Marburg, Germany. karakas@med.unimarburg.de
authors: Elias
authors: E
authors: Karakas
authors: Thorsten
authors: T
authors: Steinfeldt
authors: Andreas
authors: A
authors: Gockel
authors: Thorsten
authors: T
authors: Schlosshauer
authors: Carsten
authors: C
authors: Dietz
authors: Jens
authors: J
authors: Jäger
authors: Reiner
authors: R
authors: Westermann
authors: Frank
authors: F
authors: Sommer
authors: Hans Rudolf
authors: HR
authors: Richard
authors: Cornelia
authors: C
authors: Exner
authors: Andreas M
authors: AM
authors: Sesterhenn
authors: Detlef K
authors: DK
authors: Bartsch
mesh_terms: D000236:Adenoma / Q000601:surgery; D000368:Aged; D000818:Animals; D002102:Cadaver; D005260:Female; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000601:surgery; D020437:Hypoglossal Nerve Diseases / Q000209:etiology; D008875:Middle Aged; D023421:Models, Animal; D009055:Mouth; D057605:Natural Orifice Endoscopic Surgery / Q000009:adverse effects / Q000379:methods*; D010282:Parathyroid Neoplasms / Q000601:surgery; D016105:Parathyroidectomy / Q000009:adverse effects / Q000379:methods*; D010865:Pilot Projects; D011183:Postoperative Complications / Q000209:etiology; D012449:Safety; D013552:Swine; D013965:Thyroidectomy / Q000009:adverse effects / Q000379:methods*