title: The safety of transoral periosteal thyroidectomy: results of Swine models.
abstract: BACKGROUND
  Endoscopic thyroid surgery is gaining wide acceptance; however, existing endoscopic methods for thyroidectomy have shown several limitations. Recently, a transoral technique using video assistance and endoscopy has been reported for thyroidectomy. The aim of this study was to define a new technique of transoral thyroidectomy using a mandibular periosteal approach to complement other types of natural orifice surgery and minimally invasive surgery.
  
  
  METHODS
  Transoral periosteal thyroidectomies were performed in seven living pigs to evaluate the feasibility and safety of the new approach. Total thyroidectomies were performed in all animals. Follow-up examinations were carried out for 7 days and followed by autopsy.
  
  
  RESULTS
  Through three trocars in the mandibular periosteal area, it was possible to create a working space under the platysma muscle and to reach the pretracheal area. Total thyroidectomies were also performed via the transoral, mandibular periosteal approach without complications in seven orally intubated living pigs. Postoperatively, the white blood cell count remained normal in all cases. On the postoperative sacrifice of the pigs, three locally encapsulated seromas were observed. Both recurrent laryngeal nerves were intact in all cases.
  
  
  CONCLUSIONS
  Transoral periosteal thyroidectomy could be feasible and safe.
authors.affiliation: 1 Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine , Seoul, Korea.
authors.forename: Hye Yoon
authors.initials: HY
authors.lastname: Lee
authors.forename: Seong Bae
authors.initials: SB
authors.lastname: Hwang
authors.forename: Kang-Min
authors.initials: KM
authors.lastname: Ahn
authors.forename: Jae Bok
authors.initials: JB
authors.lastname: Lee
authors.forename: Jeoung Won
authors.initials: JW
authors.lastname: Bae
authors.forename: Hoon Yub
authors.initials: HY
authors.lastname: Kim
mesh_terms: D000818:Animals; D004724:Endoscopy / Q000379:methods*; D005240:Feasibility Studies; D005500:Follow-Up Studies; D010535:Laparoscopy / Q000295:instrumentation; D008334:Mandible / Q000033:anatomy & histology; D023421:Models, Animal; D061646:Operative Time; D009929:Organ Size; D012009:Recurrent Laryngeal Nerve / Q000033:anatomy & histology; D013552:Swine; D013961:Thyroid Gland / Q000033:anatomy & histology / Q000166:cytology; D013965:Thyroidectomy / Q000379:methods*