title: Transoral periosteal thyroidectomy: cadaver to human.
abstract: BACKGROUND
  Although endoscopic thyroid surgery is gaining wide acceptance, existing endoscopic methods for thyroidectomy are blamed for the increased frequency of flap dissections and longer surgical times. More recently, transoral endoscopic thyroidectomy has overcome the limitations of previous approaches. Herein, we present our initial experience with transoral periosteal thyroidectomy (TOPOT) in cadaver and porcine models. Using these models, the surgical view was improved and had greater freedom of motion; the technique was then performed in human subjects using robotic TOPOT, which has not previously been reported.
  
  
  METHODS
  TOPOTs were performed in seven fresh human cadavers and ten live pigs. Total thyroidectomies were performed in all cadavers and pigs. After the cadaver and animal trials, four human patients underwent robotic TOPOT performed using the da Vinci® surgical system at Korea University Anam Hospital. Recurrent laryngeal nerve function, intra- and postoperative complications, and postoperative outcomes were assessed in all patients.
  
  
  RESULTS
  One left lobectomy for follicular adenoma, two right lobectomies for nodular hyperplasia, and one left lobectomy with a central neck dissection for papillary thyroid microcarcinoma were performed in the human subjects using a robotic transoral periosteal approach. In three cases, paresthesia occurred in the mental nerve, but this improved within 4 weeks in all cases. No local infections occurred at the incision site or anterior neck, and no recurrent laryngeal nerve cord palsies occurred postoperatively.
  
  
  CONCLUSIONS
  TOPOT may be an effective and safe approach for robotic thyroid surgery.
authors.affiliation: Department of Surgery, Korea University College of Medicine, 73 Inchon-ro, Seongbuk-gu, Seoul, 136-705, Korea.
authors.forename: Hye Yoon
authors.initials: HY
authors.lastname: Lee
authors.forename: Ji Young
authors.initials: JY
authors.lastname: You
authors.forename: Sang Uk
authors.initials: SU
authors.lastname: Woo
authors.forename: Gil Soo
authors.initials: GS
authors.lastname: Son
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: D000236:Adenoma / Q000601:surgery*; D000328:Adult; D000818:Animals; D002291:Carcinoma, Papillary / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D057605:Natural Orifice Endoscopic Surgery / Q000379:methods*; D061646:Operative Time; D011183:Postoperative Complications; D065287:Robotic Surgical Procedures / Q000379:methods*; D013552:Swine; D013964:Thyroid Neoplasms / Q000601:surgery*; D016606:Thyroid Nodule / Q000601:surgery*; D013965:Thyroidectomy / Q000379:methods*; D016896:Treatment Outcome