title: Anatomical study of surgical approaches for minimally invasive transoral thyroidectomy: eMIT and TOPP.
abstract: OBJECTIVE
  Anatomical study of surgical approaches of endoscopic minimally invasive thyroidectomy (eMIT) and transoral partial parathyroidectomy (TOPP) was conducted to evaluate their safety and feasibility.
  
  
  METHODS
  After performing an eMIT- and TOPP-procedure on fresh frozen human cadavers, a layer-by-layer dissection of the floor of the mouth and the anterior cervical region was carried out in five specimens. The blood vessels, nerves and muscles related to the surgical approach were exposed.
  
  
  RESULTS
  The anterior region of the neck can be reached through the midline of the mouth floor and the suprahyoid muscles. No important nerves and vessels were found in the approach of eMIT. TOPP set up the space at the dorsal side of the thyroid gland and adjacent to the trachea. The hypoglossal nerve and the lingual nerve as well as their accompanying blood vessels were anatomically related to the approach and could be injured during the procedure. The surgical space is much limited in TOPP (<20 mm in diameter) and current surgical instruments still did not match the requirement of this technique.
  
  
  CONCLUSIONS
  This study demonstrated that the transoral approach of eMIT is anatomically safer and more feasible than that of TOPP.
authors: a 1 Department of General Surgery, Tenth People's Hospital of Tongji University , Shanghai, P.R. China.|b 2 Department of Otolaryngology/Head and Neck Surgery, University of Arkansas for Medical Sciences , W. Markham St. Slot# 543, Little Rock, AR 72205, USA.
authors: Chengzhong
authors: C
authors: Cai
authors: a 1 Department of General Surgery, Tenth People's Hospital of Tongji University , Shanghai, P.R. China.
authors: Yixiang
authors: Y
authors: Huang
authors: a 1 Department of General Surgery, Tenth People's Hospital of Tongji University , Shanghai, P.R. China.
authors: Ti
authors: T
authors: Zhang
authors: a 1 Department of General Surgery, Tenth People's Hospital of Tongji University , Shanghai, P.R. China.
authors: Li
authors: L
authors: Chai
authors: a 1 Department of General Surgery, Tenth People's Hospital of Tongji University , Shanghai, P.R. China.
authors: Gang
authors: G
authors: Wang
authors: a 1 Department of General Surgery, Tenth People's Hospital of Tongji University , Shanghai, P.R. China.
authors: Linxiang
authors: L
authors: Shi
authors: c 3 Department of Otolaryngology, Head and Neck Surgery, Philipps-University Marburg , Marburg, Germany.
authors: Susanne
authors: S
authors: Wiegand
authors: c 3 Department of Otolaryngology, Head and Neck Surgery, Philipps-University Marburg , Marburg, Germany.
authors: Christian
authors: C
authors: Güldner
authors: d 4 Department of Otolaryngology, Head and Neck Surgery , Frankfurt/Oder, Germany.
authors: Thomas
authors: T
authors: Günzel
authors: e 5 Department of Otolaryngology, Head/Neck and Facial Plastic Surgery, Sana Kliniken Leipziger Land GmbH , Sana Klinikum Borna, Germany.
authors: Thomas
authors: T
authors: Wilhelm
mesh_terms: D000328:Adult; D000368:Aged; D002102:Cadaver; D004210:Dissection / Q000379:methods; D004724:Endoscopy / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D016105:Parathyroidectomy / Q000379:methods*; D013965:Thyroidectomy / Q000379:methods*
keywords: Transoral thyroidectomy; anatomical study; endoscopic; minimally invasive