title: Transoral endoscopic thyroidectomy: preliminary experience in Italy.
abstract: Transoral endoscopic thyroidectomy vestibular approach (TOETVA) is a feasible novel surgical procedure that does not need visible incisions. We describe our initial experience with TOETVA. We recruited 15 patients who were willing to undergo TOETVA. Inclusion criteria were (a) patients who had a neck ultrasound (US) with a estimated thyroid diameter not larger than 10 cm; (b) US estimated gland volume ≤45 mL; (c) nodule size ≤50 mm; (d) a benign tumor, such as a thyroid cyst, single-nodular goiter, or multinodular goiter; (e) follicular neoplasm; (f) papillary microcarcinoma without evidence of metastasis. The procedure is carried out through a three-port technique placed at the oral vestibule, one 10-mm port for 30° endoscope and two additional 5-mm ports for dissecting and coagulating instruments. CO2insufflation pressure is set at 6 mmHg. An anterior cervical subplatysmal space is created from the oral vestibule down to the sternal notch, laterally to the sternocleidomastoid muscle. Thyroidectomy is done fully endoscopically using conventional endoscopic instruments and intraoperative neuromonitoring. There were 34% total thyroidectomies and 66% hemithyroidectomies. All TOETVA procedures were performed successfully with no conversions. The mean operative time was 87.6 (59-118) min for lobectomy and 107.6 (99-135) min for bilateral procedure. We observed one case of transient postoperative hypocalcemia. There was no recurrent laryngeal nerve palsy. The cosmetic result was excellent in all patients. This is the first case series of TOETVA in Italy. TOETVA may provide a method for ideal cosmetic results. The results are encouraging, and we are optimistic about the future expansion of its applicability.
authors.affiliation: 1st Division of Surgery, Department of Medicine and Surgery, Endocrine Surgery Research Center, University of Insubria, Varese, Italy. gianlorenzo.dionigi@uninsubria.it.
authors.forename: Gianlorenzo
authors.initials: G
authors.lastname: Dionigi
authors.affiliation: Division of Anesthesia, Ospedale di Circolo, Fondazione Macchi, Varese, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Bacuzzi
authors.affiliation: 1st Division of Surgery, Department of Medicine and Surgery, Endocrine Surgery Research Center, University of Insubria, Varese, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Lavazza
authors.affiliation: 1st Division of Surgery, Department of Medicine and Surgery, Endocrine Surgery Research Center, University of Insubria, Varese, Italy.
authors.forename: Davide
authors.initials: D
authors.lastname: Inversini
authors.affiliation: Department of General and Emergency Surgery at the IRCCS - Ca Granda, Policlinico Hospital in Milan, University of Milan, Milano, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Boni
authors.affiliation: 1st Division of Surgery, Department of Medicine and Surgery, Endocrine Surgery Research Center, University of Insubria, Varese, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Rausei
authors.affiliation: Department of Surgery, Korea University College of Medicine, Seoul, Republic of Korea.
authors.forename: Hoon Yub
authors.initials: HY
authors.lastname: Kim
authors.affiliation: Minimally Invasive and Endocrine Surgery Division, Department of Surgery Police General Hospital, Bangkok, Thailand.
authors.forename: Angkoon
authors.initials: A
authors.lastname: Anuwong
mesh_terms: D000328:Adult; D004724:Endoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D007558:Italy; D008297:Male; D009055:Mouth; D061646:Operative Time; D013959:Thyroid Diseases / Q000601:surgery*; D013965:Thyroidectomy / Q000379:methods*; D016896:Treatment Outcome
keywords: Endoscopic thyroidectomy; Minimally invasive thyroidectomy; Thyroid surgery