Transoral endoscopic thyroidectomy: our initial experience using a new endoscopic technique.

BACKGROUND: A transoral approach has been experimentally introduced to the field of thyroid surgery and several groups in Asia have recently used the technique to treat patients. We performed transoral endoscopic thyroidectomies on patients with thyroid cancer or a benign tumor.

METHODS: We reviewed the medical records of patients who underwent transoral endoscopic thyroid surgery between July 2016 and January 2017. A midline incision was made in the vestibule, and a 10 mm cannula was placed; then, the working space was widened by insufflating CO2 at a pressure of 5-6 mmHg. Two lateral incisions were made in the vestibule near the first molars, and 5-mm-diameter cannulas were inserted. A 10-mm 30° telescope was inserted through the midline cannula and instruments were positioned through the lateral cannulas. Thyroid surgery was endoscopically performed using conventional endoscopic instruments.

RESULTS: We performed 18 thyroid surgeries (15 thyroid lobectomies, one completion thyroidectomy, and two total thyroidectomies) in 17 patients. The postoperative pathology was papillary thyroid cancer in 11 cases (61.1%), a follicular carcinoma in two cases (one patient) (11.1%) and benign in five cases (27.8%). The average tumor diameter was 1.75 cm (range 0.5-7.5 cm). No patient reported sensory changes around the lower lip. No patient developed permanent recurrent laryngeal nerve palsy or hypocalcemia. No patient developed a wound infection or a fistula between the oral incision and anterior neck.

CONCLUSIONS: The transoral endoscopic approach provides a short, direct route to the thyroid gland and seems to be safe and feasible. It is important to further develop and refine the surgical techniques. The approach is optimal, and will become widely used for thyroid surgery in the near future.