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Complications of Transoral Thyroidectomy: Overview and Update

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초록

Transoral thyroidectomy via the vestibular approach has become popular worldwide, with advantages including less surgical morbidity, excellent postoperative cosmesis, and superior functional voice outcomes. Several studies have reported that the surgical outcomes of the transoral approach were comparable to those of the conventional transcervical approach in selected patients. However, unusual complications, such as CO2 embolism, mental nerve injury, surgical space infection, skin perforation, burns, and trauma have been noted in transoral thyroidectomy. This paper aims to review and provide updated information on these complications and their management. Routine intraoperative neural monitoring is required to avoid laryngeal nerve palsy in the transoral approach. To prevent CO2 embolism, surgeons need to be careful not to injure the anterior jugular vein, and the CO2 insufflation pressure should be set as low as 4–6 mmHg. To avoid mental nerve injury, vestibular incisions should be placed in the safety zone, and dissection of the vestibular area and chin should be minimized. In conclusion, recognizing the possibility of complications and understanding their prevention and management are important for patient safety and the success of the transoral approach.

Abstract

Transoral thyroidectomy via the vestibular approach has become popular worldwide, with advantages including less surgical morbidity, excellent postoperative cosmesis, and superior functional voice outcomes. Several studies have reported that the surgical outcomes of the transoral approach were comparable to those of the conventional transcervical approach in selected patients. However, unusual complications, such as CO2 embolism, mental nerve injury, surgical space infection, skin perforation, burns, and trauma have been noted in transoral thyroidectomy. This paper aims to review and provide updated information on these complications and their management. Routine intraoperative neural monitoring is required to avoid laryngeal nerve palsy in the transoral approach. To prevent CO2 embolism, surgeons need to be careful not to injure the anterior jugular vein, and the CO2 insufflation pressure should be set as low as 4–6 mmHg. To avoid mental nerve injury, vestibular incisions should be placed in the safety zone, and dissection of the vestibular area and chin should be minimized. In conclusion, recognizing the possibility of complications and understanding their prevention and management are important for patient safety and the success of the transoral approach.

참고문헌 (60)

  1. 태경, "Robotic and Endoscopic Thyroid Surgery: Evolution and Advances", Clinical and Experimental Otorhinolaryngology, 12(1), pp.1~11 (2019), 대한이비인후과학회[DOI]
  2. 태경, "Transoral Thyroidectomy: Is It a Real Game Changer?", Clinical and Experimental Otorhinolaryngology, 13(2), pp.93~94 (2020), 대한이비인후과학회[DOI]
  3. Witzel K, "Transoral access for endoscopic thyroid resection", Surg Endosc, 22(8), pp.1871~1875 (2008)
  4. Wilhelm T, "Endoscopic minimally invasive thyroidectomy (eMIT): a prospective proof-of-concept study in humans", World J Surg, 35(3), pp.543~551 (2011)
  5. Fu J, "Transoral endoscopic thyroidectomy: review of 81 cases in a single institute", J Laparoendosc Adv Surg Tech A, 28(3), pp.286~291 (2018)
  6. Richmon JD, "Transoral robotic-assisted thyroidectomy with central neck dissection: preclinical cadaver feasibility study and proposed surgical technique", J Robot Surg, 5(4), pp.279~282 (2011)
  7. Wang C, "Thyroidectomy: a novel endoscopic oral vestibular approach", Surgery, 155(1), pp.33~38 (2014)
  8. Yang J, "Complete endoscopic thyroidectomy via oral vestibular approach versus areola approach for treatment of thyroid diseases", J Laparoendosc Adv Surg Tech A, 25(6), pp.470~476 (2015)
  9. Anuwong A, "Transoral endoscopic thyroidectomy vestibular approach: a series of the first 60 human cases", World J Surg, 40(3), pp.491~497 (2016)
  10. Kim HY, "Transoral robotic thyroidectomy: lessons learned from an initial consecutive series of 24 patients", Surg Endosc, 32(2), pp.688~694 (2018)
  11. Park JO, "Gasless transoral endoscopic thyroidectomy vestibular approach (gasless TOETVA)", Surg Endosc, 33(9), pp.3034~3039 (2019)
  12. Park D, "Transoral robotic thyroidectomy on two human cadavers using the Intuitive da Vinci single port robotic surgical system and CO2 insufflation: preclinical feasibility study", Head Neck, 41(12), pp.4229~4233 (2019)
  13. Park YM, "Gasless transoral robotic thyroidectomy using the DaVinci SP system: feasibility, safety, and operative technique", Oral Oncol, 95, pp.136~142 (2019)
  14. Chan JY, "Transoral thyroidectomy with a next generation flexible robotic system: a feasibility study in a cadaveric model", Gland Surg, 8(6), pp.644~647 (2019)
  15. Tae K, "Transoral robotic thyroidectomy using the da Vinci single-port surgical system", Gland Surg, 9(3), pp.614~616 (2020)
  16. 최영준, "Transoral endoscopic thyroidectomy for papillary thyroid microcarcinoma: initial experience of a single surgeon", Annals of Surgical Treatment and Research, 93(2), pp.70~75 (2017), 대한외과학회
  17. Dionigi G, "Transoral endoscopic thyroidectomy: preliminary experience in Italy", Updates Surg, 69(2), pp.225~234 (2017)
  18. Anuwong A, "Safety and outcomes of the transoral endoscopic thyroidectomy vestibular approach", JAMA Surg, 153(1), pp.21~27 (2018)
  19. Bian C, "Complete endoscopic radical resection of thyroid cancer via an oral vestibule approach", Oncol Lett, 16(5), pp.5599~5606 (2018)
  20. Razavi CR, "Early outcomes in transoral vestibular thyroidectomy: robotic versus endoscopic techniques", Head Neck, 40(10), pp.2246~2253 (2018)
  21. Tae K, "Early experience of transoral thyroidectomy: comparison of robotic and endoscopic procedures", Head Neck, 41(3), pp.730~738 (2019)
  22. Russell JO, "Remote-access thyroidectomy: a multi-institutional North American experience with transaxillary, robotic facelift, and transoral endoscopic vestibular approaches", J Am Coll Surg, 228(4), pp.516~522 (2019)
  23. You JY, "Transoral robotic thyroidectomy versus conventional open thyroidectomy: comparative analysis of surgical outcomes in thyroid malignancies", J Laparoendosc Adv Surg Tech A, 29(6), pp.796~800 (2019)
  24. Perez-Soto RH, "Transoral endoscopic thyroidectomy by vestibular approach-initial experience and comparative analysis in the first reported Mexican cohort", J Laparoendosc Adv Surg Tech A, 29(12), pp.1526~1531 (2019)
  25. Park JO, "Transoral endoscopic thyroid surgery in a Korean population", Surg Endosc, 33(7), pp.2104~2113 (2019)
  26. Tae K, "Safety and efficacy of transoral robotic and endoscopic thyroidectomy: the first 100 cases", Head Neck, 42(2), pp.321~329 (2020)
  27. Peng X, "The clinical application of mental nerve dissection in transoral endoscopic thyroidectomy via an oral vestibular approach", Surg Endosc, 34(1), pp.153~158 (2020)
  28. Ahn JH, "Transoral endoscopic thyroidectomy for thyroid carcinoma: outcomes and surgical completeness in 150 single-surgeon cases", Surg Endosc, 34(2), pp.861~867 (2020)
  29. Park D, "Institutional experience of 200 consecutive papillary thyroid carcinoma patients in transoral robotic thyroidectomy surgeries", Head Neck, 42(8), pp.2106~2114 (2020)
  30. Hong YT, "Bi-institutional experience of transoral endoscopic thyroidectomy: challenges and outcomes", Head Neck, 42(8), pp.2115~2122 (2020)
  31. Kim SY, "Transoral endoscopic thyroidectomy using the vestibular approach with an endoscopic retractor in thyroid cancer: experience with the first 132 patients", Surg Endosc, 34(12), pp.5414~5420 (2020)
  32. Kim WW, "Real scarless transoral robotic thyroidectomy using three ports without axillary incision", J Laparoendosc Adv Surg Tech A, 30(11), pp.1165~1171 (2020)
  33. Fernandez-Ranvier G, "Transoral endoscopic thyroidectomy vestibular approach: a single-institution experience of the first 50 cases", Surg Innov, 27(5), pp.439~444 (2020)
  34. Lira RB, "Transoral thyroidectomy (TOETVA): complications, surgical time and learning curve", Oral Oncol, 110, pp.104871~ (2020)
  35. Luna-Ortiz K, "Lessons learned from the Transoral Endoscopic Thyroidectomy with Vestibular Approach (TOETVA) for the treatment of thyroid carcinoma", Ann Surg Oncol, 27(5), pp.1356~1360 (2020)
  36. Kyung Tae, "Robotic thyroid surgery", Auris Nasus Larynx, 48(3), pp.331~338 (2021), Elsevier BV[DOI]
  37. Tae K, "Transoral robotic selective neck dissection for papillary thyroid carcinoma: dissection of levels III and IV", Head Neck, 42(10), pp.3084~3088 (2020)
  38. Song CM, "Voice outcomes of transoral robotic thyroidectomy: comparison with conventional trans-cervical thyroidectomy", Oral Oncol, 107, pp.104748~ (2020)
  39. Nakajo A, "Trans-Oral Video-Assisted Neck Surgery (TOVANS): a new transoral technique of endoscopic thyroidectomy with gasless premandible approach", Surg Endosc, 27(4), pp.1105~1110 (2013)
  40. Shan L, "A systemic review of transoral thyroidectomy", Surg Laparosc Endosc Percutan Tech, 28(3), pp.135~138 (2018)
  41. Camenzuli C, "Transoral endoscopic thyroidectomy: a systematic review of the practice so far", JSLS, 22(3), pp.e2018.0002~ (2018)
  42. Tartaglia F, "Transoral video assisted thyroidectomy: a systematic review", G Chir, 39(5), pp.276~283 (2018)
  43. Chen S, "Transoral vestibule approach for thyroid disease: a systematic review", Eur Arch Otorhinolaryngol, 276(2), pp.297~304 (2019)
  44. Ji YB, "Feasibility and efficacy of intraoperative neural monitoring in remote access robotic and endoscopic thyroidectomy", Oral Oncol, 103, pp.104617~ (2020)
  45. Erol V, "Intraoperative neuromonitoring of the RLNs during TOETVA procedures", Gland Surg, 9(Suppl 2), pp.S129~S135 (2020)
  46. Dionigi G, "Neuromonitoring in endoscopic and robotic thyroidectomy", Updates Surg, 69(2), pp.171~179 (2017)
  47. Ji YB, "Neural monitoring of the external branch of the superior laryngeal nerve during transoral thyroidectomy", Laryngoscope, 131(2), pp.E671~E676 (2021)
  48. Barczynski M, "Randomized controlled trial of visualization versus neuromonitoring of the external branch of the superior laryngeal nerve during thyroidectomy", World J Surg, 36(6), pp.1340~1347 (2012)
  49. Bellantone R, "Is the identification of the external branch of the superior laryngeal nerve mandatory in thyroid operation? Results of a prospective randomized study", Surgery, 130(6), pp.1055~1059 (2001)
  50. Lennquist S, "The superior laryngeal nerve in thyroid surgery", Surgery, 102(6), pp.999~1008 (1987)
  51. Zhang D, "Stimulating and dissecting instrument for transoral endoscopic thyroidectomy: proof of concept investigation", Surg Endosc, 34(2), pp.996~1005 (2020)
  52. Kim KN, "Carbon dioxide embolism during transoral robotic thyroidectomy: a case report", Head Neck, 40(3), pp.E25~E28 (2018)
  53. 박은영, "Carbon Dioxide Embolism during Laparoscopic Surgery", Yonsei Medical Journal, 53(3), pp.459~466 (2012), 연세대학교의과대학[DOI]
  54. Kim CS, "Venous air embolism during total laparoscopic hysterectomy: comparison to total abdominal hysterectomy", Anesthesiology, 111(1), pp.50~54 (2009)
  55. Kwek JW, "Pneumoperitoneum after transoral endoscopic thyroidectomy vestibular approach", Laryngoscope Investig Otolaryngol, 5(3), pp.580~583 (2020)
  56. Tae K, "Sensory change in the chin and neck after transoral thyroidectomy: prospective study of mental nerve injury", Head Neck, 42(11), pp.3111~3117 (2020)
  57. Zhang D, "Human cadaveric model for studying the preservation of mental nerve during transoral endoscopic thyroidectomy", Surg Radiol Anat, 42(1), pp.55~62 (2020)
  58. Yang HM, "Anatomical study of gasless transoral thyroidectomy and clinical application", Surg Endosc, 34(8), pp.3414~3423 (2020)
  59. King SD, "Anatomic variations from 120 mental nerve dissections: lessons for transoral thyroidectomy", J Surg Res, 256, pp.P543~P548 (2020)
  60. Yi JW, "Evaluation of the efficacy of postoperative antibiotic treatment in transoral endoscopic thyroidectomy: a prospective randomised controlled trial", Br J Oral Maxillofac Surg, 58(3), pp.334~340 (2020)

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