Gland surgery
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Thyroidectomy associated to en bloc tracheal resection with end-to-end anastomosis is the treatment of choice of thyroid tumor invading the tracheal wall and is associated with a good prognosis. However, the postoperative morbidity is not irrelevant. The present review aims to discuss the complications occurring after this aggressive surgical procedure. ⋯ Tumor local recurrence can be considered a late on set complication. To conclude, in locally invasive thyroid cancer, en bloc resection of the thyroid with the tracheal segment interested by the tumor provides a good prognosis despite the non-negligible postoperative morbidity rate. Patients' selection and accurate surgical technique performing a tracheal tension-free anastomosis are mandatory to reduce postoperative morbidity and mortality.
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Endotracheal tube-based surface electrodes are now commonly applied to measure evoked electromyographic (EMG) response of the vocal cord during monitored thyroidectomy. The aim of the study was to determine the incidence of difficult intubation and to assess the effectiveness of using video-assisted intubating stylet (Trachway) for EMG tube placement in patients undergoing monitored thyroidectomy. ⋯ We conclude that the incidence of difficult intubation was significantly lower with Trachway than direct laryngoscopy. The Trachway video-intubating stylet is useful and helpful to reduce EMG tube intubation difficulty for monitored thyroidectomy.
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Remote-access approaches to the thyroid gland have seen a rapid evolution recently with the development of various techniques to minimize the cosmetic and quality-of-life impact of a visible scar. Most approaches have required significantly more tissue dissection and have been limited in their extent to treat contralateral disease. ⋯ Transoral thyroidectomy may be performed with either laparoscopic or robotic technology, each with various advantages and disadvantages. Herein, we discuss our experience with transoral robotic thyroidectomy (TORT).
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Transoral endoscopic thyroidectomy vestibular approach (TOETVA) provides excellent cosmetic results from its potential for scar-free operation. The procedure has been applied successfully for Graves' disease by the authors of this work and compared with the standard open cervical approach to evaluate its safety and outcomes. ⋯ TOETVA is a feasible and safe treatment for Graves' disease in comparison to the standard open cervical approach. It is considered a viable alternative for patients who have been indicated for surgery with excellent cosmetic results.
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Transoral endoscopic thyroid surgery seems to be the logical consequence in the evolution of thyroid surgery. Animal and cadaver studies have shown that different endoscopic techniques can be performed in a safe and successful way. Presently, the minimally invasive aspect and cosmetic advantage seem to be the most important factor for the patients. ⋯ The access itself needs to be further refined, and even more suitable and better adapted instruments need to be developed so that optimal and safe results that meet all requirements on endocrine surgery can be achieved and all requirements for endocrine surgery are met. The transoral thyroidectomy should only be performed in highly specialized centres for endocrine and endoscopic surgery. As an alternative, a combination with endoscopic non-transoral techniques-so called hybrid techniques-might be useful for our patients.