TY - JOUR
T1 - Strategies for superior thyroid pole dissection in transoral thyroidectomy
T2 - a video operative guide
AU - Zhang, Daqi
AU - Wang, Tie
AU - Kim, Hoon Yub
AU - Wang, Ping
AU - Dionigi, Gianlorenzo
AU - Pino, Antonella
AU - Sun, Hui
N1 - Funding Information:
This research was funded by China Postdoctoral Science Foundation (No. 2017M611313), Department of Science and Technology of Jilin Province (No. 20190201225JC) and Department of Finance of Jilin Province, (No. SCZSY201714 and 2019SCZ028). Acknowledgements
Publisher Copyright:
© 2020, Springer Science+Business Media, LLC, part of Springer Nature.
PY - 2020/8/1
Y1 - 2020/8/1
N2 - Background: The dissection of the superior thyroid gland pole is challenging when using the in TransOral Endoscopic Thyroidectomy Vestibular Approach (TOETVA) due to (a) the cranio-caudal approach, (b) cranial-caudal view, and (c) the restriction of maneuverability inside the narrow neck air pocket. Methods: In this paper and operative video guide, a series of TOETVA’s tips and tricks are presented with an emphasis on the strategies for a safe approach to the superior thyroid gland pole structures. Results: Management of the upper thyroid pole structures includes: (a) use of a 5 mm/30°-45° endoscope; (b) retraction ports up to the limit of the lower jaw edge; (c) lateral retraction of 1/3 of the cranial strap muscles; (d) isthmectomy; (e) cutting the sternothyroid muscle cranially for 1 cm; (f) retraction of the thyroid upwards and laterally; (g) monitoring the external branch of the superior laryngeal nerve, and (h) sealing individual vessel branches. Conclusion: Access to the superior thyroid pole space through the TOETVA approach presents some challenges, particularly when accessing thyroid vessels or nodules located or displaced more cranially. Strategies that enhance a critical view of the superior thyroid gland structures can protect them from damage and have the potential to improve the safety of the TOETVA and decrease potential conversion rates.
AB - Background: The dissection of the superior thyroid gland pole is challenging when using the in TransOral Endoscopic Thyroidectomy Vestibular Approach (TOETVA) due to (a) the cranio-caudal approach, (b) cranial-caudal view, and (c) the restriction of maneuverability inside the narrow neck air pocket. Methods: In this paper and operative video guide, a series of TOETVA’s tips and tricks are presented with an emphasis on the strategies for a safe approach to the superior thyroid gland pole structures. Results: Management of the upper thyroid pole structures includes: (a) use of a 5 mm/30°-45° endoscope; (b) retraction ports up to the limit of the lower jaw edge; (c) lateral retraction of 1/3 of the cranial strap muscles; (d) isthmectomy; (e) cutting the sternothyroid muscle cranially for 1 cm; (f) retraction of the thyroid upwards and laterally; (g) monitoring the external branch of the superior laryngeal nerve, and (h) sealing individual vessel branches. Conclusion: Access to the superior thyroid pole space through the TOETVA approach presents some challenges, particularly when accessing thyroid vessels or nodules located or displaced more cranially. Strategies that enhance a critical view of the superior thyroid gland structures can protect them from damage and have the potential to improve the safety of the TOETVA and decrease potential conversion rates.
KW - Intraoperative neuromonitoring
KW - Superior laryngeal nerve
KW - Transoral endoscopic thyroidectomy
KW - Vestibular approach
UR - http://www.scopus.com/inward/record.url?scp=85085141849&partnerID=8YFLogxK
U2 - 10.1007/s00464-020-07577-6
DO - 10.1007/s00464-020-07577-6
M3 - Article
C2 - 32382884
AN - SCOPUS:85085141849
VL - 34
SP - 3711
EP - 3721
JO - Surgical Endoscopy
JF - Surgical Endoscopy
SN - 0930-2794
IS - 8
ER -