Strategies for superior thyroid pole dissection in transoral thyroidectomy: a video operative guide

Daqi Zhang, Tie Wang, Hoon Yub Kim, Ping Wang, Gianlorenzo Dionigi, Antonella Pino, Hui Sun

Research output: Contribution to journalArticlepeer-review

Abstract

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.

Original languageEnglish
Pages (from-to)3711-3721
Number of pages11
JournalSurgical Endoscopy
Volume34
Issue number8
DOIs
Publication statusPublished - 2020 Aug 1

Keywords

  • Intraoperative neuromonitoring
  • Superior laryngeal nerve
  • Transoral endoscopic thyroidectomy
  • Vestibular approach

ASJC Scopus subject areas

  • Surgery

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