Transoral thyroidectomy (TOETVA): Complications, surgical time and learning curve

Renan Bezerra Lira; Andressa Teruya Ramos; Ricardo Miguel Ribeiro Nogueira; Genival Barbosa de Carvalho; Jonathon O Russell; Ralph P Tufano; Luiz Paulo Kowalski

doi:10.1016/j.oraloncology.2020.104871

Transoral thyroidectomy (TOETVA): Complications, surgical time and learning curve

Oral Oncol. 2020 Nov:110:104871. doi: 10.1016/j.oraloncology.2020.104871. Epub 2020 Jun 30.

Authors

Renan Bezerra Lira¹, Andressa Teruya Ramos², Ricardo Miguel Ribeiro Nogueira², Genival Barbosa de Carvalho², Jonathon O Russell³, Ralph P Tufano³, Luiz Paulo Kowalski⁴

Affiliations

¹ Department of Head and Neck Surgery and Otorhinolaryngology, A.C. Camargo Cancer Center, Sao Paulo, Brazil. Electronic address: renan.lira@accamargo.org.br.
² Department of Head and Neck Surgery and Otorhinolaryngology, A.C. Camargo Cancer Center, Sao Paulo, Brazil.
³ Head and Neck Endocrine Surgery, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins, Baltimore, MD, USA.
⁴ Department of Head and Neck Surgery and Otorhinolaryngology, A.C. Camargo Cancer Center, Sao Paulo, Brazil; Head and Neck Surgery, University of São Paulo Medical School, Sao Paulo, Brazil.

PMID: 32619928
DOI: 10.1016/j.oraloncology.2020.104871

Abstract

Background: Since 2018, transoral endoscopic thyroidectomy vestibular approach (TOETVA) has emerged as a true scarless thyroid surgery. In this study, we explore early outcomes and learning curve of this new approach.

Methods: A retrospective cohort including conventional thyroidectomies and TOETVAs performed in a cancer center was designed. Learning curve and early surgical outcomes of TOETVA were assessed and compared to conventional thyroidectomy.

Results: A total of 56 TOETVAs and 745 conventional thyroid procedures were included. In the TOETVA group, we had a 14.4% total complication rate with no permanent vocal cord paresis or hypocalcemia. The mean surgical time dropped from 167 to 117 min (p = 0.0001) after the 15 first cases. Comparing to conventional procedures, we didn't find any significant difference in complications rate. Operative time was longer in the TOETVA group.

Conclusions: In this study, TOETVA was safe and feasible, with a learning curve of 15 cases.

Keywords: Minimally invasive surgery; NOTES; Scarless thyroidectomy; TOETVA; Thyroid cancer; Thyroid surgery; Transoral thyroidectomy.

MeSH terms

Adolescent
Adult
Aged
Aged, 80 and over
Child
Cohort Studies
Female
Humans
Male
Middle Aged
Retrospective Studies
Thyroid Neoplasms / pathology
Thyroid Neoplasms / surgery*
Thyroidectomy / adverse effects*
Thyroidectomy / methods
Young Adult