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Case Reports
. 2020 Oct;9(5):1605-1613.
doi: 10.21037/gs-20-147.

Transoral endoscopic thyroidectomy vestibular approach in a patient with Class III goitre (operative steps and video)

Zeyang Liu  1 , Zan Li  1 , Xiaowei Peng  1 , Bo Zhou  1 , Chunliu Lv  1 , Liang Yi  1 , Hui Li  1 , Wen Peng  1 , Zhiyuan Wang  2 , Jigang Li  3
Affiliations
Case Reports

Transoral endoscopic thyroidectomy vestibular approach in a patient with Class III goitre (operative steps and video)

Zeyang Liu et al. Gland Surg. 2020 Oct.

Abstract

Transoral endoscopic thyroidectomy vestibular approach (TOETVA) has recently become a hot research topic due to the advantage of leaving no scar, but, according to most centers, its indication is restricted to the size of thyroid gland. Here we report a case of a female patient with Class III goitre who successfully underwent TOETVA (video attached). A 53-year-old woman with a previous history of chest keloidosis presented with a history of neck swelling for 3 years and was diagnosed as Hashimoto's thyroiditis with no nodules. The patient insisted that she undergo a TOETVA procedure in our hospital. Compared to the traditional TOETVA, several techniques were applied in this operation to ensure the resection and removal of the thyroid gland: with the dissection of the mental nerve and using the lateral approach to the thyroid gland. The total volume of thyroid gland was 205 mL. The operating time was 195 min. No complications were incurred. The numbness of the lip and chin was measured by the "two-points discrimination" method with several aspects (touch, pain, temperature) at different times to evaluate mental nerve injury. She felt the numbness during the first operative day but it was almost completely relieved in the third postoperative month. To our knowledge, this is the largest thyroid gland reported removed with TOETVA procedure. By carefully designing the operative steps, it is feasible to use the transoral approach in patients who have a benign thyroid disease with a Class III goitre if the patient strongly desires that operation.

Keywords: Transoral endoscopic thyroidectomy; case report; goiter; indication; transoral endoscopic thyroidectomy vestibular approach (TOETVA).

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/gs-20-147). XP has a patent No. 201821210473.4 licensed to Hunan Cancer Hospital. The other authors have no conflicts of interest to declare.

Figures

Video 1
Video 1
Video case illustrating in detail a transoral endoscopic thyroidectomy vestibular approach (TOETVA) in a patient with Class III Goitre. Compared to traditional TOETVA, several techniques, such as the dissection of mental nerve and the approach of lateral strap muscles, were applied in this operation to ensure the resection and removal of the thyroid gland.
Figure 1
Figure 1
Appearance and CT scan before surgery. (A,B) Chest keloid and neck swelling were clearly seen; (C,D) CT scan showed the left upper pole was higher than the hyoid bone.
Figure 2
Figure 2
How to pull out the Class III goitre. a: correct position of right lobe and isthmus; b: correct position of left lobe; c: wrong position of left lobe. Red dash lines represent the boundary of tunnel in this case. Blue dash lines represent the boundary of tunnel in a normal case.
Figure 3
Figure 3
Thyroid gland. (A) Left lobe; (B) right lobe and isthmus.
Figure 4
Figure 4
Appearance in postoperative month 3, no scar, no neck swelling. (A) Front view; (B) side view.
See this image and copyright information in PMC

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