Determining the optimal port placement for transoral endoscopic thyroidectomy vestibular approach in a retrospective study

Abstract

With the increasing popularity of minimally invasive techniques in thyroid surgery, the transoral endoscopic thyroidectomy vestibular approach (TOETVA) has garnered significant attention. This study aimed to compare the impact of different distances between the observation and operation ports in TOETVA on clinical treatment outcomes. Ninety patients with papillary thyroid carcinoma were retrospectively analyzed. Based on the distance between the observation and operation ports, they were divided into three groups: Group A (2.3-2.7 cm), Group B (less than 2.3 cm), and Group C (more than 2.7 cm). All three groups underwent TOETVA performed by the same surgical team. Operation time, blood loss, postoperative hospital stay, drainage volume, retrieved and metastatic central lymph nodes, postoperative complications, and tumor recurrence were compared among the groups. There were no demographic differences among the three groups. Compared to Groups B and C, patients in Group A had significantly shorter operation times, lower postoperative drainage volumes, and shorter postoperative hospital stays (p < 0.05). There were no significant differences in bleeding amount, retrieved and metastatic central lymph nodes, or incidence of complications among the groups. No postoperative recurrences were observed in any patient. In TOETVA, the best surgical outcomes were achieved when the distance between the observation and operation ports was approximately 2.5 cm (2.3-2.7 cm). This configuration ensures smooth surgical operations and facilitates postoperative rehabilitation, making it worthy of further clinical promotion.

Keywords: Observation port; Operation port; Port distance; Thyroid cancer; Transoral endoscopic thyroidectomy vestibular approach.

Fig. 1

Schematic representation of port placement and measurement of distances in TOETVA. The central observation port is positioned at the midpoint of the oral vestibule, while the operation ports are located laterally. The distances between the observation port and the operation ports (bilateral) are shown, measured from the midpoints of the inner edge of each incision near the mandibular surface.

Fig. 2

Intraoperative View of TOETVA. (A) The left-side surgical instrument needs to cross the trachea to operate on the thyroid region. (B) The right-side surgical instrument needs to cross the trachea to operate on the thyroid region.

Fig. 3

Schematic diagram of port placement for TOETVA. The schematic diagram illustrates the port placement in TOETVA. The observation port is positioned centrally in the oral vestibule, while the operation ports are placed symmetrically on either side. The mandible and trachea are labeled to show the anatomical relationships.