Elsevier

Surgery

Volume 150, Issue 1, July 2011, Pages 108-115
Surgery

Original Communication
Transoral thyroid and parathyroid surgery—Development of a new transoral technique

https://doi.org/10.1016/j.surg.2010.12.016Get rights and content

Background

Transluminal interventions via so-called natural orifices are gaining interest because they allow operative treatment without any skin incision. We previously described a transoral access for (para-)thyroid resection in pigs. To proceed with the first clinical trials, we evaluated the safety of the new technique.

Methods

Transoral hemithyroidectomies were performed on 10 living pigs using a special cervicoscope and conventional laparoscopic instruments. Follow-up examinations were carried out for 14 days and followed by autopsy, which included macroscopic evaluation, microbiologic investigations, and blood testing. In addition, refinement of the new technique was achieved by developing the techniques in 10 human cadavers. Finally, transoral parathyroidectomies were performed in 2 patients with primary hyperparathyroidism and a preoperatively localized parathyroid adenoma.

Results

All animal transoral hemithyroidectomies were performed without complications. Postoperatively, oral intake, weight gain, and white blood cell count remained normal. At autopsy, the access route, and operative field showed no signs of infection, and microbiologic swabs remained sterile. Based on these results, a transoral parathyroidectomy was performed successfully in 2 female patients with primary hyperparathyroidism; 1 patient experienced a transient palsy of the right hypoglossal nerve.

Conclusion

Transoral parathyroid and thyroid operation is feasible; however, additional controlled clinical studies are required to evaluate the safety and success rates of this new technique.

Section snippets

Animal experiments—requirements

Animal experiments were performed on juvenile pigs with an average weight of 27 kg (range, 23–31; Table I). Anesthesia was performed as described in our previous publication.13 After an intravenous administration of amoxicillin (15 mg/kg), an oral endotracheal intubation (5.5-mm diameter endotracheal tube) was carried out; the tube contained electrodes for intraoperative neuromonitoring (IONM) of the recurrent laryngeal nerve (Dr. Langer Medical, Waldkirch, Germany). Arterial oxygen saturation,

Animal experiments

To maximize the comparability of the operative procedure, the right thyroid lobes were resected in all 10 pigs using the transoral approach. Oral intubation and general anesthesia of all pigs was carried out without complication. While maintaining the intended route posterior to the strap muscles and the hyoid bone, the dorsal side of the thyroid gland and the space adjacent to the trachea was reached without major tissue damage or bleeding in all operations. Resection of the right thyroid

Discussion

Transluminal endoscopic interventions via so-called natural orifices allow operative treatment without any incision of the skin. These new techniques, which are refinements of the minimally invasive procedures, are gaining interest and are implemented more frequently in the clinical arena.21 A lack of systematic investigations persists, however, as well as basic research to evaluate risks and morbidity.

Several techniques already implemented in the clinical setting are called “minimally

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