Thyroïdectomie Trans Orale par voie endoscopique vestibulaire antérieure (TOETVA). Expérience et Résultats à propos de 200 Cas / Trans oral thyroidectomy by anterior vestibular endoscopic anterior vestibular approach (TOETVA). Experience and Results abou
Seance of wednesday 08 february 2023 (Communications libres)
DOI number : 10.26299/2zms-zg57/emem.2023.5.01
Abstract
Objective. To present the indications and limitations of Trans Oral Thyroidectomy via anterior vestibular endoscopic approach (TOETVA).
Methods. - From February 2018 to December 2022, TOETVA was offered to patients aged 15 to 70 years, interested in the absence of cervical scarring. Pre- and intraoperative data, and complications were evaluated.
Results. - Two hundred patients (186 women) aged 43±12.4 years (15-69) including 13 with BMI>25 kg/m2 and 4 >35 kg/m2 were included. Indications for surgery included: 22 papillary cancers, 10 oncocytic nodules, 30 toxic nodules, 24 Graves' disease and 114 symptomatic goiters and/or nodules. Preoperative diameter of the nodules was 36.2±17.5 mm (4-100 mm). The procedures were 119 lobo-isthmectomies, 71 total thyroidectomies and 10 isthmectomies. The operative time was 120±44 min (40-255). Fifteen patients were converted to cervicotomy (7.5%) for a nodule > 6 cm, hemorrhage or technical incident. Complications were 10 transient (5%) and 3 definitive (1.5%) recurrent paresis, 10 transient (14%) and 2 definitive (2.8%) hypoparathyroidism well tolerated. Thirty patients had transient and 2 prolonged chin neuropathies beyond 3 months. No hematoma, infection, or neuropathy at the axillary extraction site was observed. All patients reported satisfaction.
Conclusion. -TOEVA is an efficient and scarless technique for total or partial thyroidectomies with nodule size less than 6 cm. Graves' disease, BMI or cervical scar are not contraindications.
Key words: TOETVA, THYROIDECTOMY, MINI-INVASIVE SURGERY
Methods. - From February 2018 to December 2022, TOETVA was offered to patients aged 15 to 70 years, interested in the absence of cervical scarring. Pre- and intraoperative data, and complications were evaluated.
Results. - Two hundred patients (186 women) aged 43±12.4 years (15-69) including 13 with BMI>25 kg/m2 and 4 >35 kg/m2 were included. Indications for surgery included: 22 papillary cancers, 10 oncocytic nodules, 30 toxic nodules, 24 Graves' disease and 114 symptomatic goiters and/or nodules. Preoperative diameter of the nodules was 36.2±17.5 mm (4-100 mm). The procedures were 119 lobo-isthmectomies, 71 total thyroidectomies and 10 isthmectomies. The operative time was 120±44 min (40-255). Fifteen patients were converted to cervicotomy (7.5%) for a nodule > 6 cm, hemorrhage or technical incident. Complications were 10 transient (5%) and 3 definitive (1.5%) recurrent paresis, 10 transient (14%) and 2 definitive (2.8%) hypoparathyroidism well tolerated. Thirty patients had transient and 2 prolonged chin neuropathies beyond 3 months. No hematoma, infection, or neuropathy at the axillary extraction site was observed. All patients reported satisfaction.
Conclusion. -TOEVA is an efficient and scarless technique for total or partial thyroidectomies with nodule size less than 6 cm. Graves' disease, BMI or cervical scar are not contraindications.
Key words: TOETVA, THYROIDECTOMY, MINI-INVASIVE SURGERY