Strategies for superior thyroid pole dissection in transoral thyroidectomy : a video operative guide
BACKGROUND: The dissection of the superior thyroid gland pole is challenging when using the in TransOral Endoscopic Thyroidectomy Vestibular Approach (TOETVA) due to (a) the cranio-caudal approach, (b) cranial-caudal view, and (c) the restriction of maneuverability inside the narrow neck air pocket.
METHODS: In this paper and operative video guide, a series of TOETVA's tips and tricks are presented with an emphasis on the strategies for a safe approach to the superior thyroid gland pole structures.
RESULTS: Management of the upper thyroid pole structures includes: (a) use of a 5 mm/30°-45° endoscope; (b) retraction ports up to the limit of the lower jaw edge; (c) lateral retraction of 1/3 of the cranial strap muscles; (d) isthmectomy; (e) cutting the sternothyroid muscle cranially for 1 cm; (f) retraction of the thyroid upwards and laterally; (g) monitoring the external branch of the superior laryngeal nerve, and (h) sealing individual vessel branches.
CONCLUSION: Access to the superior thyroid pole space through the TOETVA approach presents some challenges, particularly when accessing thyroid vessels or nodules located or displaced more cranially. Strategies that enhance a critical view of the superior thyroid gland structures can protect them from damage and have the potential to improve the safety of the TOETVA and decrease potential conversion rates.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2020 |
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| Erschienen: |
2020 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:34 |
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| Enthalten in: |
Surgical endoscopy - 34(2020), 8 vom: 07. Aug., Seite 3711-3721 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Zhang, Daqi [VerfasserIn] |
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| Links: |
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| Themen: |
Intraoperative neuromonitoring |
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| Anmerkungen: |
Date Completed 27.05.2021 Date Revised 27.05.2021 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1007/s00464-020-07577-6 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM309661528 |
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| 500 | |a Date Revised 27.05.2021 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a BACKGROUND: The dissection of the superior thyroid gland pole is challenging when using the in TransOral Endoscopic Thyroidectomy Vestibular Approach (TOETVA) due to (a) the cranio-caudal approach, (b) cranial-caudal view, and (c) the restriction of maneuverability inside the narrow neck air pocket | ||
| 520 | |a METHODS: In this paper and operative video guide, a series of TOETVA's tips and tricks are presented with an emphasis on the strategies for a safe approach to the superior thyroid gland pole structures | ||
| 520 | |a RESULTS: Management of the upper thyroid pole structures includes: (a) use of a 5 mm/30°-45° endoscope; (b) retraction ports up to the limit of the lower jaw edge; (c) lateral retraction of 1/3 of the cranial strap muscles; (d) isthmectomy; (e) cutting the sternothyroid muscle cranially for 1 cm; (f) retraction of the thyroid upwards and laterally; (g) monitoring the external branch of the superior laryngeal nerve, and (h) sealing individual vessel branches | ||
| 520 | |a CONCLUSION: Access to the superior thyroid pole space through the TOETVA approach presents some challenges, particularly when accessing thyroid vessels or nodules located or displaced more cranially. Strategies that enhance a critical view of the superior thyroid gland structures can protect them from damage and have the potential to improve the safety of the TOETVA and decrease potential conversion rates | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Research Support, Non-U.S. Gov't | |
| 650 | 4 | |a Intraoperative neuromonitoring | |
| 650 | 4 | |a Superior laryngeal nerve | |
| 650 | 4 | |a Transoral endoscopic thyroidectomy | |
| 650 | 4 | |a Vestibular approach | |
| 700 | 1 | |a Wang, Tie |e verfasserin |4 aut | |
| 700 | 1 | |a Kim, Hoon Yub |e verfasserin |4 aut | |
| 700 | 1 | |a Wang, Ping |e verfasserin |4 aut | |
| 700 | 1 | |a Dionigi, Gianlorenzo |e verfasserin |4 aut | |
| 700 | 1 | |a Pino, Antonella |e verfasserin |4 aut | |
| 700 | 1 | |a Sun, Hui |e verfasserin |4 aut | |
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