gms | German Medical Science

80th Annual Meeting of the German Society of Oto-Rhino-Laryngology, Head and Neck Surgery

German Society of Oto-Rhino-Laryngology, Head and Neck Surgery

20.05. - 24.05.2009, Rostock

Trans-oral video assisted thyroidectomy – anatomical considerations and first experimental results of a new, minimal-invasive surgical procedure

Meeting Abstract

  • corresponding author Thomas Wilhelm - HELIOS Kliniken Leipziger Land, HNO-Klinik, Borna, Germany
  • Tahar Benhidjeb - Chirurgische Klinik, Charitè Univeritätsmedizin, Berlin, Germany
  • Joris Harlaar - Institut für Neurowissenscahften/Anatomie, Erasmus-Universität, Rotterdam, Netherlands
  • Anton Kerver - Institut für Neurowissenscahften/Anatomie, Erasmus-Universität, Rotterdam, Netherlands
  • Gert-Jan Kleinrensink - Institut für Neurowissenscahften/Anatomie, Erasmus-Universität, Rotterdam, Netherlands
  • Tom A.J. Schneider - Institut für Neurowissenscahften/Anatomie, Erasmus-Universität, Rotterdam, Netherlands
  • Michael Stark - New European Surgical Academy, Berlin, Germany

German Society of Oto-Rhino-Laryngology, Head and Neck Surgery. 80th Annual Meeting of the German Society of Oto-Rhino-Laryngology, Head and Neck Surgery. Rostock, 20.-24.05.2009. Düsseldorf: German Medical Science GMS Publishing House; 2009. Doc09hno073

doi: 10.3205/09hno073, urn:nbn:de:0183-09hno0733

Published: July 22, 2009

© 2009 Wilhelm et al.
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Outline

Text

The development of minimal-invasive, video-assisted approaches in thyroidectomy (MIVAT) helps to minimize surgical access trauma in this kind of surgery. Extra cervical approaches (breast, axillar, ABBA) removed the incision line from the visible cervical area, but due to extensive dissection are still maximally invasive. Our aim to reduce surgical access trauma by entering surgical planes directly close to the surgical field and therefore gaining an optimal functional and cosmetic result was achieved with the introduction of the trans-oral access video assisted thyroidectomy (TVT, Figure 1 [Fig. 1]).

In a first step we visualized the anatomical situation of the floor of mouth, the anterior and lateral neck region in two dissections. Following this we evaluated the feasibility of the trans-oral route for thyroidectomy with standard laparoscopic instruments in five embalmed human cadavers: for optical control we placed an endoscope via a trocar in the midline sublingually. Two working trocars were placed in the vestibule of the mouth on both sides. The access and preparation plane for all trocars was under the platysma muscle. “Air dissection” by the insufflation of CO2 created the working space over the pretracheal muscles. After dividing the strap muscles in the midline the thyroid gland could be approached, mobilized and resected. Following the procedure anatomical dissection showed the integrity of all related structures as well as a surgical plane proving this to be a fairly atraumatic procedure.

In September 2008 we conducted an experimental study on five pigs regarding the safety and feasibility of the procedure. All results of the short-term evaluation regarding local infection and postoperative food intake will be presented.

So in conclusion the minimal invasive character of the TVT, an access according to surgical planes and spaces and at least a scar less surgery are the rationales for the trans-oral thyroidectomy. Feasibility and safety have been demonstrated in our anatomical and experimental studies. Therefore the next step will be the clinical application of the TVT in humans.