E Karakas1, A Anuwong2, K Ketwong2, A Kounnamas3, S Schopf4, G Klein5. 1. Klinik für Allgmein‑, Visceral- und Endorkine Chirurgie, Krankenhaus Maria Hilf, Alexianer GmbH, 47805, Krefeld, Deutschland. e.karakas@alexianer.de. 2. Department of General Surgery, Police Hospital Bangkok, Bangkok, Thailand. 3. Klinik für Allgmein‑, Visceral- und Endorkine Chirurgie, Krankenhaus Maria Hilf, Alexianer GmbH, 47805, Krefeld, Deutschland. 4. Klinik für Allgemein, Visceral- und Gefäßchirurgie, Krankenhaus Agatharied GmbH, Hausham, Deutschland. 5. Klinik für Chirurgie, Landesklinikum Wiener Neustadt, Wien, Österreich.
Abstract
BACKGROUND: More than 10 years ago various research groups in Germany first reported the possibility of transoral surgery of the thyroid and parathyroid glands. These were developed and evaluated within the framework of natural orifice transluminal endoscopic surgery (NOTES). While development of these innovative and new techniques that enabled surgery without visible scars did not become well accepted in Europe and America, it led to an optimized transoral endoscopic thyroidectomy vestibular approach (TOETVA), which was implemented particularly in Asia. We report the preparation, step-by-step implementation, and first promising results for TOETVA of an international surgical cooperation. MATERIAL AND METHODS: A Thai-Austrian-German cooperation was started in June 2017. Between June and November 2017 the first 10 TOETVA procedures were performed in female and male patient(s) presenting with single thyroid nodules, sporadic primary hyperparathyroidism and solitary parathyroid adenoma or thyroglossal duct cysts. The TOETVA technique was performed using 3 laparoscopic ports inserted at the oral vestibule and a CO2 insufflation pressure at 6-8 mm Hg. Each surgery was performed using laparoscopic instruments and ultrasonic or bipolar devices. Surgical outcome, complications and conversions to an open technique were recorded. RESULTS: Of the patients six presented with single thyroid nodules, two patients had multinodular goitre with scintigraphically cold nodules and multifocal hyperfunctioning thyroid tissue, one patient suffered from sporadic primary hyperparathyroidism with a left sided parathyroid adenoma and one patient suffered from a thyroglossal duct cyst. No conversion to conventional open surgery was necessary. Average tumor size was 3.1 cm (range 1-4 cm). There was no relevant loss of blood or subsequent bleeding. No temporary or permanent hoarseness or mental nerve injury occurred, while transient hypoparathyroidism was evident after successful parathyroid resection. Of the patients five developed a slight postoperative hematoma in the submandibular region. No infections or disorders of wound healing occurred. CONCLUSION: The TOETVA technique is feasible and safe in selected patients; however, further prospective studies are necessary to evaluate the value of the procedure, risks and long-term results.
BACKGROUND: More than 10 years ago various research groups in Germany first reported the possibility of transoral surgery of the thyroid and parathyroid glands. These were developed and evaluated within the framework of natural orifice transluminal endoscopic surgery (NOTES). While development of these innovative and new techniques that enabled surgery without visible scars did not become well accepted in Europe and America, it led to an optimized transoral endoscopic thyroidectomy vestibular approach (TOETVA), which was implemented particularly in Asia. We report the preparation, step-by-step implementation, and first promising results for TOETVA of an international surgical cooperation. MATERIAL AND METHODS: A Thai-Austrian-German cooperation was started in June 2017. Between June and November 2017 the first 10 TOETVA procedures were performed in female and male patient(s) presenting with single thyroid nodules, sporadic primary hyperparathyroidism and solitary parathyroid adenoma or thyroglossal duct cysts. The TOETVA technique was performed using 3 laparoscopic ports inserted at the oral vestibule and a CO2 insufflation pressure at 6-8 mm Hg. Each surgery was performed using laparoscopic instruments and ultrasonic or bipolar devices. Surgical outcome, complications and conversions to an open technique were recorded. RESULTS: Of the patients six presented with single thyroid nodules, two patients had multinodular goitre with scintigraphically cold nodules and multifocal hyperfunctioning thyroid tissue, one patient suffered from sporadic primary hyperparathyroidism with a left sided parathyroid adenoma and one patient suffered from a thyroglossal duct cyst. No conversion to conventional open surgery was necessary. Average tumor size was 3.1 cm (range 1-4 cm). There was no relevant loss of blood or subsequent bleeding. No temporary or permanent hoarseness or mental nerve injury occurred, while transient hypoparathyroidism was evident after successful parathyroid resection. Of the patients five developed a slight postoperative hematoma in the submandibular region. No infections or disorders of wound healing occurred. CONCLUSION: The TOETVA technique is feasible and safe in selected patients; however, further prospective studies are necessary to evaluate the value of the procedure, risks and long-term results.
Authors: Jonathon O Russell; James Clark; Salem I Noureldine; Angkoon Anuwong; Mai G Al Khadem; Hoon Yub Kim; Vaninder K Dhillon; Gianlorenzo Dionigi; Ralph P Tufano; Jeremy D Richmon Journal: Oral Oncol Date: 2017-06-10 Impact factor: 5.337
Authors: Elias Karakas; Thorsten Steinfeldt; Andreas Gockel; Thorsten Schlosshauer; Carsten Dietz; Jens Jäger; Reiner Westermann; Frank Sommer; Hans Rudolf Richard; Cornelia Exner; Andreas M Sesterhenn; Detlef K Bartsch Journal: Surgery Date: 2011-03-31 Impact factor: 3.982
Authors: T Weber; C Dotzenrath; H Dralle; B Niederle; P Riss; K Holzer; J Kußmann; A Trupka; T Negele; R Kaderli; E Karakas; F Weber; N Rayes; A Zielke; M Hermann; C Wicke; R Ladurner; C Vorländer; J Waldmann; O Heizmann; S Wächter; S Schopf; W Timmermann; D K Bartsch; R Schmidmaier; M Luster; K W Schmid; M Ketteler; C Dierks; P Schabram; T Steinmüller; K Lorenz Journal: Langenbecks Arch Surg Date: 2021-04-21 Impact factor: 3.445