Oded Cohen1, Ralph P Tufano2, Angkoon Anuwong3, Jonathon O Russell4, Niddal Assadi1, Gianlorenzo Dionigi5, Hoon Yub Kim6, Antonio Bertelli7, Avi Khafif1. 1. ARM - Center for Head and Neck Surgery and Oncology, Assuta Medical Centers, Tel Aviv, Affiliated with Ben Gurion University, Beer Seva, Israel. 2. Division of Head and Neck Endocrine Surgery, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins, Baltimore, MD, USA. 3. Department of Surgery, Minimally Invasive Endocrine and Surgery Division, Police General Hospital, Bangkok, Thailand. 4. Division of Head and Neck Endocrine Surgery, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins, Baltimore, MD, USA. jrusse41@jhmi.edu. 5. Department of Human Pathology in Adulthood and Childhood "G. Barresi", University of Messina, Messina, Italy. 6. Department of Surgery, Korea University College of Medicine, Seoul, Korea. 7. Department of Surgery, Santa Casa de São Paulo Medical School, Sao Paulo, Brazil.
Abstract
INTRODUCTION: A cervical scar has been shown to have an impact on the quality of life of children undergoing thyroid surgery. Transoral endoscopic vestibular thyroidectomy via the vestibular approach (TOETVA) offers the absence of a cutaneous incision, and has not been described to date in the pediatric population. OBJECTIVE: To describe the first series of TOETVA in a pediatric population. PATIENTS AND METHODS: A retrospective, multicenter study, including all patients > 18 years old who underwent TOETVA. Data was prospectively collected and included demographics, preoperative ultrasound, cytology and indications for surgery. Intraoperative parameters included length of surgery and complications, with final pathology and postoperative course also reviewed. TOETVA surgical success was defined as completion of surgery via this approach. RESULTS: Forty-eight children were included. Of these, 43 (89.5%) were girls. The median age was 16 years (range 10-17). The most common indication for surgery was a benign thyroid nodule (n = 26, 54.1%). Eleven patients (22.9%) had papillary thyroid carcinoma on final pathology, of which 90.9% (10/11) were diagnosed pre-operatively based on FNA cytology. Hemithyroidectomy was performed in 36 patients (75%). All surgeries were completed endoscopically. The mean malignant tumor size was 1.4 ± 0.4 cm and all tumors were completely excised with clean margins. No permanent complications were documented. A single patient (2.1%) had transient RLN injury (1.6%, 1/60 nerves at risk). Transient hypocalcemia was documented in 4 of the 12 patients undergoing total thyroidectomy (33.3%). Transient mental nerve injury/chin hypoesthesia was documented in 2 patients (4.2%). CONCLUSIONS: TOETVA appears to be a feasible and safe approach for thyroidectomy in the pediatric population in carefully selected cases, and may be discussed with patients and parents as an alternative for the trans-cervical approach.
INTRODUCTION: A cervical scar has been shown to have an impact on the quality of life of children undergoing thyroid surgery. Transoral endoscopic vestibular thyroidectomy via the vestibular approach (TOETVA) offers the absence of a cutaneous incision, and has not been described to date in the pediatric population. OBJECTIVE: To describe the first series of TOETVA in a pediatric population. PATIENTS AND METHODS: A retrospective, multicenter study, including all patients > 18 years old who underwent TOETVA. Data was prospectively collected and included demographics, preoperative ultrasound, cytology and indications for surgery. Intraoperative parameters included length of surgery and complications, with final pathology and postoperative course also reviewed. TOETVA surgical success was defined as completion of surgery via this approach. RESULTS: Forty-eight children were included. Of these, 43 (89.5%) were girls. The median age was 16 years (range 10-17). The most common indication for surgery was a benign thyroid nodule (n = 26, 54.1%). Eleven patients (22.9%) had papillary thyroid carcinoma on final pathology, of which 90.9% (10/11) were diagnosed pre-operatively based on FNA cytology. Hemithyroidectomy was performed in 36 patients (75%). All surgeries were completed endoscopically. The mean malignant tumor size was 1.4 ± 0.4 cm and all tumors were completely excised with clean margins. No permanent complications were documented. A single patient (2.1%) had transient RLN injury (1.6%, 1/60 nerves at risk). Transient hypocalcemia was documented in 4 of the 12 patients undergoing total thyroidectomy (33.3%). Transient mental nerve injury/chin hypoesthesia was documented in 2 patients (4.2%). CONCLUSIONS: TOETVA appears to be a feasible and safe approach for thyroidectomy in the pediatric population in carefully selected cases, and may be discussed with patients and parents as an alternative for the trans-cervical approach.
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: David Liao; Lisa E Ishii; Lena W Chen; Jonlin Chen; Michelle Juarez; Halley M Darrach; Anisha R Kumar; Jonathon O Russell; Ralph P Tufano; Masaru Ishii Journal: Laryngoscope Date: 2019-10-29 Impact factor: 3.325
Authors: Karen E Kinahan; Lisa K Sharp; Kristy Seidel; Wendy Leisenring; Aarati Didwania; Mario E Lacouture; Marilyn Stovall; Anand Haryani; Leslie L Robison; Kevin R Krull Journal: J Clin Oncol Date: 2012-05-21 Impact factor: 44.544