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Cited 3 time in webofscience Cited 4 time in scopus
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Strategies for superior thyroid pole dissection in transoral thyroidectomy: a video operative guide

Authors
Zhang, DaqiWang, TieKim, Hoon YubWang, PingDionigi, GianlorenzoPino, AntonellaSun, Hui
Issue Date
Aug-2020
Publisher
SPRINGER
Keywords
Transoral endoscopic thyroidectomy; Intraoperative neuromonitoring; Vestibular approach; Superior laryngeal nerve
Citation
SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES, v.34, no.8, pp.3711 - 3721
Indexed
SCIE
SCOPUS
Journal Title
SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES
Volume
34
Number
8
Start Page
3711
End Page
3721
URI
https://scholarworks.korea.ac.kr/kumedicine/handle/2020.sw.kumedicine/27996
DOI
10.1007/s00464-020-07577-6
ISSN
0930-2794
Abstract
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 degrees-45 degrees 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.
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