[Transoral endoscopic thyroidectomy : Part 2: Surgical technique]

Thyroid surgery is one of the newest fields for application of video-assisted surgery. The majority of approaches must choose between optimizing cosmetic results by hiding scars in the chest and axillary region while maximizing tissue dissection and post-operative pain versus having a visible cervical scar with minimal tissue dissection. In an effort to minimize surgical trauma and to achieve an optimal cosmetic result we investigated the transoral approach to the thyroid.

In three cadavers the safety and reproducibility to access and resect the thyroid gland were assessed according to a defined road map. The surgical procedure itself was performed on two further cadavers with the help of one 5 mm trocar and two 3 mm trocars which were introduced bilaterally through the floor of mouth and the oral vestibule. A subplatysmal working space was created by blunt dissection and CO(2) insufflation to a pressure of 4-6 mmHg. Division of the median raphe of the neck muscles was followed by exposure of the thyroid gland. In the next step the isthmus was transected, the upper pole arteries dissected and divided and the medial thyroid vein cut close to the gland. Thyroid resection was performed from cranial to caudal and the specimen was removed transorally through the 5 mm midline incision.

Description of landmarks of the surgical steps and dissection of defined anatomic structures could be achieved. Unilateral subtotal thyroid resection could be successfully performed without any additional skin incisions in 59 min. Postoperatively performed anatomical dissection showed intact surrounding structures.

Our results demonstrate the feasibility and safety of a transoral access for thyroidectomy. In comparison to other minimally invasive thyroidectomy access procedures, the transoral approach is minimally invasive and at the same time cosmetically optimal.