Transoral endoscopic thyroidectomy with central neck dissection: experimental studies on human cadavers

Area of Science:

• Minimally Invasive Surgery
• Endoscopic Surgery
• Head and Neck Surgery

Background:

• Natural orifice trans-luminal endoscopic surgery (NOTES) has advanced, enabling preclinical studies of transoral video-assisted thyroidectomy.
• Anatomical dissections in human cadavers (2009-2011) defined safe transoral access routes to the anterior cervical spaces.
• Experimental transoral endoscopic thyroidectomy was recently validated on 15 fresh specimens.

Purpose of the Study:

• To evaluate the feasibility and outcomes of transoral endoscopic thyroidectomy.
• To define anatomical landmarks and surgical planes for safe transoral access.
• To assess the cosmetic and functional benefits of this minimally invasive approach.

Main Methods:

• Three endoscopic incisions were made in the oral cavity.
• Sublingual and bilateral vestibular tunnels were created to access the cervical region.
• Carbon dioxide insufflation created a working space for endoscopic dissection of thyroid lobes and lymph nodes.

Main Results:

• The transoral approach provided the shortest distance to the anterior neck, enabling full resection of thyroid lobes and central lymph nodes.
• A craniocaudal view facilitated access to retrosternal thyroid glands and lymph nodes.
• The recurrent laryngeal nerve was safely identified; the mental nerve was at risk, and maxillary dentition slightly limited camera motion.

Conclusions:

• Transoral endoscopic thyroidectomy is a progressive technique offering superior cosmetic results and minimal access trauma.
• The approach provides an advantageous craniocaudal surgical view.
• This method demonstrates feasibility for thyroid and lymph node resection via an endoscopic transoral route.