Comparison between the 4K ultra-high definition (UHD) and high definition (HD) endoscopic systems for transoral...

The transoral endoscopic thyroidectomy vestibular approach (TOETVA) is the most recently introduced method of minimally invasive thyroid surgery. To our knowledge, no studies have compared TOETVA outcomes using different laparoscopic systems. This study compared outcomes of TOETVA using conventional high definition (HD) and ultra-high definition (UHD) equipment.

Medical data and surgery videos of 62 patients who randomized to undergo thyroid lobectomy by TOETVA using an HD or UHD system from August 2018 to April 2019 were retrospectively reviewed. Endoscopic procedures were divided into four phases: flap creation to isthmectomy (phase I); strap muscle division to upper pole ligation (phase II); trimming recurrent laryngeal nerve (phase III); and ligation of Berry's ligament to complete resection (phase IV).

Of the 62 patients, 28 underwent TOETVA using an HD device and 34 using a UHD device. The clinical characteristics of the two groups were not different. Mean operating time for lobectomy was similar in the HD and UHD groups (44.19±9.94 versus 43.47±12.19 min, P=0.825). The times required for phases I (15.02±5.33 versus 13.67±5.44 min, P=0.397); II (12.89±2.84 versus 13.17±5.22 min, P=0.816); III (9.85±4.36 versus 9.98±4.55 min, P=0.918); and IV (6.43±3.69 versus 6.65±3.45 min, P=0.840) were also similar in the HD and UHD groups. The numbers of retrieved lymph nodes did not differ significantly in the HD and UHD groups (3.26±2.62 versus 3.45±2.81, P=0.807).

Applying a UHD system in TOETVA resulted in outcomes similar to those observed with a conventional HD system. Operation time tended to be lower, especially for flap dissection, and numbers of harvest lymph nodes tended to be higher in the UHD group. Large-scale studies are needed to assess the advantages of the UHD system.