Minimally Invasive Neck Surgery: An Animal Model Study.

Area of Science:

• Surgical Innovation
• Pediatric Surgery
• Endoscopic Techniques

Background:

• Minimally invasive surgery (MIS) is becoming standard in adult surgery, but its application in pediatric cervical surgery remains controversial.
• Challenges in pediatric cervical MIS include the lack of a natural cavity and limited workspace.
• Transoral approaches offer cosmetic benefits and utilize natural orifices for neck surgery.

Purpose of the Study:

• To evaluate the feasibility and identify pitfalls of a transoral endoscopic approach for minimally invasive thyroidectomy in a pediatric training model.
• To assess the safety and efficacy of the vestibular approach for accessing pediatric neck pathology.

Main Methods:

• Transoral endoscopic thyroidectomies were performed on 10 rabbits using a vestibular approach.
• A working space was created via one trocar and two lateral stab incisions.
• Surgical time, anatomical identification, difficulties, and complications were documented via video recording.

Main Results:

• Total thyroidectomies were successfully completed in all 10 rabbits with a mean operative time of 51 minutes.
• Key anatomical structures, including fascial spaces and major vessels, were identified.
• Minor complications included limited bleeding (2 cases) and a mild tracheal laceration (1 case), neither requiring conversion to open surgery.

Conclusions:

• The transoral vestibular approach is a feasible technique for pediatric neck pathology, offering a suitable training model.
• The limited workspace in the rabbit model effectively simulates the conditions encountered in pediatric surgery.
• Precise and gentle surgical maneuvers are crucial for success in this approach.