A Porcine Model for Training Novices in Transoral Endoscopic Thyroidectomy Vestibular Approach

Historically, live pigs have been utilized for technical exploration in developing the transoral endoscopic thyroidectomy vestibular approach (TOETVA). This study aims to design a TOETVA training model using porcine subjects for junior doctors.

Trainees from hospitals across China were invited to participate in a TOETVA training workshop. We documented the duration of each procedural step, surgical complications, and specific details, which were then compared to the initial human TOETVA procedures conducted by specialists from our institution. After the workshop, participants completed online questionnaires using a 1-5 Likert Scale to assess their subjective experiences of each step in comparison to human procedures.

The study involved 17 trainees and seven mentors from institutions in four Chinese cities, using five pigs for the workshop. All five surgeries were successfully completed, although there was a loss of recurrent laryngeal nerve (RLN) signal in one case. Remarkably, one trainee successfully performed their first human TOETVA 3 days after the workshop. The overall complication rates were comparable between the porcine TOETVAs and human procedures (20.0% vs. 11.4%, p > 0.999). Participants rated the training on assistance in performing human TOETVA between 3.54 ± 1.18 and 4.29 ± 0.55 on the Likert Scale. In terms of similarity to human TOETVA, steps such as establishing working space, identifying RLNs, and dissecting central lymph nodes were rated above 3.

This study is the first to confirm the feasibility of a porcine TOETVA training model. Despite anatomical differences, the porcine TOETVA effectively simulates human procedures.