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Surgical Endoscopy

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01-08-2020 | Thyroidectomy | Dynamic Manuscript

Strategies for superior thyroid pole dissection in transoral thyroidectomy: a video operative guide

Authors: Daqi Zhang, Tie Wang, Hoon Yub Kim, Ping Wang, Gianlorenzo Dionigi, Antonella Pino, Hui Sun

Published in: Surgical Endoscopy | Issue 8/2020

Abstract

Background

The dissection of the superior thyroid gland pole is challenging when using the in TransOral Endoscopic Thyroidectomy Vestibular Approach (TOETVA) due to (a) the cranio-caudal approach, (b) cranial-caudal view, and (c) the restriction of maneuverability inside the narrow neck air pocket.

Methods

In this paper and operative video guide, a series of TOETVA’s tips and tricks are presented with an emphasis on the strategies for a safe approach to the superior thyroid gland pole structures.

Results

Management of the upper thyroid pole structures includes: (a) use of a 5 mm/30°-45° endoscope; (b) retraction ports up to the limit of the lower jaw edge; (c) lateral retraction of 1/3 of the cranial strap muscles; (d) isthmectomy; (e) cutting the sternothyroid muscle cranially for 1 cm; (f) retraction of the thyroid upwards and laterally; (g) monitoring the external branch of the superior laryngeal nerve, and (h) sealing individual vessel branches.

Conclusion

Access to the superior thyroid pole space through the TOETVA approach presents some challenges, particularly when accessing thyroid vessels or nodules located or displaced more cranially. Strategies that enhance a critical view of the superior thyroid gland structures can protect them from damage and have the potential to improve the safety of the TOETVA and decrease potential conversion rates.

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Title: Strategies for superior thyroid pole dissection in transoral thyroidectomy: a video operative guide
Authors: Daqi Zhang
Tie Wang
Hoon Yub Kim
Ping Wang
Gianlorenzo Dionigi
Antonella Pino
Hui Sun
Publication date: 01-08-2020
Publisher: Springer US
Keywords: Thyroidectomy
Thyroidectomy
Published in: Surgical Endoscopy / Issue 8/2020
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-020-07577-6

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Strategies for superior thyroid pole dissection in transoral thyroidectomy: a video operative guide

Abstract

Background

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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