A Feasible Technique for Transoral Endoscopic Thyroidectomy Through Vestibular Access Using a Single-port Technique: A Video Vignette in Cadaver Dissection
Makaleler > Tam Makale · 2022
Yazarlar: Ziya Karimov, Yiğit TÜRK, Murat Ozdemir, Servet ÇELİK, Okan Bilge, Francesco Frattini, Gianlorenzo Dionigi, Ozer Makay
Surgical Laparoscopy, Endoscopy & Percutaneous Techniques, SCI Expanded İndekslerine Giren Dergi, Uluslararası, Wos, 2022, cilt 33, ss 84-88
DOI: 10.1097/sle.0000000000001124
Özet
BACKGROUND: The aim of this study was to evaluate the safety and feasibility of a single-port system for transoral endoscopic thyroidectomy with vestibular access (TOETVA). MATERIALS AND METHODS: Two embalmed human cadavers were used to test the single-port technique. After positioning, a median vestibular incision was made. Adipose tissue was dissected through the mentum with a Kelly clamp to reach the subplatysmal level. The Keyport Single Port System (Richard Wolf) was then inserted. After port placement, flexible endoscopic dissectors and a 5-mm endoscope were advanced. After removing the dissectors, we inserted the ArtiSential laparoscopic instruments. We also used a 3-port TOETVA on another human cadaver to compare the results with those of the single-port surgery. RESULTS: In the first cadaver, skin tension was observed during trocar insertion and dissection. Trocar insertion resulted in skin perforation in the submental area. In the second cadaver, the single-port trocar was successfully inserted despite the significant skin tension. However, the trocar did not allow the necessary surgical maneuvers to proceed with subsequent surgical steps and create a working space. Postprocedural anatomic dissection revealed that the distal branches of the mental nerve were related to the trocar passage. CONCLUSIONS: Our cadaver study demonstrated that single-port TOETVA is unsafe and not feasible with the current technology of the Keyport single-port system. This approach needs to be improved to perform this technique without injury to distal branches of the mental nerve, skin perforation, and other complications.