Trans-oral Video-Assisted Neck Surgery (tovans) – A New Trans-oral Technique of Endoscopic Thyroidectomy With Gasless Pre-mandible Approach

Akihiro Nakajo, PhD, Hideo Arima, PhD, Munetsugu Hirata, Tadao Mizoguchi, Yuko Kijima, PhD, Heiji Yoshinaka, PhD, Shoji Natsugoe, PhD. Surgical Oncology of Kagoshima University Hospital


Background: Endoscopic thyroidectomy is a well-established surgical technique. We have been utilizing precordial video-assisted neck surgery (VANS) with a gasless anterior neck skin lifting method. Recently, natural orifice translumenal endoscopic surgery (NOTES) has generated excitement among surgeons as potentially scar-free surgery. We developed an innovative gasless transoral technique for endoscopic thyroidectomy that incorporated the concept of NOTES in a VANS-technique (TOVANS)

Methods: Incision was made at the vestibulum under the inferior lip. From the vestibulum to the anterior cervical region, a subcutaneous tunnel in front of the mandible was created and cervical skin was lifted by Kirschner wires and a mechanical retracting system. This method without CO2 insufflation created an effective working space and provided an excellent cranio-caudal view so that we could perform thyroidectomy and central node dissection safely.

Results: The amount of bleeding was slight in this surgical procedure. All patients began oral intake one day after surgery, and left the hospital on the 4th or 5th day after operation. The sensory disorder around the chin disappeared about 3 to 6 months after surgery. No infection developed with use of preventive anti-bacterial tablets for 3 days.

Conclusions: We developed a new method for gasless transoral endoscopic thyroidectomy with a pre-mandibular approach and anterior neck-skin lifting. TOVANS makes possible complete endoscopic radical lymphadenectomy for papillary thyroid cancer. We believe that this method is innovative and progressive and has not only a cosmetic advantage but also provides easy access to the central node compartment for dissection in endoscopic thyroid cancer surgery.

Session Number: SS06 – NOTES
Program Number: S031

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