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Thinking outside the box| Volume 93, ISSUE 1, P224-228, January 2021

Flexible endoscopic transoral thyroidectomy: a pilot study in a porcine model (with video)

Published:August 24, 2020DOI:https://doi.org/10.1016/j.gie.2020.07.033
Flexible endoscopic transoral thyroidectomy: a pilot study in a porcine model (with video)
Previous ArticleColon Capsule CLEansing Assessment and Report (CC-CLEAR): a new approach for evaluation of the quality of bowel preparation in capsule colonoscopy
Next ArticleNOTES revisited
      Both endoscopic (laparoscopic) and robotic approaches to minimally invasive thyroidectomy have been developed, but none has gained widespread acceptance.
      • Camenzuli C.
      • Schembri Wismayer P.
      • et al.
      Transoral endoscopic thyroidectomy: a systematic review of the practice so far.
      JSLS. 2018; 22 (e2018.00026)
      ,
      • Holsinger F.C.
      • Chung W.Y.
      Robotic thyroidectomy.
      Otolaryngol Clin North Am. 2014; 47: 373-378
      Laparoscopic surgery requires 3 ports and a large working space. Transoral endoscopic thyroidectomy and hybrid natural orifice transluminal endoscopic surgery (NOTES) with the use of a vestibular approach has had success in producing a scar-free thyroidectomy
      • Anuwong A.
      • Ketwong K.
      • Jitpratoom P.
      • et al.
      Safety and outcomes of the transoral endoscopic thyroidectomy vestibular approach.
      JAMA Surg. 2018; 153: 21-27
      ,
      • Anuwong A.
      Transoral endoscopic thyroidectomy vestibular approach: a series of the first 60 human cases.
      World J Surg. 2016; 40: 491-497
      but also requires a large working space. Inspired by our pure NOTES experience, we hypothesized that flexible endoscopic thyroidectomy could be done by using a single operating channel and thus obviate the need for hybrid NOTES or laparoscopic instrument-assisted rigid endoscopic operations. We used an animal model to test this hypothesis. The study was undertaken after approval by and under the guidance of the ethics committee of the First Affiliated Hospital of Zhengzhou University.

      Abbreviation:

      NOTES (natural orifice transluminal endoscopic surgery)
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      References

        • Camenzuli C.
        • Schembri Wismayer P.
        • et al.
        Transoral endoscopic thyroidectomy: a systematic review of the practice so far.
        JSLS. 2018; 22 (e2018.00026)
        View in Article
        • Holsinger F.C.
        • Chung W.Y.
        Robotic thyroidectomy.
        Otolaryngol Clin North Am. 2014; 47: 373-378
        View in Article
        • Anuwong A.
        • Ketwong K.
        • Jitpratoom P.
        • et al.
        Safety and outcomes of the transoral endoscopic thyroidectomy vestibular approach.
        JAMA Surg. 2018; 153: 21-27
        View in Article
        • Anuwong A.
        Transoral endoscopic thyroidectomy vestibular approach: a series of the first 60 human cases.
        World J Surg. 2016; 40: 491-497
        View in Article
        • Liu B.R.
        • Ullah S.
        • Liu D.
        • et al.
        A snare-assisted pure NOTES retrograde cholecystectomy using a single channel flexible endoscope: a pilot experiment in a porcine model.
        Surg Endosc. 2020; 34: 3706-3710
        View in Article
        • Liu B.R.
        • Liu Dan
        • Ullah S.
        • et al.
        Endoscopic full-thickness resection and endoscopic lymphadenectomy for advanced colonic cancer in an inoperable patient: first human clinical experience.
        Gastrointest Endosc. 2020; 91: 451-452
        View in Article

      Article info

      Publication history

      Published online: August 24, 2020
      Accepted: July 15, 2020
      Received: May 5, 2020

      Footnotes

      Supported by the National Natural Science Foundation of China (No. 818704540) and the Henan Province Innovation Talents of Science and Technology Plan (No. 184200510020).

      Identification

      DOI: https://doi.org/10.1016/j.gie.2020.07.033

      Copyright

      © 2021 by the American Society for Gastrointestinal Endoscopy

      ScienceDirect

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      Linked Article

      • NOTES revisited
        Gastrointestinal EndoscopyVol. 93Issue 1
        • Preview
          In this issue, Liu et al1 report a pilot porcine study assessing the feasibility of flexible endoscopic transoral thyroidectomy. By the opening of a transoral incision, the endoscope was used to create a subcutaneous tunnel from the mouth to the thyroid gland to perform a partial thyroidectomy. The procedure was successfully performed in 6 swine, with a mean procedure time of 35 minutes, and none of the swine had adverse events.
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