Transoral Robotic Thyroidectomy: Surgical Procedure and Tips

    • Presentation Speakers / Moderators
    To hide neck scarring, various remote access thyroidectomy procedures using surgical robots or endoscopy have been developed, using axillary, breast, postauicular facelift or transoral approaches. Recently, transoral thyroidectomy has been increasingly adopted, and it is considered a form of true natural orifice transluminal endoscopic surgery (NOTES), and is less invasive in terms of working space than other types of remote access thyroidectomy. Here I present a surgical video of transoral robotic thyroidectomy and evaluate its surgical tips and efficacy. In brief, a 1.5-2 cm horizontal incision at the end of the lower lip frenulum, and two lateral incisions were made on either side of the central incision close to the oral commissure so as not to injure the mental nerve. After the mucosal incision, a skin flap was elevated to form the working space under the endoscopic view in the plane of the subplatysmal layer. After creating the working space, three robotic arms were docked through the oral incision ports. If necessary, a third robotic instrument was inserted through the right axillary port. The midline fascia and the sternohyoid and sternothyroid muscles were dissected to expose the thyroid gland. The isthmus was divided first. The superior parathyroid gland was identified and preserved. The RLN was identified using an intraoperative nerve monitoring (IONM) probe. After total thyroidectomy, the resected specimen was extracted with a plastic endobag through the central oral incision port or axillary port. The oral vestibular mucosal incisions were closed, and no drain was inserted.

 

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