Transoral endoscopic thyroidectomy in the thyroid cancer in children

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Abstract

BACKGROUND: Transoral endoscopic thyroidectomy (TE) by the vestibular access is an advanced technique in modern domestic oncology as it enables to have a perfect cosmetic results without any asymmetry caused by the scar strain on the visualized surface of the neck skin.

CLINICAL CASE DESCRIPTION: The article presents the first Russian experience, obtained in the research and clinical institution specializing in oncological diseases, in the application of transoral endoscopic TE by the vestibular access in children suffering of differentiated thyroid cancer. 9 children with thyroid cancer (TC), who were hospitalized to the A. Tsyb Medical Radiological Research Center from July 5, 2022, till December 20, 2022, were taken in the study. Tumor stage was estimated by the International Classification TMN TC (UICC, 8th ed., 2017): cT1a — 6 patients, cT1b — 3 patients. The age ranged from 6 to 17 y.o., average 15.2±1.1 (5 boys, 4 girls). All patients survived endoscopic surgery on the thyroid gland (TG) by the vestibular access: 6 patients — hemithyroidectomy (HTE) and 3 patients — TE, selective cervical lymphadenectomy (level VI).

All nine endoscopic surgeries on the thyroid gland by the vestibular access were successful, without conversion. In all patients, paratracheal, pretracheal and prelaryngeal groups of lymph nodes on the lesion side (level VI) were removed. Surgery duration ranged from 59 to 143 minutes, average 95±20.5 minutes. No complications, such as laryngeal nerve paresis or hypoparathyroidism, were observed. Intradermal hematoma and chin skin paresthesia were registered as local postoperative complications which did not require any treatment. All patients were satisfied with their cosmetic outcomes.

CONCLUSION: Transoral endoscopic thyroidectomy by the vestibular access is a safe and feasible alternative surgical intervention for neoplasms in the carefully selected infants so as to avoid scar formations on the frontal neck surface. Transoral endoscopic interventions in the thyroid gland and regional lymphatic regions by the vestibular access should be performed only in highly specialized oncological centers equipped with modern endoscopic devices.

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About the authors

Vyacheslav V. Polkin

A.F. Tsyba Medical Radiological Research Center

Email: polkin83@mail.ru
ORCID iD: 0000-0003-0857-321X
SPIN-code: 5604-2012

MD, Cand. Sci. (Medicine)

Russian Federation, Obninsk

Pavel A. Isaev

A.F. Tsyba Medical Radiological Research Center

Author for correspondence.
Email: isaev@mrrc.obninsk.ru
ORCID iD: 0000-0001-9831-4814
SPIN-code: 2181-4935

MD, Dr. Sci. (Medicine)

Russian Federation, Obninsk

Alexey A. Ilyin

A.F. Tsyba Medical Radiological Research Center

Email: ilin.grand@gmail.com
ORCID iD: 0000-0002-6581-633X
SPIN-code: 2493-6490

MD, Dr. Sci. (Medicine)

Russian Federation, Obninsk

Alice K. Plugar

A.F. Tsyba Medical Radiological Research Center

Email: fedina.a.k@yandex.ru
ORCID iD: 0000-0002-0049-4309

MD

Russian Federation, Obninsk

Sergey A. Ivanov

A.F. Tsyba Medical Radiological Research Center; Peoples' Friendship University of Russia

Email: mrrc@mrrc.obninsk.ru
ORCID iD: 0000-0001-7689-6032

MD, Dr. Sci. (Medicine), Professor

Russian Federation, Obninsk; Moscow

Andrei D. Kaprin

National Medical Research Radiological Center; Peoples' Friendship University of Russia; P.A. Hertzen Moscow Oncology Research Institute

Email: mrrc@mrrc.obninsk.ru
ORCID iD: 0000-0001-8784-8415

MD, Dr. Sci. (Medicine), Professor

Russian Federation, Moscow; Moscow; Moscow

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2. Fig. 1. The technique of vestibular access during transoral endoscopic interventions on the thyroid gland: a — hydrodissection of the submucosal layer of the oral cavity; b — transverse incision of the mucous membrane before the oral cavity; c, d — a curved mosquito clamp and surgical curved scissors are forming a channel for tunneling; e — a tunneller is inserted through the formed channel into the subplatysmic space to form an artificial plane; f — insertion of a 11-mm trocar; g, h, I — position of all trocars before the beginning of the endoscopic stage of surgery.

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3. Fig. 2. Patient's appearance before (a) and in two months (b) after surgery.

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