经口腔前庭入路腔镜甲状腺手术的研究进展及技术要点

doi:10.16139/j.1007-9610.2025.01.04

摘要/Abstract

摘要：

经口腔前庭入路腔镜甲状腺切除术（TOETVA）是近几年兴起的新型甲状腺腔镜术式。TOETVA可彻底清扫中央区和Ⅳ区淋巴结，兼顾美容与疗效双重优点。笔者结合开展此技术的临床经验，回顾近年来TOETVA的发展演变、适应证和并发症及手术技巧，展望该技术的发展趋势。

关键词: 经口腔前庭入路腔镜甲状腺切除术, 侧颈淋巴结清扫, 美容效果

Abstract:

Transoral endoscopic thyroidectomy vestibular approach (TOETVA) is a novel endoscopic thyroid surgery method. TOETVA can completely dissect the lymph nodes in the central area and Ⅳ area. TOETVA has both advantages of beauty and curative effect. Based on the clinical experience of this technique, the author reviewed the development, indications, complications and surgical skills of TOETVA in recent years, and looked forward to the development trend of this technique.

Key words: Transoral endoscopic thyroidectomy vestibular approach(TOETVA), Lateral neck lymph node dissection, Cosmetic outcome

中图分类号:

R653

陈朋, 史加宁, 贾文俊, 方静. 经口腔前庭入路腔镜甲状腺手术的研究进展及技术要点[J]. 外科理论与实践, 2025, 30(01): 17-20.

CHEN Peng, SHI Jianing, JIA Wenjun, FANG Jing. Progress and technical points of transoral endoscopic thyroidectomy vestibular approach[J]. Journal of Surgery Concepts & Practice, 2025, 30(01): 17-20.

参考文献 27

[1]	WANG Y, ZHANG Z, ZHAO Q, et al. Transoral endoscopic thyroid surgery via the tri-vestibular approach with a hybrid space-maintaining method: a preliminary report[J]. Head Neck, 2018, 40(8):1774-1779.
[2]	KIM K N, LEE D W, KIM J Y, et al. Carbon dioxide embolism during transoral robotic thyroidectomy: a case report[J]. Head Neck, 2018, 40(3):E25-E28.
[3]	CHEN C M, HUNG I Y, LIU W C, et al. A great variation in the reported incidence of postoperative subcutaneous emphysema in trans-oral vestibular endoscopic thyroidectomy[J]. World J Surg, 2017, 41(10):2647-2648.
[4]	WILHELM T, METZIG A. Endoscopic minimally invasive thyroidectomy (eMIT): a prospective proof-of-concept study in humans[J]. World J Surg, 2011, 35(3):543-551. doi: 10.1007/s00268-010-0846-0 pmid: 21088839
[5]	WANG C, ZHAI H, LIU W, et al. Thyroidectomy: a novel endoscopic oral vestibular approach[J]. Surgery, 2014, 155(1):33-38.
[6]	ANUWONG A. Transoral endoscopic thyroidectomy vestibular approach: a series of the first 60 human cases[J]. World J Surg, 2016, 40(3):491-497. doi: 10.1007/s00268-015-3320-1 pmid: 26546193
[7]	ANUWONG A, KIM H Y, DIONIGI G. Transoral endoscopic thyroidectomy using vestibular approach: updates and evidences[J]. Gland Surg, 2017, 6(3):277-284. doi: 10.21037/gs.2017.03.16 pmid: 28713700
[8]	ANUWONG A, KETWONG K, JITPRATOOM P, et al. Safety and outcomes of the transoral endoscopic thyroidectomy vestibular approach[J]. JAMA Surg, 2018, 153(1):21-27. doi: 10.1001/jamasurg.2017.3366 pmid: 28877292
[9]	ANUWONG A, SASANAKIETKUL T, JITPRATOOM P, et al. Transoral endoscopic thyroidectomy vestibular approach (TOETVA): indications, techniques and results[J]. Surg Endosc, 2018, 32(1):456-465. doi: 10.1007/s00464-017-5705-8 pmid: 28717869
[10]	NAKAJO A, ARIMA H, HIRATA M, et al. Trans-oral video-assisted neck surgery (TOVANS). a new transoral technique of endoscopic thyroidectomy with gasless premandible approach[J]. Surg Endosc, 2013, 27(4):1105-1110. doi: 10.1007/s00464-012-2588-6 pmid: 23179070
[11]	PARK J O, WANG S G, PARK D, et al. The feasibility of a prototype thyroidoscope for gasless transoral endoscopic thyroidectomy: a preclinical cadaver study[J]. J Laparoendosc Adv Surg Tech A, 2019, 29(7):953-957.
[12]	方静, 郑绪才, 陈公仆, 等. 免充气经口腔镜甲状腺切除术24例分析[J]. 中华内分泌外科杂志, 2020, 14(1):13-17.
	FANG J, ZHENG X C, CHEN G P, et al. Analysis of 24 cases of transoral endoscopic thyroidectomy vestibular approach[J]. Chin J Endocr Surg, 2020, 14(1):13-17.
[13]	方静, 郑绪才, 周径, 等. 免充气经口腔镜甲状腺癌根治术的临床研究[J]. 中国普通外科杂志, 2022, 31(11):1430-1436.
	FANG J, ZHENG X C, ZHOU J, et al. Clinical study on radical transoral endoscopic thyroidectomy vestibular approach[J]. China J Gen Surg, 2022, 31(11):1430-1436.
[14]	FANG J, LIU J, ZHENG X, et al. Novel trocars and suspension system application in gasless transoral endoscopic thyroidectomy vestibular approach oral endoscopic surgery[J]. Front Oncol, 2021,11:694133.
[15]	刘松, 方静, 郑绪才, 等. 多功能吸引器在免充气经口腔镜甲状腺癌中央区淋巴结清扫术中的应用[J]. 腹腔镜外科杂志, 2023, 28(3):195-198.
	LIU S, FANG J, ZHENG X C, et al. Application of multifunctional aspirator in central lymph node dissection of thyroid cancer through transoral endoscopic thyroidectomy vestibular approach[J]. J Laparosc Surg, 2023, 28(3):195-198.
[16]	WU Y J, CHI S Y, ELSARAWY A, et al. What is the appropriate nodular diameter in thyroid cancer for extraction by transoral endoscopic thyroidectomy vestibular approach without breaking the specimens? A surgicopathologic study[J]. Surg Laparosc Endosc Percutan Tech, 2018, 28(6):390-393.
[17]	RAZAVI C R, RUSSELL J O. Indications and contraindications to transoral thyroidectomy[J]. Ann Thyroid, 2017, 2(5):12.
[18]	ZHANG D, PARK D, SUN H, et al. Indications, benefits and risks of transoral thyroidectomy[J]. Best Pract Res Clin Endocrinol Metab, 2019, 33(4):101280.
[19]	JITPRATOOM P, KETWONG K, SASANAKIETKUL T, et al. Transoral endoscopic thyroidectomy vestibular approach (TOETVA) for Graves' disease: a comparison of surgical results with open thyroidectomy[J]. Gland Surg, 2016, 5(6):546-552. doi: 10.21037/gs.2016.11.04 pmid: 28149798
[20]	王平, 吴国洋, 田文, 等. 经口腔前庭入路腔镜甲状腺手术专家共识(2018版)[J]. 中国实用外科杂志, 2018, 38(10):21-24.
	WANG P, WU G Y, TIAN W, et al. Expert consensus on transoral endoscopic thyroidectomy vestibular approach (Version 2018)[J]. Chin J Pract Surg, 2018, 38(10):21-24.
[21]	WANG Y, YU X, WANG P, et al. Implementation of intraoperative neuromonitoring for transoral endoscopic thyroid surgery: a preliminary report[J]. J Laparoendosc Adv Surg Tech A, 2016, 26(12):965-971. doi: 10.1089/lap.2016.0291 pmid: 27585396
[22]	CHEN Z X, SONG Y M, CHEN J B, et al. Safety and feasibility of the transoral endoscopic thyroidectomy vestibular approach with neuroprotection techniques for papillary thyroid carcinoma[J]. BMC Surg, 2022, 22(1):270.
[23]	CHAI Y J, CHAE S, OH M Y, et al. Transoral endoscopic thyroidectomy vestibular approach (TOETVA): surgical outcomes and learning curve[J]. J Clin Med, 2021, 10(4):863.
[24]	ZHENG G, MA C, SUN H, et al. Safety and surgical outcomes of transoral endoscopic thyroidectomy vestibular approach for papillary thyroid cancer: a two-centre study[J]. Eur J Surg Oncol, 2021, 47(6):1346-1351. doi: 10.1016/j.ejso.2021.01.028 pmid: 33558121
[25]	ZHENG G, WANG X, WU G, et al. The sensorimotor changes of the lower lip and chin after transoral endoscopic thyroidectomy vestibular approach[J]. Updates Surg, 2021, 73(6):2283-2291. doi: 10.1007/s13304-021-01133-0 pmid: 34287761
[26]	TAN Y, GUO B, DENG X, et al. Transoral endoscopic selective lateral neck dissection for papillary thyroid carcinoma: a pilot study[J]. Surg Endosc, 2020, 34(12):5274-5282.
[27]	NGO D Q, TRAN T D, LE D T, et al. Transoral endoscopic modified radical neck dissection for papillary thyroid carcinoma[J]. Ann Surg Oncol, 2021, 28(5):2766. doi: 10.1245/s10434-020-09466-7 pmid: 33462715