Asymptomatic carbon dioxide embolism during transoral vestibular thyroidectomy:A case report

BACKGROUND Endoscopic thyroidectomy has obvious advantages over conventional surgical techniques in terms of postoperative cosmetic outcome.Although the incidence of carbon dioxide embolism(CDE)during endoscopic thyroidectomy is very low,it is potentially fatal.The clinical manifestations of CDE vary,and more attention should be paid to this disorder.CASE SUMMARY A 27-year-old man was scheduled for thyroidectomy by the transoral vestibular approach.The patient had no other diseases or surgical history.During the operation,he developed a CDE following inadvertent injury of the anterior jugular vein.The clinical manifestation in this patient was a transient sharp rise in end-tidal carbon dioxide,and his remaining vital signs were stable.In addition,loud coarse systolic and diastolic murmurs were heard over the precordium.The patient was discharged on day 4 after surgery without complications.CONCLUSION A transient sharp rise in end-tidal carbon dioxide is considered a helpful early sign of CDE during endoscopic thyroidectomy.

The pros and cons of additional axillary arm for transoral robotic thyroidectomy

Background:Transoral vestibular approach thyroidectomy using robotic system has advantages with articulating instrumentation.Transoral robotic thyroidectomy(TORT)can be done either using just two robot arms for instruments and an extra one for the endoscopic camera,or using three robot arms for instruments(third arm through axila)and an additional arm for the camera.Pros of additional axillary arm for TORT:The 4th arm through an additional axillary port is mainly responsible for a counter-traction of strap muscles and thyroid tissue.The additional axillary port tract is also an excellent passage for the specimen removal with lower risk of disruption or fragmentation.Ultimately,these merits from the additional axillary arm allows TORT to be performed safely in a wide range of patient groups.Cons of additional axillary arm for TORT:One of the issue with the additional axillary arm in TORT is that it leaves a cutaneous scar.Another issue to consider is the cost.In some places,robotic surgery operation fee varies with the number of arms used during the operation.Retraction of strap muscles through subcutaneous stitches applied after establishing the working space may make up for the lack of counter-traction.Conclusion:TORT can be done safely with or without the transaxillary arm and surgeon may consider pros and cons based on multiple factors.

The role of surgeon-performed ultrasound in transoral endoscopic thyroidectomy vestibular approach(TOETVA)

Transoral Endoscopic Thyroidectomy Vestibular Approach(TOETVA)is a recently described surgical technique where the thyroid and central neck can be accessed without a cutaneous incision.To date nearly 700 cases have been described within the English literature demonstrating the feasibility,safety,and efficacy of the technique.As more institutions begin to adopt the surgical approach,it is important that surgeons pay close attention to appropriate patient selection and surgical optimization to prevent experience-related complications.A valuable tool to facilitate these considerations is the utilization of surgeon-performed ultrasonography(US).While the merits of surgeon-performed US are well-documented within head&neck endocrine surgery as a whole,its value may be of even greater importance when implementing a novel surgical technique such as TOETVA.Here we highlight and summarize the role of surgeon-performed US within head&neck endocrine surgery,focusing on how it may influence patient selection and surgical planning with TOETVA.