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1

Kim, Hong Kyu, Hoon Yub Kim, Young Jun Chai, Gianlorenzo Dionigi, Eren Berber, and Ralph P. Tufano. "Transoral Robotic Thyroidectomy." Surgical Laparoscopy, Endoscopy & Percutaneous Techniques 28, no. 6 (December 2018): 404–9. http://dx.doi.org/10.1097/sle.0000000000000587.

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2

Park, Dawon, Hong Kyu Kim, and Hoon Yub Kim. "Transoral Robotic Thyroidectomy." International Journal of Thyroidology 11, no. 1 (2018): 26. http://dx.doi.org/10.11106/ijt.2018.11.1.26.

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3

Ng, Wai-Tat. "Transoral endoscopic thyroidectomy." Surgical Practice 17, no. 2 (April 14, 2013): 77–78. http://dx.doi.org/10.1111/1744-1633.12011.

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4

Giorgio Calò, Pietro, Fabio Medas, Gian Luigi Canu, and Enrico Erdas. "Monitored transoral endoscopic thyroidectomy." Gland Surgery 8, no. 4 (August 2019): 318–21. http://dx.doi.org/10.21037/gs.2018.07.07.

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5

Zhang, Daqi, Hoon Yub Kim, Ralph P. Tufano, and Gianlorenzo Dionigi. "Single port transoral thyroidectomy." Gland Surgery 9, no. 2 (April 2020): 159–63. http://dx.doi.org/10.21037/gs.2020.01.09.

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6

Shaha, Ashok R. "Transoral thyroidectomy-learning curve." Archives of Endocrinology and Metabolism 65, no. 3 (June 2021): 255–56. http://dx.doi.org/10.20945/2359-3997000000382.

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7

Jamikorn, Tanyanan, and Angkoon Anuwong. "Transoral Endoscopic Thyroidectomy (TOETVA)." Current Otorhinolaryngology Reports 7, no. 3 (July 22, 2019): 209–18. http://dx.doi.org/10.1007/s40136-019-00250-0.

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8

Seo, Woogeun, Yong Bae Ji, Kyung Tae, and Chang Myeon Song. "Transoral Robotic Lingual Thyroidectomy." International Journal of Thyroidology 15, no. 2 (November 30, 2022): 116–20. http://dx.doi.org/10.11106/ijt.2022.15.2.116.

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9

Zalazar, Alejandro M., Javier L. Rossi, José M. Moreno Negri, and Francisco Santucho Saravia. "Tiroidectomía transoral endoscópica por abordaje vestibular." Revista Argentina de Cirugía 112, no. 2 (June 1, 2020): 185–88. http://dx.doi.org/10.25132/raac.v112.n2.1439.es.

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Natural orifice transluminal endoscopic surgery (NOTES) was applied for the first time by K. Witzel in 2008, introducing the transoral endoscopic resection of the thyroid gland in human cadavers and living pigs. In 2016, A. Anuwong published the first case series using the vestibular approach in humans. We report the case of a 37-year-old female patient with a mass in the anterior aspect of the neck which appeared two months before consultation. The thyroid ultrasound reported multinodular goiter. The fine-needle aspiration (FNA) biopsy reported hyperplastic follicular nodule in both lobes. The patient underwent transoral endoscopic thyroidectomy by vestibular approach. Operative time was 180 minutes and blood loss was 20 mL. Pain was minimal and hospital stay was 36 hours. We report our first experience with total thyroidectomy in a patient with benign thyroid nodules.
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10

Fernandez-Ranvier, Gustavo, Aryan Meknat, Daniela E. Guevara, and William B. Inabnet. "Transoral Endoscopic Thyroidectomy Vestibular Approach." JSLS : Journal of the Society of Laparoendoscopic Surgeons 23, no. 4 (2019): e2019.00036. http://dx.doi.org/10.4293/jsls.2019.00036.

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11

Witzel, Kai, Achim Hellinger, Cornelia Kaminski, and Tahar Benhidjeb. "Endoscopic thyroidectomy: the transoral approach." Gland Surgery 5, no. 3 (June 2016): 336–41. http://dx.doi.org/10.21037/gs.2015.08.04.

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12

Kim, Wan Wook. "Transoral Thyroidectomy: Advantages and Disadvantages." Journal of Minimally Invasive Surgery 23, no. 3 (September 15, 2020): 112–13. http://dx.doi.org/10.7602/jmis.2020.23.3.112.

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13

Le, Quang V., Duy Q. Ngo, Toan D. Tran, and Quy X. Ngo. "Transoral Endoscopic Thyroidectomy Vestibular Approach." Surgical Laparoscopy, Endoscopy & Percutaneous Techniques 30, no. 3 (June 2020): 209–13. http://dx.doi.org/10.1097/sle.0000000000000764.

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14

Erinjeri, Neeta J., and Robert Udelsman. "Transoral Endoscopic Thyroidectomy Vestibular Approach." Advances in Surgery 53 (September 2019): 179–93. http://dx.doi.org/10.1016/j.yasu.2019.04.009.

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15

Abeywardana, Charaka Yapa, and Ramya Amarasena. "Anaesthesia for Transoral Endoscopic Thyroidectomy." Sri Lankan Journal of Anaesthesiology 26, no. 2 (July 15, 2018): 159. http://dx.doi.org/10.4038/slja.v26i2.8342.

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16

Dionigi, G., R. P. Tufano, J. Russell, H. Y. Kim, E. Piantanida, and A. Anuwong. "Transoral thyroidectomy: advantages and limitations." Journal of Endocrinological Investigation 40, no. 11 (April 21, 2017): 1259–63. http://dx.doi.org/10.1007/s40618-017-0676-0.

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17

Hong, Yong Tae. "Benefits and Limitations in Transoral Endoscopic Thyroidectomy." Korean Journal of Otorhinolaryngology-Head and Neck Surgery 66, no. 1 (January 21, 2023): 1–6. http://dx.doi.org/10.3342/kjorl-hns.2022.01018.

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Transoral endoscopic thyroidectomy (TOET) is the recent remote access approach which leaves no cutaneous scar in the body. It has advantages in minimize the surgical dissection, could perform total thyroidectomy and central lymph node dissection easily under a good surgical view. TOET has gained popularity in both the East and Western countries since the first large series report by Dr. Anuwong in 2016. In this article we described and critically analyze the indications and contraindications, advantages and limitations, landmarks for recurrent laryngeal nerve and strategies for superior pole dissection in transoral thyroidectomy.
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18

Shah, Kshitij, Shivali Patekar, Tejal Patel, and Renuka Bradoo. "Feasibility of Transoral Thyroidectomy by Vestibular Approach." Bengal Journal of Otolaryngology and Head Neck Surgery 28, no. 1 (April 30, 2020): 67–70. http://dx.doi.org/10.47210/bjohns.2020.v28i1.176.

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Introduction An open approach to thyroidectomies through neck provides good exposure and safe dissection however, the patient still has a scar. Endoscopic thyroid surgery has been practised since the late 90s. The latest addition is the transoral endoscopic thyroidectomy by vestibular approach. Materials and Methods We at our centre performed this surgery on 3 patients. Here we present our initial experience of transoral endoscopic thyroidectomy by vestibular approach (TOETVA). Results Two of the three patients did not have any complication. Diffuse bleeding was encountered during one instance and decision was taken to convert it into an open procedure. Conclusion The preliminary experience of transoral thyroidectomy by vestibular approach shows it to be a feasible and promising ‘scarless’ and ‘minimally invasive’ surgery.
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19

Liang, Tsung-Jung, Kuo-Chiang Wang, Nai-Yu Wang, I.-Shu Chen, and Shiuh-Inn Liu. "Indocyanine Green Angiography for Parathyroid Gland Evaluation during Transoral Endoscopic Thyroidectomy." Journal of Personalized Medicine 11, no. 9 (August 27, 2021): 843. http://dx.doi.org/10.3390/jpm11090843.

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Indocyanine green (ICG) angiography, a real-time intraoperative imaging technique, is associated with better parathyroid identification and functional evaluation during open thyroidectomy. However, the benefits of ICG fluorescence imaging application in transoral endoscopic thyroidectomy are not well-documented. Consecutive patients who underwent transoral endoscopic thyroidectomy were retrospectively reviewed. Parathyroid glands were assessed with visual inspection followed by ICG angiography. The fluorescence intensity of all parathyroid glands was recorded. In total, 158 parathyroid glands from 60 patients (41 underwent lobectomy and 19 underwent total thyroidectomy) were eligible for evaluation. A total of 135 parathyroid glands (85.4%) were identified, including nine glands (5.7%) that were solely localized because of ICG angiography. Incidental parathyroidectomy occurred in 12 patients with predominant inferior gland (83.3%) and associated with central neck dissection (66.7%). Among patients receiving total thyroidectomy, patients who retained at least one well-perfused parathyroid gland had higher parathyroid hormone (PTH) level and were less likely to develop hypoparathyroidism on postoperative day one than those without any well-perfused ICG-enhanced parathyroid gland (p = 0.038). In addition, the duration of calcium supplementation to maintain normocalcemia was also shorter. ICG angiography is a feasible adjunct procedure for parathyroid identification and postoperative functional prediction in transoral endoscopic thyroidectomy.
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20

Anuwong, Angkoon. "Transoral endoscopic thyroidectomy—essentiality of classification." Translational Cancer Research 6, S2 (March 2017): S450—S452. http://dx.doi.org/10.21037/tcr.2017.03.55.

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21

Dionigi, Gianlorenzo, Matteo Lavazza, Chei-Wei Wu, Hui Sun, Xiaoli Liu, Ralph P. Tufano, Hoon Yub Kim, Jeremy D. Richmon, and Angkoon Anuwong. "Transoral thyroidectomy: why is it needed?" Gland Surgery 6, no. 3 (June 2017): 272–76. http://dx.doi.org/10.21037/gs.2017.03.21.

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22

Razavi, Christopher R., and Jonathon O. Russell. "Indications and contraindications to transoral thyroidectomy." Annals of Thyroid 2 (2017): 12. http://dx.doi.org/10.21037/aot.2017.10.01.

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23

Wu, Che-Wei, Antonio Giacomo Rizzo, Vincenzo Bartolo, Francesca Pia Pergolizzi, Massimo Marullo, Antonino Cancellieri, Giuseppinella Melita, Antonina Catalfamo, and Gianlorenzo Dionigi. "Energy based devices for transoral thyroidectomy." Annals of Thyroid 3 (February 10, 2018): 4. http://dx.doi.org/10.21037/aot.2018.01.02.

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24

Huang, Tzu-Yen, Antonina Catalfamo, Che-Wei Wu, Feng-Yu Chiang, and Gianlorenzo Dionigi. "Neural monitoring in transoral endoscopic thyroidectomy." Annals of Thyroid 3 (March 2018): 7. http://dx.doi.org/10.21037/aot.2018.03.01.

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25

Jongekkasit, Isariya, Pornpeera Jitpratoom, Thanyawat Sasanakietkul, and Angkoon Anuwong. "Transoral Endoscopic Thyroidectomy for Thyroid Cancer." Endocrinology and Metabolism Clinics of North America 48, no. 1 (March 2019): 165–80. http://dx.doi.org/10.1016/j.ecl.2018.11.009.

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26

Pai, Vishwanath M., Pari Muthukumar, Apoorva Prathap, Jayanth Leo, and Rekha A. "Transoral endoscopic thyroidectomy: A case report." International Journal of Surgery Case Reports 12 (2015): 99–101. http://dx.doi.org/10.1016/j.ijscr.2015.04.010.

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27

Lee, Hye Yoon, Ji Young You, Sang Uk Woo, Gil Soo Son, Jae Bok Lee, Jeoung Won Bae, and Hoon Yub Kim. "Transoral periosteal thyroidectomy: cadaver to human." Surgical Endoscopy 29, no. 4 (August 15, 2014): 898–904. http://dx.doi.org/10.1007/s00464-014-3749-6.

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28

Zhang, D., E. Caruso, H. Sun, A. Anuwong, R. Tufano, G. Materazzi, G. Dionigi, and H. Y. Kim. "Classifying pain in transoral endoscopic thyroidectomy." Journal of Endocrinological Investigation 42, no. 11 (June 11, 2019): 1345–51. http://dx.doi.org/10.1007/s40618-019-01071-0.

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29

Wang, Dun, Yichao Wang, Shengliang Zhou, Xueting Liu, Tao Wei, Jingqiang Zhu, and Zhihui Li. "Transoral thyroidectomy vestibular approach versus non-transoral endoscopic thyroidectomy: a comprehensive systematic review and meta-analysis." Surgical Endoscopy 36, no. 3 (November 8, 2021): 1739–49. http://dx.doi.org/10.1007/s00464-021-08836-w.

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30

Zhou, Silvia, and Wymen Chen. "Dr. Insoo Suh: my thoughts on transoral endoscopic thyroidectomy vestibular approach and transoral and submental thyroidectomy." Annals of Laparoscopic and Endoscopic Surgery 4 (August 2019): 13. http://dx.doi.org/10.21037/aot.2019.07.02.

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31

Cuello, Natalia L., Sergio C. Gentile, and Gustavo Fernández Ranvier. "Primera tiroidectomía transoral vestibular endoscópica (TOETVA) en la Argentina." Revista Argentina de Cirugía 111, no. 4 (December 1, 2019): 284–88. http://dx.doi.org/10.25132/raac.v111.n4.1412es.

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A 53-year-old female patient with a 40-mm nodule in the left thyroid lobe underwent surgery using the transoral endoscopic thyroidectomy vestibular approach (TOETVA) because she was particularly interested in the cosmetic results. She evolved with excellent postoperative outcome. We review the literature dealing with this approach and report the first case in our country
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32

Kim, Mi Ra, Yeong Jun Park, Byung Whoo Park, Taekyung Suh, Sang-Yeon Kim, Tae Hoon Moon, Dong Hyun Lee, and Jun-Ook Park. "Can Voice Pitch Be Preserved in Patients after Transoral Endoscopic Thyroidectomy Vestibular Approach?" Journal of Clinical Medicine 9, no. 9 (August 27, 2020): 2777. http://dx.doi.org/10.3390/jcm9092777.

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Introduction: Transoral endoscopic thyroidectomy vestibular approach (TOETVA) has become increasingly popular. Several reports have emphasized the safety and efficacy of this new approach. However, there is no report on functional voice outcomes, including voice pitch change after TOETVA. Methods: The functional voice outcomes of patients undergoing TOETVA were compared with those of patients undergoing conventional thyroidectomy. A total of 82 consecutive patients were included in the study: 44 underwent thyroid lobectomy via TOETVA (transoral group) and 38 underwent thyroid lobectomy via the classic cervical approach (open group). Thyroidectomy-related voice questionnaire (TVQ), perceptual voice analysis, fiberoptic laryngoscopic and videolaryngostroboscopic examinations, and acoustic analysis were carried out before and one month after surgery. The changes in these values after surgery and the differences between the transoral and open groups were analyzed. Results: We found no significant postoperative change in voice workups in either group. The mean high pitch decreased (from 367.91 ± 120.98 to 325.80 ± 100.86 Hz, p = 0.069) in the transoral group, but statistical significance was not attained. Clinically significant changes in pitch (postoperative change in speaking fundamental frequency, ΔSFF ≥ 12) after surgery were evident in seven (15.91%) patients in the transoral group and eight (21.05%) patients in the open group without significant difference (p = 0.579). Conclusions: This is the first study to assess functional voice outcomes (including pitch) after TOETVA compared with conventional open surgery. TOETVA was associated with good voice outcomes without any significant drop in pitch.
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33

Kadem, Sadq G., Sarmad M. Habash, and Ali H. Jasim. "Transoral Endoscopic Thyroidectomy via Vestibular Approach: A series of the first ten cases in Iraq." Sultan Qaboos University Medical Journal [SQUMJ] 19, no. 1 (May 30, 2019): 68. http://dx.doi.org/10.18295/squmj.2019.19.01.013.

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Transoral endoscopic thyroidectomy was first described as an experimental sublingual approach. This approach was modified to a vestibular approach to avoid complications. In this report, we describe the results of the first ten cases of a transoral endoscopic thyroidectomy via vestibular approach (TOETVA) performed in Iraq. All operations were performed at Al Shifa General Hospital, Basrah, Iraq, in 2017 using three laparoscopic ports inserted at the oral vestibule. One out of ten patients underwent a near total thyroidectomy, the remaining cases underwent thyroid lobectomies. The average operative time was 113.5 minutes and the average duration of hospital stay was 41.9 hours. One case of mild cervical emphysema and one case of temporary mental nerve palsy were reported but both were treated conservatively without permanent sequelae. In conclusion, TOETVA is a safe, feasible procedure with an excellent cosmetic outcome when the patients are selected carefully.Keywords: Thyroidectomy; Endoscopy; Mouth; Robotics; Case Reports; Iraq.
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34

Lee, Dong Won, Jeong Kyu Kim, Seung Heon Shin, and Kyung Tae. "Application of Ultrasonography for Safe Flap Elevation at the Learning Period of Transoral Thyroidectomy: A Technical Report." Korean Journal of Otorhinolaryngology-Head and Neck Surgery 65, no. 3 (March 21, 2022): 180–85. http://dx.doi.org/10.3342/kjorl-hns.2021.01053.

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Transoral thyroidectomy using the vestibular approach has achieved excellent cosmetic outcomes without leaving any visible scars. However, concerns have been raised on how to prevent complications, such as skin perforation and anterior jugular vein injury, especially in the learning period. This is because working space is generally created via blind and blunt dissection using a blunt dilator through small vestibular incisions unfamiliar to beginners. Herein, we explain an intraoperative real-time ultrasound technique employed in transoral thyroidectomy to safely elevate a skin flap while avoiding any damage to the flap and anterior jugular vein in the learning period.
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35

Wang, Yichao, Shengliang Zhou, Xueting Liu, Shu Rui, Zhihui Li, Jingqiang Zhu, and Tao Wei. "Transoral endoscopic thyroidectomy vestibular approach vs conventional open thyroidectomy: Meta‐analysis." Head & Neck 43, no. 1 (October 12, 2020): 345–53. http://dx.doi.org/10.1002/hed.26486.

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36

Kaczka, Krzysztof, and Lech Pomorski. "New Techniques in Thyroid Surgery – Critical Evaluation." Polish Journal of Surgery 91, Suplement 1 (May 30, 2019): 12–16. http://dx.doi.org/10.5604/01.3001.0013.2092.

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Introduction: Operations due to benign and malignant thyroid neoplasms constitute a significant percentage of operations in general and oncological surgery wards. Therefore, unsurprisingly, better and better methods are being sought to avoid the occurrence of two major complications after those operations, i.e. laryngeal nerve palsy and hypoparathyroidism and new minimally invasive accesses. M aterial and methods: Authors searched MEDLINE database using the following search terms: modern technologies AND/ OR thyroid surgery AND/OR intermittent neuromonitoring AND/OR continuous neuromonitoring AND/OR parathyroid preservation AND/OR transoral endoscopic thyroidectomy AND/OR TOETVA. Results: The paper discusses the following new techniques of thyroid surgery with particular focus on limitations: neuromonitoring, narrowband imaging, fluorescence angiography and transoral endoscopic thyroidectomy by vestibular approach. Conclusions: Some of the new techniques are highly clinically useful. Their use can become a routine element of standard thyroidectomy.
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37

Nomine-Criqui, C., and L. Brunaud. "And now… thyroidectomy through a transoral approach!" Journal of Visceral Surgery 158, no. 2 (April 2021): 101–2. http://dx.doi.org/10.1016/j.jviscsurg.2021.02.005.

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38

Benhidjeb, Tahar, Michael Stark, Isabel Gerntke, Ospan Mynbaev, and Kai Witzel. "Transoral thyroidectomy—from experiment to clinical implementation." Translational Cancer Research 6, S1 (February 2017): S174—S178. http://dx.doi.org/10.21037/tcr.2017.01.23.

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39

Stark, Michael, and Tahar Benhidjeb. "The NESA transoral thyroidectomy at a crossroad." Gland Surgery 9, no. 5 (October 2020): 1170–71. http://dx.doi.org/10.21037/gs-20-549.

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40

Richmon, Jeremy D., and Hoon Yub Kim. "Transoral robotic thyroidectomy (TORT): procedures and outcomes." Gland Surgery 6, no. 3 (June 2017): 285–89. http://dx.doi.org/10.21037/gs.2017.05.05.

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41

Benhidjeb, Tahar. "Transoral Endoscopic Thyroidectomy with Central Neck Dissection." Chinese Medical Journal 128, no. 13 (July 2015): 1838. http://dx.doi.org/10.4103/0366-6999.159366.

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42

Gryaznov, S. E., G. G. Melkonyan, A. M. Shulutko, V. I. Semikov, E. G. Osmanov, and E. G. Gandybina. "TRANSORAL THYROIDECTOMY AND PARATHYROIDECTOMY: SERIES OF CASES." Novosti Khirurgii 29, no. 3 (July 25, 2021): 382–91. http://dx.doi.org/10.18484/2305-0047.2021.3.382.

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Objective. To present the results of the author’s own series of transoral operations in patients with pathology of the thyroid and parathyroid glands. Methods. Transoral surgery was performed in women (n=20) and (n=1) man. All patients were operated on for the primary disease and met the selection criteria based on ultrasound and cytological examinations, hormonal levels, and somatic status. Indications for surgery were: nodular goiter in 17 cases, diffuse toxic goiter - in 2 cases, parathyroid adenoma - in 2 cases. The surgical technique included a three-port approach in the lower fornix of the vestibule of the mouth and a gas technique for maintaining the working cavity. Standard laparoscopic instruments and an energy based ultrasonic device were used for the operation. In the postoperative period, patients underwent a test for subjective assessment of the aesthetic result of the operation using the survey of thedermatology life quality index. Results. Thyroidectomy was performed in 4 patients, hemithyroidectomy - in 15 patients and parathyroidectomy - in 2 patients. In one patient, transoralparathyroidectomy was performed as a part of a simultaneous operation for multiple endocrine neoplasia type 1 syndrome. Papillary cancer T1N0M0 was verified in two patients after surgery. The mean operation time was 196.1 min (range 110 - 300 min). Average blood loss - 3 9.5 ml (range 10 - 300 ml). The nineth operation required the conversion due to severebleeding. In one case, the temporary recurrent laryngeal nerve(RLN)injury was reported, in one case - hematoma. After surgery, the median and average values of thedermatology life quality index were 1 (IQR 0-4) and 2.05, respectively, which indicates an insignificant effect on the quality of life. Conclusion. Transoral endoscopic surgery on the thyroid and parathyroid glands would be thepromising optimal choice in patients to avoid scarring on the neck.
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43

Park, Jun-Ook, Mi-Ra Kim, Do Hun Kim, and Dong Kun Lee. "Transoral endoscopic thyroidectomy via the trivestibular route." Annals of Surgical Treatment and Research 91, no. 5 (2016): 269. http://dx.doi.org/10.4174/astr.2016.91.5.269.

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44

Kim, Hong Kyu, Dawon Park, and Hoon Yub Kim. "Robotic transoral thyroidectomy for papillary thyroid carcinoma." Annals of Surgical Treatment and Research 96, no. 5 (2019): 266. http://dx.doi.org/10.4174/astr.2019.96.5.266.

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45

Dionigi, Gianlorenzo, Alessandro Bacuzzi, Matteo Lavazza, Davide Inversini, Luigi Boni, Stefano Rausei, Hoon Yub Kim, and Angkoon Anuwong. "Transoral endoscopic thyroidectomy: preliminary experience in Italy." Updates in Surgery 69, no. 2 (April 12, 2017): 225–34. http://dx.doi.org/10.1007/s13304-017-0436-x.

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46

Kwek, James Wei Ming, Maria Judith Pang, and Harold H. W. Heah. "Pneumoperitoneum after transoral endoscopic thyroidectomy vestibular approach." Laryngoscope Investigative Otolaryngology 5, no. 3 (May 30, 2020): 580–83. http://dx.doi.org/10.1002/lio2.393.

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47

Zhang, Daqi, Dawon Park, Hui Sun, Angkoon Anuwong, Ralph Tufano, Hoon Yub Kim, and Gianlorenzo Dionigi. "Indications, benefits and risks of transoral thyroidectomy." Best Practice & Research Clinical Endocrinology & Metabolism 33, no. 4 (August 2019): 101280. http://dx.doi.org/10.1016/j.beem.2019.05.004.

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48

Chen, Lena W., Christopher R. Razavi, Hanna Hong, Akeweh Fondong, Rohit Ranganath, Surya Khatri, Wojciech K. Mydlarz, et al. "Cosmetic outcomes following transoral versus transcervical thyroidectomy." Head & Neck 42, no. 11 (August 6, 2020): 3336–44. http://dx.doi.org/10.1002/hed.26383.

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49

Chang, Brent A., Ameya A. Asarkar, and Cherie‐Ann O. Nathan. "What is the Role of Transoral Thyroidectomy?" Laryngoscope 130, no. 9 (February 21, 2020): 2096–97. http://dx.doi.org/10.1002/lary.28578.

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50

Alnehlaoui, Fadi, and Salman Yousuf Guraya. "Transoral and submental thyroidectomy using intraoperative nerve stimulation and indocyanin green fluorescence imaging." BMJ Case Reports 14, no. 8 (August 2021): e243306. http://dx.doi.org/10.1136/bcr-2021-243306.

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Abstract:
There is a recent proliferation of clinical studies about the minimally invasive scarless thyroid surgery. The transoral endoscopic thyroidectomy vestibular approach (TOETVA) carries a great potential for being scarless surgery via a short dissection flap. However, TOETVA has limitations in extracting larger thyroid tumours via the transoral vestibular incision and due to its potential damage to the branches of the mental nerve. The rapidly evolving surgical innovations have now introduced transoral and submental thyroidectomy (TOaST) approach that allows extraction of large thyroid tumours with less flap dissection and minimal postoperative pain. We present a 39-year-old man with a large multinodular goitre. The patient was euthyroid with moderate to severe compression symptoms of difficulty in breathing and swallowing. We performed a TOaST procedure using intraoperative neuromonitoring and indocyanin green fluorescence imaging with an uneventful recovery. This is a first case report from the middle east region that will pave the way to large clinical trials to determine the efficacy and safety of TOaST.
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