A presentation on the latest technique to remove the thyroid gland; via the transoral route. This novel technique is a form natural orifice trans-endoscopic surgery (NOTES) and is truly scarless. Comparisons with the traditional open and other remote endoscopic techniques are explored.
6. History
• Compressive symptoms
• Malignancy component
• Risk factors
• Red flags
• Cancer spread symptoms
• Thyroid status
• Hyper or hypothyroidism
symptoms
• Past thyroid or neck surgery
7.
8.
9.
10.
11. Graves eye signs
NO SPECS
Class 0 None
Class 1 Only signs (lid retraction ± lag)
Class 2 Soft tissue (conjunctival & lids edema, injection)
Class 3 Proptosis
Class 4 Extraocular muscles involvement
Class 5 Corneal involvement
Class 6 Sight loss (usually CNII)
48. Advantages
• No visible scar
• Minimal skin area dissected, less
bleeding, less infection, less
thickening
Disadvantages
• New technique
• Not for huge goitres
• Potential contamination by oral
cavity bacteria
• Numbness at chin
49. Patients who are not suitable
• Previous radiotherapy to neck
• Previous neck surgery
• Goitre extends into chest
• Goitre stuck to other organs
• Needs extensive lymph node dissection
• Nodule > 6cm
51. Conclusion
• Goitres are common
• Beware of red flag symptoms that suggest malignancy
• Surgery had always been a main treatment option for goitres
• Transoral thyroidectomy avoids a visible neck scar
• Transoral thyroidectomy is the next frontier in thyroid surgery