Endocrine Abstracts

Recent progress in surgical technology has resulted in new techniques as transoral endoscopic thyroidectomy (TOETVA) that is an option for patients’ cosmetic requests. We evaluated patients with thyroid cancer who underwent thyroidectomy by TOETVA approach and their follow-up. Retrospective study, 5 patients were included, Bethesda classification in FNAC resulted: 2 patients with VI category (CAT), 2: V CAT and 1: III CAT. All patients were operated by TOETVA between 2020-2021. Median age: 48 years (36-64). Median nodules size was: 13.5 mm (7.7-23). No patients presented adenopathies. Total thyroidectomy was performed by TOETVA in 4 patients, one patient required conversion to open thyroidectomy. Hemithyroidectomy was performed in the patient with III CAT, the pathology report resulted in follicular carcinoma and she was later operated by conventional approach. Median size of malignant tumors was 14.7 mm (12-21). Of the 2 patients with VI CAT: 1 had a classical papillary carcinoma, the other one had a follicular variant of papillary carcinoma. Of the two patients with V CAT, 1 had a classical follicular carcinoma and the other one had a nodular goiter; the patient with III CAT had a clear cell variant of follicular carcinoma. In 3 patients the thyroid capsule was absent in some areas, predominantly in the posterior margin. In 4 patients we observed electrocautery effects and tissue attrition. Postoperative complications were: inferior lip insensitivity (5/5), hypogeusia (4/5), mild to soft pain and hematoma in the neck (5/5), suffocating hematoma (1/5), hypoparathyroidism (3/5); all complications were transient. Four patients underwent I-131 therapy; post-therapeutic WBS showed higher and nodular uptake in the neck compared with the patients with conventional thyroidectomy. Stimulated thyroglobulin (TG) was normal in 3 patients and 1 had elevated TG. In the follow-up, only the patient with clear cell variant of follicular carcinoma had increased TG and presented recurrence in the neck, so she was operated again and later received radiotherapy. The remaining patients had normal ultrasonography and TG below 1.

Conclusions: patient selection is very important in TOETVA approach. The cosmetic objective of TOETVA was reached; the complications were different, probably related to the learning curve required for surgeons. Except the patient with the aggressive follicular carcinoma, the patients’ follow-up was satisfactory. However, we need more patients and longer follow-ups to determine if the higher and different RAI uptake in the neck scan and the histological findings have an impact in the long follow-up of these patients.