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IntroductionAlthough transoral endoscopic thyroidectomy (TOETVA) is widely utilized in clinical practice, some problems and restrictions still remain. Our study compared the perioperative features and early surgical efficacy of TOETVA and a modified transoral and submental endoscopic thyroidectomy (TOaST) in early stage papillary thyroid carcinoma (PTC).MethodsThe clinical data of PTC patients who underwent endoscopic thyroidectomy, including 42 modified TOaST patients and 114 traditional TOETVA patients, were retrospectively collected. Propensity score matching was employed to reduce patient selection bias. The perioperative features and early surgical efficacy data of two groups were compared.ResultsThe operation time of the TOaST group was significantly shorter than that of the TOETVA group (150.00 ± 35.47 min vs. 168.75 ± 44.49 min; P = 0.030). Furthermore, the TOaST group required shorter days for a normal diet (3.38 ± 0.93 days vs. 4.04 ± 1.03 days; P = 0.000) and a shorter hospital stay than the TOETVA group (5.85 ± 2.17 days vs. 6.12 ± 2.01 days; P = 0.003). There was no statistical difference in complications between the two groups, but the probability of numbness of the lower lip and chin in the TOaST group was lower than that in the TOETVA group(5.12% vs. 13.04%, P = 0.321). The symptoms of mandibular numbness and hoarseness of most patients were relieved in both groups 6 months after surgery, and no abnormalities and recurrence were found in the thyroid ultrasound. All the patients were satisfied with the appearance of their surgical incision.ConclusionIn early stage PTC patients, TOaST had the same surgical effectiveness as traditional TOETVA but can minimize the probability of mandibular numbness and improve the perioperative quality of life.

BackgroundAlthough transoral thyroidectomy has become popular in thyroid surgery, transoral robotic thyroidectomy (TORT) has only been successfully applied in a very small number of medical centers worldwide.[1,2,3,4,5] In this video, we show a three-port TORT without an axillary incision for papillary thyroid carcinoma.Patient and methodsA 35-year-old female with cT1aN0M0 papillary thyroid carcinoma had a strong motivation to proceed with surgery but avoid external neck incisions. Thus, we decided to perform a hemithyroidectomy with isthmusectomy using a transoral robotic approach, employing the da Vinci Xi surgical system.ResultsThe operation was completed successfully without conversion to open surgery. The working space creation time, docking time, and console time were 30 min, 40 min, and 130 min, respectively. The pathological results were papillary thyroid carcinoma with 6- and 5-mm tumors. The patient was discharged 4 days after surgery without any complications such as bleeding, infection, mental nerve damage, permanent hoarseness, or hypoparathyroidism. The patient was completely satisfied with the cosmetic result.ConclusionThree-port TORT without an axillary incision is a promising approach with optimal cosmetic outcomes. For Vietnam, a developing country, success in the application of TORT using the new da Vinci Xi robotic platform for thyroid cancer is an important milestone in the development of thyroid surgery.

Background: To assess the safety and effectiveness of transoral robotic thyroidectomy (TORT) in thyroid tumor. Methods: PubMed, Embase, Web of Science, SCOPUS, Cochrane database, and Google Scholar up to June 2022. Studies comparing outcomes and complications between TORT and control groups (robotic bilateral axillo-breast, trans-axillary, postauricular approach, conventional open thyroidectomy (OT), and transoral endoscopic approach) were analyzed. Results: Ten studies of 1420 individuals. The operative time (SMD 1.15, 95%CI [0.48; 1.89]) was significantly longer and the number of retrieved lymph nodes (LNs) (SMD −0.27, 95%CI [−0.39; −0.16]) was fewer in TORT than in the control group. The postoperative cosmetic satisfaction score (SMD 0.60, 95%CI [0.28; 0.92]) was statistically higher in TORT than in the control group. In subgroup analysis, there was no significant difference between robotic surgeries. However, TORT had significantly longer operative times (SMD 2.08, 95%CI [0.95; 3.20]) and fewer retrieved LNs (SMD −0.32, 95%CI [−0.46; −0.17]) than OT. TORT satisfied significantly more patients in cosmetic view. However, it increased hospitalization days and postoperative pain on the operation day and first day compared to OT. Conclusions: TORT is not inferior to other robotic-assisted approaches. Its operation time and hospitalization days are longer and postoperative pain is greater than OT, although its cosmetic satisfaction is high.

Abstract Introduction: Thyroid tumours are a common condition and open surgery is a conventional method for treating benign thyroid tumours when surgery is indicated. In this study, we evaluate the outcomes of benign thyroid tumour treatment using transoral endoscopic thyroidectomy via vestibular approach (TOETVA) and compare the results with those of conventional open thyroidectomy (COT). Patients and Methods: We conducted a prospective cohort study between 100 patients who underwent TOETVA and 100 who underwent COT surgery for benign diseases from June 2018 to December 2021 in our hospital. Outcomes between the two groups, including post-operative complications, operative time and length of stay, were compared. Results: The surgical time in the TOETVA group was significantly longer than in the COT group. The operative time of lobectomy in the TOETVA and COT groups was 77.5 ± 13.3 and 51.5 ± 4.2 min, respectively, with a P < 0.001. The operative time of total thyroidectomy in the TOETVA and COT groups was 108.1 ± 7.0 and 65.0 ± 4.1 min, respectively, with a P < 0.001. There was no difference in post-operative length of stay between the two groups. In TOETVA group, there were no patients who converted to open surgery. Amongst all 200 patients in the study, there were no cases of post-operative bleeding. The transient hypoparathyroidism rate after surgery in the TOETVA and COT groups was 3% and 2%, respectively, with no statistically significant difference (P = 0.651). Similarly, the transient recurrent laryngeal nerve injury rate showed no difference between the two groups, with rates of 5% and 4% in the TOETVA and COT groups, respectively (P = 0.733). There were no cases of post-operative infection in either group in our study. At 3 months postoperatively, the cosmetic satisfaction were significantly higher in the endoscopic groups than in the conventional group (P < 0.001). Conclusions: TOETVA is a safe and effective method, with a low complication rate and optimal aesthetic results compared to traditional surgery to treat benign thyroid tumours.

PurposeThere is an increased demand for surgical solutions to treat craniocervical instability. This retrospective study demonstrates the clinical and radiological outcomes of unstable craniocervical junction treated with occipitocervical fusion.Material and methodsThe mean age of 52 females and 48 males was 56.89 years. The clinical and radiological outcomes were assessed, including NDI, VAS, ASIA score, imaging, complications and bony fusion in two used constructs: a modern occipital plate–rod–screw system (n = 59) and previous bilateral contoured titanium reconstruction plates–screws (n = 41).ResultsClinically and on imaging, patients presented with neck pain, myelopathy, radiculopathy, vascular symptoms and craniocervical instability. The mean follow-up was 6.47 years. A solid bony fusion was achieved in 93.81% of the patients. The NDI and the VAS improved significantly from 28.3 and 7.67 at the presentation to 16.2 and 3.47 at the final follow-up. The anterior and posterior atlantodental interval (AADI and PADI), the clivus canal angle (CCA), the occipitoaxial angle (OC2A) and the posterior occipitocervical angle (POCA) improved significantly. Six patients required early revision.ConclusionOccipitocervical fusion can yield excellent results regarding clinical improvement and long-term stability with a high fusion rate. Simple reconstruction plates, though more demanding surgically, achieve similar results. Preserving a neutral patient’s position for fixation avoids postoperative dysphagia and may help prevent adjacent segment disease development.

Purpose To investigate a unique procedure of joined transoral and retropharyngeal high cervical approach (JTRC) without mandibulectomy for treating upper cervical neoplasm involving both C2 and C3. Method A 23-year-old male patient had neoplasma involving C2 and C3 that caused pathologic fracture of C2 and bony destruction of C3. The neoplasm excision and cervical spine reconstruction were performed through JTRC approach without splitting up the mandible. In this approach, there were two surgery windows that could be applied in turns by closing or opening the mouth to gain an ideal exposure. By rotating the mandible, we could gain maximized exposure for either surgery windows. In addition, there was an overlay zone between transoral approach and high cervical retropharyngeal approach that could eliminate the blind area behind the mandible. Results All the procedures were successfully performed; the surgical incisions healed without infection. By operating alternatively between the two surgery windows, we have successfully performed neoplasm excision and cervical spine reconstruction involving both C2 and C3. Pathologic results showed metastatic renal cell cancer to the resected cervical tumor and confirmed the patient’s diagnosis of tuberous sclerosis (Bourneville disease). A 3-month postoperative cervical spine radiography and CT scan demonstrated a favorable placement of the bone implant as well as a favorable instrumentation. Conclusion The JTRC approach could provide good surgical exposure for treating disorders involving both upper and lower cervical spine without splitting up the mandible.

Background Extended endoscopic endonasal operations of the sinuses and the frontal skull base require a bimanual action of the surgeon in many cases. Thus, typically an assistant guides the endoscope and centers the field of view. In this study, we investigate in which cases an endoscope holding arm can be used alternatively. Materials and methods The electromagnetic system ENDOFIXexo was used in different surgical interventions of the paranasal sinuses and beyond questioning ergonomics and geometrical limitations. The realized degrees of freedom were documented, and a topography of possible applications compiled. Results The presented system is limited by the anatomy of the anterior ethmoid and dynamic working conditions in the sagittal direction. Especially in extended interventions in the posterior ethmoid, in which parts of the nasal septum have been resected and a static position of the endoscope is desired the surgeon can greatly benefit from the robotic arm. Moreover, through the high flexibility of the endoscopic arm surgeries of the pharynx and larynx were performed, questioning the current gold standard of microscope-assisted surgical procedures. Conclusion Under the impression of an urging staff shortage and due to its unlimited patience, the ENDOFIXexo arm seems promising. Taking into account the complex anatomy and the limited access, we especially see a favorable field of application in the surgery of the pituitary gland and skull base tumors.

Endoscopic surgery is useful and helpful especially to access areas with limited visibility. The combination of this technique with innovative approaches could be the solution to improve quality of surgery and patients’ outcome. This study aimed to illustrate how Endoscopic-Assisted Transoral Approach (EATA) can be used to successfully remove specific extracranial tumors with defined characteristics. Eleven patients with extracranial tumors underwent surgical resection using an EATA between 2003 and 2025. All patients underwent clinical examination and fiberoptic laryngoscopy. Preoperative CT and/or MRI was performed in all cases. All patients were successfully treated utilizing an EATA. Histological examination revealed nine parapharyngiomas, comprising five pleomorphic adenomas, two schwannomas, one ectopic thyroid gland, one lipoma, one masticator space schwannoma, and one nasopharyngeal pleomorphic adenoma. No intra-operative nor peri-operatory complications were observed. The only long-term sequela observed was Horner’s syndrome in the two schwannomas originating from the parapharyngeal-carotid space. The mean hospital stay was 2.6 days, while the mean follow-up duration was 9.8 years. The EATA represents a valid surgical technique for the treatment of benign, encapsulated, and non-vascular parapharyngeal space (PPS) tumors exhibiting posterior displacement of major vessels. This approach may also prove beneficial for the management of other benign, encapsulated, and non-vascular tumors located in the nasopharynx and masticator space.

Introduction The surge in the popularity of midface and temporal lifting procedures can be attributed to evolving social media trends and heightened patient expectations, particularly among younger individuals seeking “beautification” rather than traditional rejuvenation. Scarless techniques, such as transtemporal/transoral approaches, are increasingly preferred. This study aimed to combine the advantages of both superficial and deep dissection planes in midface and temporal lifting procedures. Methods This retrospective study included 184 patients who underwent surgery using a dual-plane midface and temporal lift technique. Preoperative and postoperative assessments, including P1/P2 ratio calculations, were performed to evaluate volumetric distribution in the midface. Results The study cohort exhibited a significant improvement in the P1/P2 ratio postoperatively ( p < 0.05), indicating successful volume redistribution. Complications, including hypoesthesia, bruising, and infection, were managed effectively. Minor asymmetries were observed, with revisions offered, but declined by the patient. Discussion This technique offers hidden incisions and reduces the risk of scar-related complications, making it suitable for patients seeking facial enhancement. Addressing the tear trough area and the lateral canthus provides comprehensive facial rejuvenation. The dual-plane approach facilitates both skin mobilization and volume shift, yielding favorable aesthetic outcomes. Conclusions The dual-plane midface and temporal lift technique presented in this study offers a bi-vectoral approach to midfacial lifting, suitable for both beautification and rejuvenation goals. Despite the potential limitations, including infection risk, this method is an effective option for facial enhancement. Level of Evidence II This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors  www.springer.com/00266 .

Background Transoral atlantoaxial reduction plate (TARP) fixation or occipitocervical fixation (OF) is an effective treatment for basilar invagination (BI) with irreducible atlantoaxial dislocation (IAAD). But, all current clinical studies involved a single surgical procedure. The clinical effects of TARP and OF operation for BI with IAAD have yet to be compared. We therefore present this report to compare the treatment of TARP and OF procedure for BI with IAAD. Methods Fifty-six patients with BI with IAAD who underwent TARP or OF operation from June 2011 to June 2017 were retrospectively analyzed. Among these, 35 patients underwent TARP operation (TARP group), and 21 patients underwent OF operation (OF group). We compared the difference of clinical, radiological, and surgical outcomes between the TARP and OF groups postoperatively. Results Compared with OF group, the operative time and blood loss in TARP group were lower. There was no statistical difference in the atlantodental interval (ADI), clivus canal angle (CCA), cervicomedullary angle (CMA), distance between the top of the odontoid process and the Chamberlain line (CL) and Japanese Orthopaedic Association (JOA) score between the TARP and OF groups preoperatively, but the improvements of these parameters in the TARP group were superior to those in the OF group postoperatively. The fusion rates were higher in the TARP group than those in the OF group at the early stage postoperatively. Conclusions TARP and OF operations are effective surgical treatment for BI with IAAD, but the performance of reduction and decompression and earlier bone fusion rates of TARP procedure are superior to those of OF.