Article Summary
This article’s main objective is to compare the Transoral endoscopic vestibular (TOETVA) approach to conventional thyroidectomies in terms of postoperative outcomes. The article also compared operative times concluding that TOETVA is a longer procedure.
TOETVA is a minimally invasive surgery that will not leave a scar on the neck. It is a more cosmetically pleasing alternative for those who need, or elect, to get their thyroid removed. However, according to this article, there is not much of a difference in outcomes of interest besides cosmetic. The outcomes of interests measured include transient recurrent laryngeal nerve palsy, permanent laryngeal nerve palsy, transient and permanent hypocalcemia, number of retrieved lymph nodes, hematoma and wound infection.
In conclusion, the study confirms that TOETVA is a scar free minimally invasive surgery that provides easy access to the bilateral thyroid and central compartment. Operating time was significantly longer in TOETVA which may be due to additional time for port insertion and work- space creation. There were no differences found in recurrent laryngeal nerve damage, hypocalcemia or hematoma between the two methods. TOETVA however is more likely to have a wound infection but this is not statistically significant. TOETVA may also cause mental nerve damage.
Case Presentation
My case presentation was on a 38 y/o F POD#1 of total thyroidectomy. The next day the patient complaint of hoarseness of voice which is likely a complication of a damaged recurrent laryngeal nerve. Below is a SOAP note that I wrote on her.
Procedure: 38 y/o F s/p total thyroidectomy POD 1
S
Pt notes pain with swallowing and hoarse voice since the procedure yesterday morning. Pt given Tylenol and Dilaudid which provided minimal relief. She reports nausea when admitted to the floor last night. It resolved on its own but it returned 30 mins ago. Pt notes 1 episode of voiding. Pt denies Bowel movements, chest pain, SOB or calf pain. Pt has only been eating ice chips.
O
Vitals:
BP: 114/79
HR: 63
Temp: 99.2
RR:18
SpO2: 100%
Wt: 189lb
Ht: 5’7
BMI: 29.6
PE:
General: Alert and oriented x 3
Neck: long horizontal Incision covered with steri-strips. Incision is clean, dry, and tender to palpation
Heart: RRR, no murmurs or gallops
Lungs: Clear to auscultation
Calves: non tender to palpation
A
38 y/o F s/p total thyroidectomy POD 1 appears to be in pain, and has hoarse voice.
P
Plan is to be discharged today,
A speech pathology consult is ordered and is necessary for pt to be discharged.
Pt is encouraged have normal diet and eat breakfast today.
Pain control with PO dilaudid (2 mg, every 4 hours/PRN). Do not use ibuprofen due to increased risk of hematoma
Follow up with same surgeon in 6 days.
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