LAUSR

In the past decade, transoral thyroidectomy has been introduced as an alternative to traditional open thyroidectomy for patients who wish to avoid a cutaneous scar. Initial experiences with transoral endoscopic thyroidectomy vestibular approach (TOETVA) as well as a similar approach using robotic instrumentation were reported from Asia. Since these initial reports, transoral thyroidectomy has been increasingly adopted in several centers worldwide. Initial studies of transoral thyroidectomy aimed to examine its safety by measuring the incidence of overt complications. Compared to traditional open thyroidectomy, transoral thyroidectomy has been shown to have similar rates of recurrent laryngeal nerve palsy and hypoparathyroidism, but introduces a small number of new risks such as mental nerve injury. More recently, as in the study by Liang and colleagues published in the most recent issue of this journal, surgeons have begun to explore more subtle outcomes related to transoral thyroidectomy. In their study, the authors prospectively examined sensory changes in the lower face and neck in 51 patients who underwent TOETVA [1]. Each patient underwent a questionnaire, the Semmes–Weinstein monofilament test, and the two-point discrimination test to assess sensory changes before and after surgery. In the patient questionnaire, sensory change was most commonly reported in the chin area, and these changes mostly resolved by six months after surgery. The monofilament test and two-point discrimination test also found that chin sensation was significantly reduced in the immediate postoperative setting. Sensation generally returned to baseline by three months, but five patients experienced sensory change beyond three months. Prolonged sensory change was associated with male sex and older age. The authors hypothesized that the transoral approach in men may require additional force for straight surgical instruments to overcome a more prominent jaw and thyroid cartilage, resulting in greater potential trauma to the mental nerves. Liang et al. also found that sensation in the upper neck was significantly reduced when assessed with the Semmes– Weinstein monofilament test and the two-point discrimination test, although neck sensation returned to the preoperative baseline by three months. Their findings echoed those from a 2020 study by Tae et al. that also observed altered sensation in the upper neck after transoral thyroidectomy [2]. The authors of both studies hypothesize that the sensory changes in the neck may be related to the use of blunt dissection to create a working space in transoral thyroidectomy, which disrupts small sensory nerves in the neck. Beyond sensory changes in the face and neck, studies have examined other facets of the patient experience after transoral thyroidectomy, such as quality of life and postoperative pain. In a 2019 study examining pain after TOETVA vs. open thyroidectomy, pain scores and distributions were different for each approach [3]. Patients who underwent TOETVA experienced more chin and lower lip pain, while open thyroidectomy patients had more neck and back pain. Whether pain or sensation, these studies have collectively found that these changes tend to be transient after transoral thyroidectomy. & Insoo Suh [email protected]