Minimally Invasive Neck Surgery: An Animal Model Study

Background: Minimally invasive surgery (MIS) is replacing conventional surgery as the "gold standard" in different surgical areas. Although cervical MIS is already accepted in the adult population, its use in children is still new and controversial. The natural obstacles to this approach are the absence of a natural cavity, with the inherent complications of creating one artificially, and the limited existing workspace especially in pediatric patients. All endoscopic techniques in the field of neck surgery try to live up to the high cosmetic expectations and the transoral cervical approach as a natural orifice surgery technique excels at it. Aim: Besides the goal of feasibility, we aim to report on the pitfalls of this approach, by using an experimental rabbit model for minimally invasive thyroidectomy. Materials and Methods: Transoral endoscopic thyroidectomies using a vestibular approach were performed in 10 anesthetized rabbits. All surgeries were video recorded. The surgical time, anatomy identified, difficulties, and intraoperative complications were documented. Results: Through one trocar in the vestibular area and two lateral stab incisions, it was possible to create a working space and to reach the peritracheal area. Total thyroidectomies were completed in the 10 animals with a mean operative time of 51 minutes. In all of them we were able to identify the fascial spaces of the neck and the major vessels. During surgery, the lack of space required surgical gestures to be very precise, soft, and gentle. There were 2 cases with a small amount of bleeding and one mild trachea laceration during the procedure, but none of them required suspension or conversion to an open procedure. Animals were euthanized immediately after the surgical procedure. Conclusions: The vestibular approach seems to be a feasible technique to access pediatric neck pathology. Despite the differences in the cervical anatomy, the limited workspace of the rabbit model perfectly matches the requirements of a pediatric training model.