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Updated: Oct 2, 2026
Transoral Endoscopic Thyroidectomy Vestibular Approach for Thyroid Lobectomy
Published on: May 12, 2023
An easier option for "invisible scar" thyroidectomy: hybrid-transoral endoscopic thyroidectomy submental access
Giuliano Perigli1, Fabio Cianchi1, Benedetta Badii1
1Unit of Endocrine Surgery, Florence University Hospital, Florence, Italy.
Background:
Transoral endoscopic thyroidectomy vestibular approach (TOETVA) is currently the only "cervical invisible scar" procedure with a surgical access close to the thyroid area. The aim of this technical note was to describe a hybrid technique with a vestibular and a submental access as applied in 22 consecutive patients undergoing lobectomy.
Methods:
Out of 502 thyroidectomies performed from February 1, 2018 to May 31, 2019, feasibility of Hybrid-TransOral Endoscopic Thyroidectomy Submental Access (H-TOETSA) was assessed in 22 patients meeting the inclusion criteria. Differently from TOETVA, a central trocar (≤ 10 mm) for the camera was placed on the natural skin depression immediately under the chin. A left 3 mm and a right 5 mm (or 3 mm if a 3 mm energy device was available) trocars were placed in the vestibulum (as in TOETVA).
Results:
Operative time was 74.32 (± 34.16) min. Two temporary recurrent nerve paralysis and three lip/chin dysesthesia were observed. In two patients, an additional 3 cm horizontal access was performed 2 cm above the clavicle to control a persistent bleeding. Patients complained pain only in the first postoperative hours. All patients perceived excellent cosmetic results even at postoperative day 1.
Conclusion:
H-TOETSA was feasible and resulted to have some technical and clinical advantages maintaining the purpose to avoid a visible scar on the neck.
