Trans oral endoscopic thyroidectomy (TOETVA): First French experience in 90 patients

Area of Science:

• Minimally Invasive Surgery
• Endocrine Surgery
• Surgical Oncology

Background:

• Extracervical thyroidectomy techniques are gaining popularity for scarless thyroid surgery.
• The anterior vestibular endoscopic approach (TOETVA) is one such technique, offering an alternative to conventional cervical incisions.
• Evaluating the feasibility and outcomes of TOETVA is crucial for its wider adoption.

Purpose of the Study:

• To assess the safety and efficacy of the trans-oral endoscopic thyroidectomy (TOETVA) approach.
• To evaluate the initial results of a patient series undergoing TOETVA.
• To determine complication rates and patient satisfaction associated with this scarless thyroid surgery technique.

Main Methods:

• A prospective study included 90 patients (aged 18-70, ASA I/II) who desired to avoid cervical scars.
• The TOETVA approach involved an anterior vestibular incision, with specimen extraction transorally or via axilla.
• Recurrent laryngeal nerve neuromonitoring was used in most cases; pre- and intra-operative data, complications, and follow-up were recorded.

Main Results:

• 90 patients underwent TOETVA for various thyroid conditions, with a mean operating time of 134 minutes.
• Conversion to open surgery occurred in 5.5% of cases. Transient recurrent nerve palsy (7.8%) and hypoparathyroidism (19%) were the main complications.
• Patient satisfaction was high, with no reported hematomas, infections, or axillary extraction complications.

Conclusions:

• The trans-oral endoscopic thyroidectomy (TOETVA) is a safe and reliable surgical technique for carefully selected patients.
• This endoscopic approach effectively avoids visible cervical scars, leading to high patient satisfaction.
• TOETVA demonstrates favorable outcomes and manageable complication rates in this initial series.