Transoral thyroid surgery vestibular approach

Area of Science:

• Endocrine Surgery
• Minimally Invasive Surgery
• Surgical Oncology

Background:

• Transoral thyroid surgery vestibular approach (TOETVA) is an emerging technique for thyroidectomy without visible neck scars.
• Aesthetic outcomes are increasingly important in elective surgery, driving interest in scarless procedures.
• While gaining traction globally, TOETVA adoption varies, with higher prevalence in Asian countries and select US centers.

Purpose of the Study:

• To evaluate the feasibility and outcomes of the transoral thyroid surgery vestibular approach (TOETVA).
• To compare TOETVA results with traditional transcervical thyroidectomy, focusing on complications and aesthetics.
• To discuss the evolving indications and the role of combined extracervical techniques in TOETVA.

Main Methods:

• TOETVA utilizes a three-port technique within the oral vestibule, employing an endoscope and specialized instruments.
• CO2 insufflation at 6 mmHg creates a working space, with hydrodissection defining the anterior cervical plane.
• Combinations with other extracervical approaches, such as retroauricular endoscopic cephalic access thyroid surgery (EndoCATS), are described.

Main Results:

• Over 1,000 cases reported since 2016 show results comparable to traditional thyroidectomy, particularly regarding standard complications.
• The transoral access offers a short route with dissection planes similar to transcervical surgery.
• Indications and contraindications are evolving, with patient and surgeon selection being critical.

Conclusions:

• Transoral surgery is expected to increase in popularity as surgeon experience grows.
• With increased experience, operative times and complication rates are anticipated to decrease, narrowing the gap with transcervical approaches.
• Novel complications associated with TOETVA require ongoing evaluation.