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Related Concept Videos

The Thyroid Gland01:23

The Thyroid Gland

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The thyroid gland is a small, butterfly-shaped gland located in the neck and covers the anterior surface of the trachea. The gland has two lateral lobes connected by a thin tissue mass called the isthmus. Internally, each lobe comprises many small spherical structures known as thyroid follicles, surrounded by a network of blood vessels.
The follicles have a central cavity lined by simple cuboidal to squamous epithelial cells called follicular cells. These cells produce the glycoprotein...
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Related Experiment Video

Updated: Aug 16, 2025

Transoral Endoscopic Thyroidectomy Vestibular Approach for Thyroid Lobectomy
05:12

Transoral Endoscopic Thyroidectomy Vestibular Approach for Thyroid Lobectomy

Published on: May 12, 2023

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Transoral thyroid surgery vestibular approach.

Elias Karakas1, Günther Klein2, Stefan Schopf3

  • 1Dept. of General-, Abdominal- and Endocrine Surgery, Hospital Maria Hilf, Alexianer GmbH, Krefeld, Germany.

Innovative Surgical Sciences
|December 23, 2022
PubMed
Summary

Transoral thyroid surgery (TOETVA) offers a scarless approach to thyroidectomy, with results comparable to traditional methods. Continued experience is expected to improve outcomes and reduce operative time.

Keywords:
remote accessthyroidtransoral

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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.