Natural Orifice Trans-oral, Trans-vestibular Endoscopic Thyroidectomy (NO-TOTVET): a Case Series

Natural orifice scarless cosmetic surgeries are becoming a reality with the increasing experience of advanced laparoscopic surgeries and the availability of modern energy sources. Many techniques of minimally invasive video-assisted thyroidectomy through cervical and extra-cervical routes such as chest wall, trans axillary, submental, post-auricular, and trans-luminal approach have been attempted. However, trans-oral trans-vestibular endoscopic thyroidectomy with its excellent cosmetic effect and minimal side effects has become the more popular option among the surgical community. In this case series, we present 11 patients operated via natural orifice trans-oral, trans-vestibular endoscopic thyroidectomy approach (NO-TOTVET) by the same surgical team. From November 2022 to July 2023, NO-TOTVET was performed for 11 consecutive patients presenting with goiter to the Department of General Surgery, Command Hospital Eastern Command Kolkata. Surgery was performed using a 10-mm midline port inserted opposite incisors and two 5-mm ports inserted opposite to the left and right canine in the gingivo-buccal sulcus. NO-TOTVET was completed successfully through these ports without converting to open thyroidectomy. The demographic data and surgical outcomes of the patients were retrospectively analyzed. Eleven patients with a mean age of 37.5 ± 10.4 years were incorporated into this study. Three patients presented with papillary thyroid micro-carcinomas, and eight presented with benign nodules. A total of six hemithyroidectomies and five near-total thyroidectomies were done. All surgeries were performed successfully without conversion to open thyroidectomy. The mean operating time was 138.8 ± 33.2 min, and the average hospital stay was 1.5 days. Two patients developed seroma, and one patient had cutaneous burns. Transient recurrent laryngeal nerve paralysis was observed in one patient. There was no evidence of postoperative bleeding, infection, tetany, or any other complications. NO-TOTVET is a safe and effective technique in the hands of a trained surgeon and is a viable alternative to open thyroidectomy. It is a true scarless surgery with advantages like decreased hospital stay and minimal complications. This case series adds to the literature the scenarios and technique in which NO-TOTVET can be utilized, thus adding to the repertoire of the operating surgeon.