Transoral Endoscopic Thyroidectomy via Vestibular Approach (TOETVA)

Traditional transcervical thyroidectomy has been a standard surgical procedure since its introduction in 1906. Advancements in surgical technique, general anesthesia, hemostasis, and neuromonitoring have made it a safe and successful procedure with low morbidity and mortality [1]. Transcervical thyroidectomy leaves the patient with a neck scar that could be distressing especially in patients with darker complexions and a history of keloid formation [2]. Minimally invasive techniques have been developed using endoscopic and robotic approaches with the goal of avoiding disfiguring scars to the neck. These include endoscopic and robotic trans-axillary thyroidectomy, both of which require a wide flap dissection and leave incisions away from the neck. None of these approaches have gained significant widespread acceptance [3]. Transoral endoscopic thyroidectomy via vestibular approach (TOETVA) has been developed since 2008 and has gained popularity and acceptance as a true scarless procedure. It can be performed with standard laparoscopic instruments, provides clear view of vital structures, and allows access to both lobes. This approach was also shown to have post-operative outcomes comparable with the traditional open thyroidectomy [4]. Surgeons should have a baseline mastery of the open technique, laparoscopic, and endocrine surgery to be able to adapt this procedure [5].