For patients undergoing thyroidectomy, the minimally invasive aspect and the cosmetic advantage of the procedure seem to be important factors in surgery. Studies in cadaver and animals have shown that different endoscopic techniques can be performed in a safe and successful way. In the evolution of thyroid surgery, for many endocrine surgeons, the transoral approach seems to be the next step. Even if such procedures are more and more frequently applied in patients, these procedures are far from being generally implemented in routine surgery. In this study, we report on our own experience and considerations in the process of finding a sublingual endoscopic transoral way to the endoscopic transoral thyroidectomy. We describe our failures, risk assessment and compare that with the available literature on transoral sublingual and vestibular thyroid surgery. The access itself needs to be further refined, and even more suitable and better adapted instruments need to be developed, so that optimal and safe results that meet all requirements on endocrine surgery can be achieved. A learning curve at the risk of patients' lives should be avoided. Furthermore, a combination of transoral endoscopic non-transoral techniques might be a useful safer, but more traumatising alternative for implementation. The sublingual access seems to be less invasive than the vestibular access. For a sublingual single-access routine surgery, better instruments are needed. Only in highly specialized centres for endocrine and endoscopic surgery, transoral thyroidectomy should be performed.

The transoral access seems to be less invasive than other extracollar endoscopic accesses in thyroid surgery. For a sublingual single-access routine surgery, better instruments are needed. The vestibular access is possible with standard instruments. Using hybrid technologies for implementation should not be considered as a failure. The transoral thyroidectomy can be a safe method in the hand of experienced surgeons. We expect this hybrid technique to play a major part in further spreading endoscopic transoral thyroid surgery.

Cervical endoscopic video-assisted thyroid surgery (CEViTS) can be considered a safe, less traumatizing and useful minimally invasive procedure in endoscopic thyroid surgery.