Transoral Vestibular Thyroidectomy: Current State of Affairs and Considerations for the Future

Abstract

Context The transoral endoscopic thyroidectomy vestibular approach (TOETVA) is a recently described procedure for surgical management of select thyroid pathology that avoids a cutaneous scar. TOETVA is far from the first described remote-access approach to the thyroid. In fact, numerous such techniques have been described over the past 20 years, although none has gained widespread implementation in North America or Europe. However, with its rapid growth worldwide and excellent outcomes to date, TOETVA may succeed where these prior techniques have failed. Evidence Acquisition The English literature was reviewed using the following keywords: transoral thyroidectomy, remote-access thyroidectomy, minimally invasive thyroidectomy, and TOETVA. Because three systematic reviews of this technique were recently conducted, this manuscript does not seek to provide a fourth. Rather, we summarize salient findings from these reviews and focus on candidates for the procedure, technique-specific characteristics that have led to early success with TOETVA, and prospects for the future. Evidence Synthesis TOETVA is the only thyroidectomy approach obviating the need for a cutaneous incision, and it offers several advantages over previously described remote-access thyroidectomy techniques. These include a favorable anatomic surgical perspective, a comparatively short learning curve, no requirement for expensive instrumentation, and a broad inclusion criterion. These characteristics have facilitated the excellent surgical outcomes to date. Conclusions TOETVA is a suitable surgical option with proven safety and feasibility for a carefully selected patient population. The potential value of the procedure outside enhanced cosmesis continues to be defined.

Safety and efficacy of transoral robotic and endoscopic thyroidectomy: The first 100 cases

“…Some workers have suggested that the transoral endoscopic thyroidectomy vestibular approach is more effective than transoral robotic thyroidectomy in view of high cost and long operative time of the latter . In this study, as in our previous one comparing transoral robotic and endoscopic thyroidectomy, the operative time of the robotic procedure was significantly longer than that of the endoscopic procedure, although other surgical outcomes did not differ between the two groups.…”

Comparative Study Between Endoscopic Thyroid Surgery via the Oral Vestibular Approach and the Areola Approach

“…Expansion fluid (1:500,000 adrenaline saline 70 mL +20 mL ropivacaine) is injected into the observation tunnel to create a space for surgery. According to the ''seven-step'' method, we resect the thyroid gland endoscopically through the areola approach, as follows: (1) expose the thyroid gland, (2) expose the trachea, (3) expose the common carotid artery, (4) disconnect the upper thyroid blood vessel, (5) break the thyroid lower blood vessel, (6) expose the recurrent laryngeal nerve (RLN) and functional protection, and (7) retain the upper parathyroid gland in situ, and completely remove thyroid gland.…”

“…Until now, the transoral approach was reported to effectively treat thyroid cancer and benign tumors. [6][7][8] The difference between TOETVA and chest approach endoscopic thyroid treatment has not been reported to date. In our article, we aim to analyze the treatment of patients undergoing either the areola breast approach or the transoral vestibular approach to explore the clinical efficacy and safety of the two approaches.…”

Transoral parathyroidectomy—Why make a simple operation complicated? A surgical fantasy

“…There is a large experience of transoral thyroidectomy in Thailand and Korea, with limited experience and expertise in the United States . However, this approach becomes a focus of discussion in the majority of endocrine conferences.…”