Abstract
Transoral endoscopic thyroidectomy vestibular approach (TOETVA) is a minimally invasive
surgical technique that offers safety comparable to conventional open thyroidectomy,
with the added benefit of superior cosmetic outcomes due to the absence of visible
scars. This innovative approach is gaining popularity worldwide as an alternative
for patients seeking thyroid surgery without postoperative scarring. TOETVA involves
positioning the patient supine with slight neck extension under general anesthesia.
The procedure uses three trocars placed via midline and lateral incisions, with a
10-mm 30-degree laparoscope for visualization. Preoperative care includes cleaning
the surgical area and administering intravenous antibiotics to prevent infection.
The technique mirrors conventional thyroidectomy but utilizes standard laparoscopic
instruments. It emphasizes the precise identification and preservation of critical
anatomical structures, such as the cricoid cartilage, thyroid isthmus, trachea, carotid
artery, superior laryngeal nerve, and recurrent laryngeal nerve. The use of an energy
device and careful dissection help minimize bleeding and reduce nerve injury risks.
Superior pole management and meticulous handling of the thyroid lobe ensures optimal
outcomes. The growing popularity of TOETVA indicates a shift toward minimally invasive
thyroid surgery, with TOETVA emerging as a leading method. This paper provides a comprehensive
overview of the procedure, highlighting its benefits and critical aspects of its successful
implementation.
Keywords
endoscopic thyroidectomy - TOETVA - transoral
