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4. Laryngoscope, 2467-2472, 2018.

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Background: The modified Blair incision is the standard facial incision for the vast majority of parotid gland lesions. We utilize three types of incisions: "classic mini-Blair" for parotid body tumors, "cervical mini-Blair" for parotid tail tumors, and "vertical mini-Blair" for anterior parotid tumors. In this study, we describe the surgical and esthetic outcomes of these individually tailored incisions. Methods: Patients undergoing parotidectomy between 2011 and 2013 were included. The surgical outcomes and patients' satisfaction were assessed. Results: Of 122 patients, 89 were included. All patients completed a questionnaire assessing the postoperative course and patients' satisfaction regarding the surgery in general and the scar in particular. Among these patients, 78 (87%) had a benign pathology and 11 (13%) had malignant tumors. The tumors were located at the parotid body in 57 patients (64%), at the parotid tail in 19 (21%), at the deep lobe in 8 (9%), and at the anterior parotid gland in 5 (6%). All tumors were removed successfully with negative margins on pathology. No inadvertent permanent facial nerve paralysis occurred. The median operation time was 72 min (23-211). The average patient scores of satisfaction with the surgical scar and with the surgery were 9.54 and 9.72, respectively. Conclusions: Individualized mini-Blair incision is feasible for benign as well as selected malignant parotid tumors.

Background: Transoral endoscopic vestibular approach (TOEVA) for thyroidectomy (TOETVA) and parathyroidectomy (TOEPVA) is gaining popularity, yet knowledge is based on a limited number of studies, mostly performed by surgeons experienced in laparoscopicnrobotic surgery. Methods: All patients who underwent TOEVA at our institution between February 2018 and October 2019 were followed prospectively. Main outcomes were ability to accomplish surgery endoscopically (failure defined as conversion to open approach) and complications. Results: Seventy-one patients (52 TOETVA and 19 TOEPVA) were included. 98% (51/52) and 100% (19/19) of TOETVA and TOEPVA surgeries were accomplished endoscopically, respectively. Transient vocal cord and mental nerve injuries rates were 8.4% (6/71) and 2.8% (2/71), respectively. Thyroid carcinoma was diagnosed in 27 patients (51.9%), all completely excised with clean margins. Conclusions: Adoption of the TOEVA suggested framework by head and neck surgeons without prior experience in laparoscopic/robotic techniques is feasible resulting in nearly 100% of surgeries accomplished endoscopically. K E Y W O R D S endoscopic, parathyroidectomy, thyroidectomy, transoral, vestibular approach 1 | BACKGROUND The use of the transoral endoscopic thyroidectomy vestibular approach (TOETVA) is increasing, as both surgeons and patients are becoming more and more familiar with this technique and its advantages. Unlike other approaches for scarless thyroidectomies, TOETVA does not require a surgical robot, 1 and can be relatively quickly adopted in different centers worldwide.

Background We investigated preferences between the transcervical and transoral thyroidectomy approach in the United States and Israel. Methods An online survey assessing scar attitudes and surgical preferences, in English and Hebrew, was distributed on http://thyca.com and other platforms. Results 928 and 339 responses from the United States and Israel cohorts, respectively, were analyzed. In both countries, individuals without prior thyroidectomy preferred a scarless approach when hypothetical risks equaled those of traditional thyroidectomy (77% United States, 76% Israel, p = 0.61). U.S. respondents without thyroidectomy had greater preference to avoid a scar and would pay more to do so than those with thyroidectomy (both p < 0.001). Many respondents with prior thyroidectomy still expressed interest in scarless alternatives (57% United States). Conclusions Populations in Israel and the United States prefer scarless thyroidectomy when risks equal the traditional approach. While individuals without prior thyroidectomy are more likely to favor a scarless option, former thyroidectomy patients may have preferred avoiding a scar.

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