Transoral endoscopic thyroidectomy using vestibular approach: updates and evidences

Abstract

Recently, natural orifice transluminal endoscopic surgery (NOTES) has been applied in thyroid surgery with transoral access. The benefit of transoral endoscopic thyroidectomy is the potential for scar-free surgery. However, there are many concerns over some aspects, such as infection, recurrent laryngeal nerve injury, and oncological outcome. In this paper, we have reviewed the development history and the current clinical evidence of this innovative surgery. We conclude that the transoral endoscopic thyroidectomy vestibular approach (TOETVA) is feasible and can be considered no longer an experimental operation.

Transoral robotic thyroidectomy on two human cadavers using the Intuitive da Vinci single port robotic surgical system and CO2 insufflation: Preclinical feasibility study

“…Transoral endoscopic thyroidectomy vestibular approach (TOETVA) has been an appealing method to numerous surgeons around the world, and has seen an increase in utilization due to its short learning curve and truly scarless surgery . Its proximity to the thyroid gland through oral mucosa not only provides an excellent cosmetic outcome but also minimizes the flap dissection necessary with other remote access approaches hence more approximating the idea of true minimally invasive surgery .…”

“…The working space boundaries were the sternal notch inferiorly, thyroid cartilage superiorly and medial border of the sternocleidomastoid muscle on both sides. This is the approach that has been reported on a number of occasions . Once the working space formation was completed, the midline incision was extended to 20‐ to 25‐mm for further dilation with the da Vinci single port (SP) cannula.…”

“…This is the approach that has been reported on a number of occasions. 12,[19][20][21][22] Once the working space formation was completed, the midline incision was extended to 20-to 25-mm for further dilation with the da Vinci single port (SP) cannula. This is followed by the insertion of the Alexis wound retractor (XXS size) through the midline incision, and the inferior part of the retraction ring was securely placed under the inferior edge of mandible.…”

Anterior cervical incision‐sparing thyroidectomy: Comparing retroauricular and transoral approaches

“…More recently, Anuwong described the transoral endoscopic thyroidectomy vestibular approach (TOETVA), which similarly, utilizes a familiar dissection plane but provides a midline surgical field with equal access to both thyroid lobes. 10,12,[15][16][17] As early North American adopters of both techniques, our institution wished to compare our initial experience with RFT and TOETVA in terms of outcomes, complications, and learning curve. To our knowledge, this is the first manuscript to compare the experience with TOETVA and RFT at a single institution.…”

Central neck dissection via the transoral approach

“…” However, these authors further state that the utility for any individual patient must be based upon the importance placed in staging information CND may provide the multidisciplinary treatment team. Given that we do not recommended TONS for T3 and T4 disease (22,32), a prophylactic CND may be considered if preoperative workup is consistent with a 2-cm or smaller well differentiated thyroid cancer and the treatment team believes that staging information gained from CND outweigh the operative risks of recurrent laryngeal nerve (RLN) injury or hypoparathyroidism (19,30,31)…”