Transoral endoscopic thyroidectomy vestibular approach (TOETVA): initial experience in Australia

Abstract

Background Thyroidectomy is traditionally an open procedure. The potential for and unpredictability of patients developing an unsightly anterior neck scar has led many investigators to develop various ‘scarless’ thyroidectomy techniques. Here we report on our initial experience, and to our knowledge, the first and largest series of this technique in Australia and New Zealand. Methods Across two centres in Western Australia, three Endocrine surgeons utilized the Transoral Endoscopic Thyroidectomy vestibular approach (TOETVA). Key endpoints such as operating time, blood loss, pain scores, recurrent laryngeal nerve injury and hypoparathyroidism was collected. Data was analysed using R statistical program. Results One hundred and two TOETVAs were performed between March 2018 and May 2021. There were 66 hemithyroidectomies, 34 total thyroidectomies (four converted to open), and two isthmusectomies. We noted a trend in median operating time decreasing over the study period. There were no cases of permanent recurrent laryngeal nerve palsy, wound infection, seroma or haematoma. We had four instances of open conversion; one temporary RLN palsy, and 12 cases of temporary hypoparathyroidism. Conclusion This is the first series of TOETVA reported in Australia and New Zealand. Our results demonstrate that with appropriate surgeon experience, training, collaboration, and in well selected patients, this is a feasible and safe thyroidectomy technique. We hope that our work will build confidence in Endocrine Surgical units seeking to develop this technique in Australia.

Scar‐less thyroidectomy: an evolving role in the surgical armamentarium

“…In this issue, Pradhan et al 1 . report their early experience with Trans‐Oral Endoscopic Thyroidectomy Vestibular Approach (TOETVA) in an Australian setting.…”

“…In this issue, Pradhan et al 1 report their early experience with Trans-Oral Endoscopic Thyroidectomy Vestibular Approach (TOETVA) in an Australian setting. TOETVA is an attractive option when compared to other so called 'minimally invasive' approaches to the thyroid, such as the trans-axillary approach, the axillo-breast approach, and the retro-auricular approach, which require extensive dissection, and place the patient at risk of additional complications, including major neuro-vascular injury.…”