Transoral Endoscopic Thyroidectomy Vestibular Approach (TOETVA): Surgical Outcomes and Learning Curve

Abstract

The transoral endoscopic thyroidectomy vestibular approach (TOETVA) has excellent cosmetic effects and its popularity is increasing worldwide. We present our experience with TOETVA and its short-term outcomes. This study included 110 consecutive patients who underwent TOETVA at a single institution between July 2016 and June 2020. We analyzed clinicopathologic data, short-term postoperative outcomes, and learning curve using cumulative summation (CUSUM) analysis. Of the 110 patients who underwent TOETVA, 101 had malignant disease and 100 (90.9%) underwent lobectomy. The mean age was 39.7 ± 9.7 years, and the mean tumor size was 1.0 ± 0.7 cm (range, 0.3–3.6 cm). Operation time was 168.0 ± 63.4 min for total thyroidectomy, 111.0 ± 27.7 min for lobectomy, and 73.7 ± 18.1 min for isthmusectomy. Five patients (4.5%) experienced transient vocal cord palsy (VCP) and one (0.9%) had permanent VCP. The swallowing impairment index-6 score was 2.18 ± 3.21 at postoperative three months, and 0.97 ± 1.72 at postoperative six months. The learning curve for lobectomy was 58 cases in CUSUM analysis. TOETVA is a safe and feasible approach with an acceptable operation time and a low complication rate. This approach is a surgical option for patients who desire excellent cosmesis.

Balloon Dilators for Fast and Safe Flap Dissection in Transoral Endoscopic Vestibular Approach Thyroidectomy Vestibular Approach (TOETVA)

“…TOETVA procedures after working space formation have been described in detail in previous studies (1,3,13). In brief, after creating the working space, the midline of the strap muscles was divided.…”

“…However, the process of flap dissection for creating working space can be particularly technically challenging. Because forming working space in TOETVA involves a very small space and increased risk of bleeding, it requires the surgeon to overcome a steep learning curve and may be especially difficult for surgeons with little experience with remote-access surgeries (3).…”

Transcutaneous Laryngeal Ultrasonography for Assessing Vocal Cord Twitch Response in Thyroid Operation during Predissection Vagus Nerve Stimulation

“… 11 Though invasive procedure for assessing of vocal cord function as laryngoscopy might not be used in all institutes or worldwide as Chai and colleagues recently reported routine rigid laryngoscope for assessing of vocal cord mobility. 33 Generally, assessment of the vocal cord function by laryngoscopy could be used. In our study, the vocal cord function was confirmed by combined modalities such as TLUSG visualization, IONM, and laryngoscopy in symptomatic patients.…”

Patient Eligibility for Transoral Endoscopic Thyroidectomy Vestibular Approach (TOETVA) in an Endemic Region

“…While the operation period was prolonged in the same report, it was shown in several studies that the operation time decreased with adequate preparation and practice due to the TOETVA’s low learning curve. [ 27 , 28 ] Numerous multicenter researches verifying the safety and effectiveness of TOETVA are continued to be conducted and larger-scale randomized controlled trials remain necessary due to the small number of case. [ 29 - 31 ]…”