Abstract
Abstract
Introduction:
The open transverse cervical “Kocher” incision is the standard technique for thyroidectomy. To avoid a neck incision, however, various approaches of endoscopic thyroidectomy have been developed, including the lateral, axillary, axillobilateral breast, bilateral axillobreast, and postauricular–transaxillary approaches.1–5 The transoral vestibular approach (TOETVA) is the newest and most direct route to thyroidectomy.6–9
Methods:
The aim of the video is to provide detailed instruction of the TOETVA. A 36-year-old euthyroid female presented with a symptomatic left thyroid nodule. Sonography showed a 4.2-cm solid and cystic nodule in the left lobe and fine needle aspiration was benign. Three incisions were made at the oral vestibule and an 11-mm trocar was inserted centrally with two 5-mm trocars laterally. The carbon dioxide insufflation pressure was set at 6 mmHg to maintain the working space.
Results:
The left thyroid lobe was resected effectively through this novel endoscopic approach without any intraoperative complications. The mental nerve, recurrent laryngeal nerve, and parathyroid glands were preserved. The operative time was 115 minutes with negligent blood loss and the patient was discharged within 23 hours. The final pathology analysis was multinodular goiter. The patient had an excellent cosmetic outcome without complications, including infection, mental or recurrent laryngeal nerve injuries, hematoma, or seroma.
Conclusions:
TOETVA is feasible and safe and provides an excellent cosmetic outcome. Compared with other endoscopic thyroidectomy techniques, it is a more direct approach. TOETVA is an excellent option for select patients requiring thyroidectomy who wish to avoid a neck incision.
Runtime of video: 7 mins 52 secs
Get full access to this article
View all access options for this article.