Transoral and Submental Thyroidectomy

Abstract

Abstract

Introduction:

There has been growing interest in minimally invasive and remote access thyroid surgery in an attempt to eliminate a visible scar in the neck. This has involved a variety of techniques such as approaches from the breast, axilla, or retroauricular regions. The transoral endoscopic thyroidectomy vestibular approach (TOETVA) has recently been popularized as a technique that completely eliminates the need for any cutaneous incisions and limits dissection by providing the shortest path to the thyroid.^1,2 However, there are limitations in terms of tumor size, with larger tumors requiring disruption of the capsule to extract them from the intraoral incision. This can lead to pathologic uncertainty especially for follicular tumors. TOETVA has also been associated with sensory disturbances over the anterior chin. ³

Materials and Methods:

The hybrid technique of transoral and submental thyroidectomy (TOaST) was developed to address some of these limitations. This video shows the technique of TOaST applied to a 33-year-old female with an enlarging 4 cm cytologically benign right thyroid nodule who underwent an endoscopic right thyroid lobectomy.

Results:

The patient recovered well after surgery and was discharged on postoperative day 1 without any evidence of recurrent laryngeal nerve injury or other complications. Final pathology analysis showed a 4.2 cm follicular adenoma with chronic lymphocytic thyroiditis and no evidence of malignancy. Cosmetic results and patient satisfaction at 2- and 6-week follow-up were excellent.

Conclusions:

The hybrid TOaST technique is a safe and viable alternative to TOETVA that may potentially extend the indications for transoral thyroid surgery by allowing for larger tumors to be removed intact and minimizing sensory disturbances to the anterior chin while still maintaining an excellent cosmetic result.

The authors have no conflicts of interest to report. Consent for photography and filming was obtained from the patient.

Runtime of video: 8  mins 48 secs

This video was presented in part at the American Association of Endocrine Surgeons meeting in Durham, NC on May 8, 2018.