Abstract
Abstract
Introduction:
In recent years, “endoscopic thyroidectomy” methods have shown rapid progress. Among these techniques, transoral endoscopic thyroidectomy, vestibular approach (TOETVA) is applied by placing three ports in the oral vestibule; it has been proven to safe and with acceptable outcomes.1,2 In this video, we explain the technique of TOETVA step by step—from preoperative preparation to postoperative care—by drawing attention to the anatomical structures that need to be considered while placing the trocar. 3
Materials and Methods:
A 44-year-old female patient had a solid nodule of ~2 cm in the left lobe, suspicious for malignancy (Bethesda 5). The patient, placed in the supine position, was intubated nasotracheally. The neck was slightly extended and she was placed in Trendelenburg position. Three incisions were made in total: two close to the oral commissura of the lower vermillion at the oral vestibulum and one median incision close to the frenulum. The working space was prepared until the inferior border of the cricoid cartilage; the medial parts of the sternocleidomastoid muscles served as the lateral border of the space. A 10 mm blunt tip trocar was placed in the preprepared midline area and working space was inflated with carbon dioxide to a target pressure of 6 mm Hg. In the direction of the incisors and canines, 5 mm trocars were placed by making lateral incisions as close as possible to the lip, considering possible vascular and mental nerve damage, including the root and its most distal branches. A retraction suture was applied to retract the strap muscles. Thyroid dissection was performed similar to standard thyroidectomy, but in a craniocaudal manner. Intraoperative nerve monitoring was used during the procedure.
Results:
There were no postoperative complications. The patient was discharged 24 hours postoperatively. The patient was satisfied with the cosmetic result.
Conclusion:
This video shows the technical details of the TOETVA procedure, which has proven itself in terms of safety and effectiveness, highlighting the anatomical structures that need attention during trocar insertion and dynamic manipulation.
This video is invited by the IAES to be presented at the 2021 virtual program congress.
Patient Consent:
Authors have received and archived patient consent for video recording/publication in advance of video recording of the procedure.
Runtime of video: 11 mins 16 secs
Keywords
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