Clinical Case Report: Re TOETVA

Abstract

Introduction:

Surgical scars represent a major cosmetic problem and affect the quality of life of patients, particularly when they are located in sites of great exposure, as in the case of thyroidectomy, whose most frequently used approach is the conventional open one through transverse incision at the anterior cervical level. Transoral endoscopic thyroidectomy via vestibular approach (TOETVA) is a safe, reproducible, and feasible approach for thyroid disease, whether benign or malignant, with many advantages such as scar-free healing and accessible approach to both lobes.^2,3,4 However, whenever we carry out a TOETVA, we consider what would be the most appropriate route in case of needing to reoperate due to factors related to thyroid pathology. At this work, we present our first case of re-TOETVA procedure.

Materials and Methods:

This video presentation describes the technical aspect of completing thyroidectomy through an endoscopic vestibular approach. A 38-year-old female presented an asymptomatic thyroid mass on routine follow-up examination. Thyroid ultrasound imaging revealed a 1.5 cm left thyroid irregular nodule. Fine needle aspiration biopsy revealed papillary thyroid carcinoma (Bethesda category VI). Patient underwent transoral endoscopic left hemithyroidectomy. Pathology of the left thyroid lobe was consistent with papillary thyroid carcinoma of 13 × 8 mm with angioinvasion (more than 4 vessels) with no perineural invasion. Completion of thyroidectomy with the same technique was performed because of its increased regional lymph node recurrences and distant metastases in papillary carcinoma. ¹ Pathology of the right thyroid lobe presented no morphological alterations.

Results:

This video illustrates the case of lobectomy through endoscopic vestibular approach for papillary thyroid carcinoma followed by interval completion thyroidectomy with the same technique because of the presence of histological vascular invasion, which is associated with increased regional lymph node recurrences and distant metastases in papillary carcinoma. ¹

Conclusions:

TOETVA is a safe, reproducible, and feasible approach that provides excellent cosmetic outcomes.^2,3,4 It is an approach for patients who wish to avoid neck incision. With the presentation of this clinical case, we want to emphasize that it is possible to perform a transoral approach a second time, without major difficulties or complications, sticking to the patient’s choice of a scarless procedure.

Author Disclosure Statement:

The authors have had no commercial associations during the past 2 years that might create a conflict of interest in connection with this video. Consent for photography and filming was obtained from the patient.

Runtime of video: 5 min 24 sec