Transoral Endoscopic Thyroidectomy Vestibular Approach (TOETVA)-a Case Series Analysis

Transcervical approach to thyroid gland is a well-established standard technique for years which is a direct approach to thyroid gland with minimal tissue disruption but a visible neck scar. Various remote access approaches developed in recent years either minimize the scar length or make the scar non-visible with the use of optical devices. However, a significant tissue disruption with a distinct distant cutaneous scar is needed. Natural orifice transluminal endoscopic surgery (NOTES) provides a natural corridor to perform minimal invasive surgery without any scar. Transoral endoscopic thyroidectomy vestibular approach (TOETVA) has been introduced recently as a novel remote access approach using a natural orifice for thyroid surgery without any cutaneous scar and minimal tissue disruption. The present study is a case series analysis of 25 patients between November 2020 and December 2021 presenting with either thyroid nodules or parathyroid adenoma. Operative details including type of surgery, average thyroid volume, surgical time, blood loss, time to oral intake, length of stay, and complications were evaluated. Hemithyroidectomy was done in 23 patients (22 euthyroid patients and 1 intra thyroid parathyroid adenoma); 1 patient each underwent total thyroidectomy (for malignancy) and parathyroidectomy. F:M ratio was 11.5:1 with mean age of 35 years. Average nodule size, mean thyroid volume, operative time, blood loss, and hospital stay were 2.8 cm SD9.46 cm, 16.1 SD 9.4 ml, 142 SD 57 min, 10.4 SD 6.1 ml, and 2 days, respectively. One patient developed permanent RLN palsy, while 2 had transient weakness which recovered in 4-6 weeks. No patient had major mental nerve injury. One patient each had surgical site infection and hematoma which required drainage. Minor complications like seroma and ecchymosis were managed conservatively. TOETVA is a novel, safe, feasible, and promising approach with optimal cosmetic outcomes in a carefully select patient population.