Transoral Endoscopic Thyroidectomy Vestibular Approach: Lessons from a Five Years’ Experience

The transoral endoscopic thyroidectomy vestibular approach (TOETVA) has demonstrated excellent cosmetic and clinical outcomes with low complication rates. In addition to a relatively steep learning curve, TOETVA offers real alternative open minimally invasive techniques. is indicated for hemithyroidectomies in patients without prior neck surgery. Technically, it involves 10-mm incision on the inside of lower lip, followed by subplatysmal hydrodissection create space between platysma infrahyoid musculature. Three trocars are inserted prementally through lip approaches. our experience TOETVA, several critical steps appropriate solutions were defined: 1. team positioning technical improvement using 4 K laparoscopic tower; 2. lateral cranial avoid mental nerve injury; 3. initial space; 4. use dissector that gradually creates surgical field anterior neck; 5. musculature retraction externally fixed sutures; 6. intraoperative neuromonitoring routinely performed or percutaneously 1-mm incision; 7. specimen removal recovery bag. Our results confirm feasibility safety combined curve. Further studies needed determine potential indications standard care.