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. 2021 Feb 19;10(4):863.
doi: 10.3390/jcm10040863.

Transoral Endoscopic Thyroidectomy Vestibular Approach (TOETVA): Surgical Outcomes and Learning Curve

Young Jun Chai  1 , Sumin Chae  2 , Moon Young Oh  3 , Hyungju Kwon  4 , Won Seo Park  2
Affiliations

Transoral Endoscopic Thyroidectomy Vestibular Approach (TOETVA): Surgical Outcomes and Learning Curve

Young Jun Chai et al. J Clin Med. .

Abstract

The transoral endoscopic thyroidectomy vestibular approach (TOETVA) has excellent cosmetic effects and its popularity is increasing worldwide. We present our experience with TOETVA and its short-term outcomes. This study included 110 consecutive patients who underwent TOETVA at a single institution between July 2016 and June 2020. We analyzed clinicopathologic data, short-term postoperative outcomes, and learning curve using cumulative summation (CUSUM) analysis. Of the 110 patients who underwent TOETVA, 101 had malignant disease and 100 (90.9%) underwent lobectomy. The mean age was 39.7 ± 9.7 years, and the mean tumor size was 1.0 ± 0.7 cm (range, 0.3-3.6 cm). Operation time was 168.0 ± 63.4 min for total thyroidectomy, 111.0 ± 27.7 min for lobectomy, and 73.7 ± 18.1 min for isthmusectomy. Five patients (4.5%) experienced transient vocal cord palsy (VCP) and one (0.9%) had permanent VCP. The swallowing impairment index-6 score was 2.18 ± 3.21 at postoperative three months, and 0.97 ± 1.72 at postoperative six months. The learning curve for lobectomy was 58 cases in CUSUM analysis. TOETVA is a safe and feasible approach with an acceptable operation time and a low complication rate. This approach is a surgical option for patients who desire excellent cosmesis.

Keywords: minimally invasive surgery; thyroid; transoral endoscopic thyroidectomy vestibular approach.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Trocar placement for transoral endoscopic thyroidectomy vestibular approach.
Figure 2
Figure 2
Endoscopic view of the transoral endoscopic thyroidectomy vestibular approach. RT: right thyroid gland, RCCA: right common carotid artery, SM: strap muscle, Arrow: external retractor.
Figure 3
Figure 3
External branch of the superior laryngeal nerve monitoring using a long ball-tip monopolar stimulation probe.
Figure 4
Figure 4
Oral mucosal incisions after suturing.
Figure 5
Figure 5
Operation time of lobectomy with transoral endoscopic thyroidectomy vestibular approach. (a) Operation time plotted in chronological order. (b) Cumulative summation test of operation time.
See this image and copyright information in PMC

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