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. 2022 Oct;15(10):1283-1293.
doi: 10.25122/jml-2021-0276.

Transoral endoscopic thyroidectomy vestibular approach (TOETVA): first twelve case series in Erbil, Iraq

Samir Anwar Jabbar  1 , Nooraddin Ismail Alla Werdi  2
Affiliations

Transoral endoscopic thyroidectomy vestibular approach (TOETVA): first twelve case series in Erbil, Iraq

Samir Anwar Jabbar et al. J Med Life. 2022 Oct.

Abstract

Endoscopic thyroid surgery has gained popularity with the advances in laparoscopic and endoscopic instruments and techniques. Of all endoscopic approaches for thyroidectomy, the transoral endoscopic thyroidectomy vestibular approach (TOETVA) is the most promising procedure as it avoids neck scars and has less tissue dissection than other endoscopic techniques. This study aimed to present our first impression and initial experience with TOETVA in Erbil city. Twelve patients underwent surgery between November 2020 and April 2021, including eleven females and one male. Eleven total thyroidectomies and one lobectomy were performed. We found no significant postoperative complications. TOETVA is a safe and effective procedure, but it is challenging, needs good skills, and is a promising technique.

Keywords: TOETVA; endoscopic thyroidectomy; scarless; transoral.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Patient's position.
Figure 2
Figure 2
Position of the surgeon and the two assistants.
Figure 3
Figure 3
The process of hydrodissection and the insertion of all three ports with instruments. A – hydrodissection; B – kelly clamp to widen the space; C – introducing a blunt dilator to create subplatysmal space; D – inserting the central port for camera; E – CO2 insufflation through the central port; F – first 5 mm port inserted in the right side to do some dissection before inserting the last port; G – fine 5 mm port inserted in the left side.
Figure 4
Figure 4
Sutures to elevate the skin and the muscles fixed on the external retractor.
Figure 5
Figure 5
Left superior artery, RLN and trachea after the removal of the gland. A – Shows left superior thyroid artery; B – shows left RLN with trachea after the removal of the gland; C – Shows clear thyroid bed after thyroidectomy.
Figure 6
Figure 6
Patient after surgery following gland extraction.
Figure 7
Figure 7
Post-operative view of the neck. A – Lateral view of the neck; B – Anterior view of the neck.
Figure 8
Figure 8
Picture of a patient on the first postoperative day.
Figure 9
Figure 9
Post-operative picture of intra-oral incision.
See this image and copyright information in PMC

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