A novel surgical approach offers scarless thyroidectomy

In a case report, surgeons describe performing a right lobectomy using a novel surgical procedure, the transoral endoscopic thyroidectomy vestibular approach (TOETVA), on a 17-year-old adolescent boy with a suspicious thyroid nodule. The patient had a normal postsurgical recovery. His parents and he were satisfied with the cosmetic results: Because TOETVA is performed through a natural opening in the oral cavity, he did not have the scar associated with conventional thyroid surgery.

The procedure called for extending the patient’s neck by placing a pillow under his shoulder in the supine position, putting the chin and sternal notch at the same level for ergonomic study, and making it unnecessary to break the table from the waist, which is done for a standard thyroidectomy. During trocar incisions, the surgeons paid particular attention to avoid damage to mental nerves located on both sides, given that incision locations are crucial to preserve these structures.

The authors noted several advantages of TOETVA over conventional endoscopic techniques for thyroid surgery. First, it not only leaves no visible scars but also offers a shorter dissection distance than conventional surgery. Also, because TOETVA is done with endoscopic equipment similar to that used in laparoscopic cholecystectomy, it provides easy access. Finally, TOETVA is safe and reproducible because it offers significant anatomical landmarks, such as the location of trocar incisions, cricoid cartilage, trachea, strap muscles, sternocleidomastoid muscles, and sternal notch.

Thoughts from Dr. Farber

Here is another fascinating concept: First came laparoscopic operations, and now this. Surgeons can be very creative, but this is still far from general use. Avoiding visible scars is nice, but we will need to see if this approach results in less morbidity and faster recovery, the true major benefits of laparoscopic surgery.

Reference

Divarci E, Ulman H, Ozok G, Ozen S, Ozdemir M, Makay O. Transoral endoscopic thyroidectomy vestibular approach (TOETVA): a novel surgical technique for scarless thyroidectomy in pediatric surgery. J Pediatr Surg. Published online February 1, 2022. doi:10.1016/j.jpedsurg.2022.01.038