Endocrine Abstracts

Background: Both Transoral (TOETVA) and several Retroauricular approaches (e.g. EndoCATS) are described as feasible and safe procedures in the literature. The TOETVA enables angulation of instruments and provides a good working space by dividing the strap muscles in the first step. Therefor one should be able to dissect even larger specimen than the short incision in the lip allows to remove. However EndoCATS is a single port access with limited working space, but with good potential to increase incision length along the hairline without leaving a visible scar to remove large specimen.

Methods: In December 2017 a patient with a 65 ml nodule in the right thyroid lobe asked for an endoscopic resection without a visible scar in the décolleté. She rejected ABBA because of the areolar incisions. As EndoCATS has a limited working space, we decided to improve our technique by a combination with TOVARA which provides a better angulation and an increased working space.

Results: The operation was performed as planned in January 2018, by first dissecting the specimen with TOVARA and removing it via EndoCATS on the ipsilateral side. The operation time was 165 min. There were no complications except of a mild hypocalcemia on the first postoperative day. A numbness of 5 cm in diameter at the chin vanished within 14 days. The patient had a VAS for pain of 2 at the first day and 1 for the next 3 days. RLN and EBSLN were proven intact by laryngoscopy. Wound healing was primarily and without infection. The patient was highly satisfied with the procedure.

Conclusions: This is the first report about a hybrid operation of the two endoscopic techniques TOVARA and EndoCATS. Only extracervical endoscopic thyroid surgery provides the benefit of an unscathed décolleté. It is the next step in endoscopic thyroid surgery to combine safe techniques to enlarge the number of possible indications.