Endocrine Abstracts

In thyroid surgery recently is a very important issue to maintain good cosmesis of the scar which can always be visible. Even smaller incisions have been utilized in order to improve satisfaction of the patient. In the last decades new endoscopic techniques have been applied using breast or axillary approach with unfavourable cosmetic outcome In the last couple of years there has been a development of a new endocopic technique known as transoral endoscopic thyroidectomy vestibular approach (TOETVA) which is suitable for patients with small thyroid carcinomas without extrathyroidal extension, for benign nodules up to 4-5 cm, and also for parathyroid adenomas. Metastatic thyroid diseases and large substernal goiters should be operated with conventional open surgery.

Methods: From June 2018 to October 2021, a total of 12 patients with thyroid cancer or nodule (size of 1-5 cms) were operated with TOETVA in the National Institute of Oncology. Lobectomy was performed in 11 cases, and 1 patient had ithmusectomy.

Results: 10 patients were female, 2 were men, mean age was 48 years (41-72) . 10 right sided, 1 left sided and 1 isthmusectomy were performed. The histological report referred papillary thyroid cancer (size 0,8 cm-1,7 cm) in 4 cases, follicular neoplasm in 5 cases , and collid nodules in 3 patients. TOETVA patients had no drain placement, and were discharged on the 1st postop day. The average operating time was 107 minutes (76-124 min). Injury of the recurrent laryngeal nerve was not detected. Any other complications were not detected.

Conclusion: A TOETVA is the only scar –free, and effective procedure of the thyroid gland, which provides good cosmetic outcome. The long operative procedure time will be shortened with experience after a learning curve of 15-20 operations. The surgeon must be a high volume surgeon on the field of thyroid surgery.

Key words: (TOETVA) transoral endoscopic thyroidectomy vestibular approach, thyroid surgery