Endocrine Abstracts

Objective: Scarless thyroid and parathyroid surgery have been explored for many years but previous surgical interventions have not been widely adopted. Transoral endoscopic thyroidectomy vestibular approach (TOETVA) is utilizing a natural orifice to manipulate the thyroid, resulting in improved cosmetic outcomes, similar operative time to conventional approach, shorter recovery, and smoother post-operative course. Herein, we aim to present the enhanced comprehensive framework we have carefully developed, which firmly establishes the basis for the secure implementation of the TOETVA service.

Methods: Built upon the latest literature introduced by TOETVA experts, our framework rests on three fundamental pillars including training, collaboration and meticulous preparation. Training, which formed the cornerstone of our approach, included attendance in two cadaveric courses and a hands-on fellowship in Brazil under the guidance of Prof XXXXX, who is one of the pioneers on this field. Furthermore, our commitment to excellence extended to 20 hours of intensive laparoscopic simulation training, ensuring proficiency with the laparoscopic equipment. Collaboration emerged as another crucial pillar to our framework. Active engagement of our anaesthetic and nursing colleagues as well as laparoscopic surgical team has been of paramount in fostering team-work and ensuring patients safety. Seeking expertise and working in close collaboration among colleagues in a national level, has further enriched our practice by facilitating constructive dialogue and experience sharing. The unwavering support of hospital management has been instrumental to ensure availability of resources and dedicated theatre time. Thorough preparation procedures completed our framework. Careful patient selection, dry sessions to safeguard understanding and predict potential pitfalls and guidance of a proctor for our first lists have all been essential components in our approach.

Results: With invaluable proctoring support for our first 3 cases, we managed to perform a full range of TOETVA and TOEPVA surgery including a cancer case, including the UK’s first cancer case, achieving an R0 resection, obliviating the need for further treatment, demonstrating TOETVA’s safety and efficacy in carefully selected cancer cases. The surgical time for our first cases was on average less than 3 hours which is markedly less than the average time reported in the literature.

Conclusions: The robust framework we have constructed ensures both safety and time efficiency, facilitating the effective and successful establishment of the TOETVA/TOEPVA procedures as a new pioneer service.