Objective: To present and evaluate the limitations of transoral thyroidectomy via the anterior vestibular endoscopic approach, in 140 cases (TOETVA).
Methods: From February 2018 to April 2021, the data of included patients aged 15 to 70 years, interested in the absence of a scar, were evaluated.
Results. One hundred and forty patients (134 women) aged 46±12.4 years (15-70), including 13 with a BMI between 25 and 30 and 4>30. The indications were: 15 papillary cancers, 7 oncocytic nodules, 16 toxic nodules, 20 cases of Graves’ disease and 82 symptomatic goitres and/or nodules. The pre-operative diameter of the nodules was 38.1±19.9 mm (4-90 mm). The procedures were 83 hemithyroidectomies, 51 total thyroidectomies and 6 isthmectomies. The operating time was 135±45 min (40-262 min). One patient underwent completion thyroidectomy by a second TOETVA and 2 had neck scars from other surgery (carotid, melanoma). There were 10 conversions to cervicotomy (7.1%): 6 for a nodule > 6 cm, 4 for haemorrhage. The complications were 9 transient recurrent nerve pareses (6.4%) and 2 permanent ones (1.4%), 10 cases of transient hypoparathyroidism (19.6%) and 2 permanent ones (3.9%) that were well tolerated. Thirty patients had transient neuropathic disorders of the chin. No haematoma, infection or axillary neuropathy was observed. All patients reported being satisfied.
Conclusion: TOETVA is an effective and scarless technique for total or partial thyroidectomies in which the nodule size is less than 6 cm. Graves’ disease, BMI>30 and a history of neck surgery are not absolute contraindications.
See also: Scarless thyroidectomy (TOETVA) · More than 250 cases presented in Bangkok
