An easier option for "invisible scar" thyroidectomy: hybrid-transoral endoscopic thyroidectomy submental access (H-TOETSA)-experience on twenty-two consecutive patients.

Abstract

Transoral endoscopic thyroidectomy vestibular approach (TOETVA) is currently the only "cervical invisible scar" procedure with a surgical access close to the thyroid area. The aim of this technical note was to describe a hybrid technique with a vestibular and a submental access as applied in 22 consecutive patients undergoing lobectomy. Out of 502 thyroidectomies performed from February 1, 2018 to May 31, 2019, feasibility of Hybrid-TransOral Endoscopic Thyroidectomy Submental Access (H-TOETSA) was assessed in 22 patients meeting the inclusion criteria. Differently from TOETVA, a central trocar (≤ 10mm) for the camera was placed on the natural skin depression immediately under the chin. A left 3mm and a right 5mm (or 3mm if a 3mm energy device was available) trocars were placed in the vestibulum (as in TOETVA). Operative time was 74.32 (± 34.16) min. Two temporary recurrent nerve paralysis and three lip/chin dysesthesia were observed. In two patients, an additional 3cm horizontal access was performed 2cm above the clavicle to control a persistent bleeding. Patients complained pain only in the first postoperative hours. All patients perceived excellent cosmetic results even at postoperative day 1. H-TOETSA was feasible and resulted to have some technical and clinical advantages maintaining the purpose to avoid a visible scar on the neck.