Endoscopic approaches in head and neck endocrine surgery − introduction of TOETVA (TransOral Endoscopic Thyroidectomy by Vestibular Approach) into clinical use at the Department of Surgery of the University Hospital in Brno

Abstract

Transoral endoscopic surgery of the thyroid and parathyroid glands is amodification of neck surgery using natural orifices. The classic approach in neck surgery is the gold standard, which we modified in 2007 by introducing Minimally Invasive Video-Assisted Thyroidectomy/Parathyroid-ectomy (MIVAT/P). We have been using TransOral Endoscopic Thyroidectomy/Parathyroidectomy by Vestibular Approach (TOETVA/TOEPVA) since the end of the last year and have operated on four patients. This method is more attractive for patients because it does not leave avisible scar on the neck, which is common in MIVAT/P. TOETVA is apromising procedure with many advantages, such as healing without visible scars, less pain, minimally invasive dissection and aclear operating field to both thyroid lobes and parathyroid glands. Presentation of the first case. Patients indicated for TOETVA must meet certain criteria - nodule(s) up to 3.5 cm, gland volume up to 30 ml, benign FNAB, papillary, follicular carcinoma not advanced, well differentiated, up to the nodule size of 10 mm with 1 lymph node up to 10 mm. The contraindications include alarge goiter, previous neck surgery, history of thyroiditis, lymphadenopathy of the neck, advanced thyroid cancer. Relative contraindications include previous radiotherapy to the throat, Grave´s disease, and obese patients with ashort neck. Intraoperative findings may result in amodification of the procedure. TOETVA is an excellent choice for selected patients who want to avoid aneck incision. This method provides the benefit of using standard endoscopic instruments and techniques. It is asafe and effective procedure that provides agood cosmetic result and considerable comfort in terms of clarity of the operating field by zooming in with an endoscopic camera.Longer operating times become shorter due to the learning curve effect.