Technical Innovation in Transoral Endoscopic Endocrine Surgery: A Modified “Scarless” Technique

Abstract

BackgroundThe transoral endoscopic approach to thyroidectomy aims to eliminate a visible neck incision. Early experience has demonstrated promising safety and efficacy results but has uncovered unique drawbacks from the middle oral incision. We present a case series of our institutional experience with a technical innovation called the TransOral and Submental Technique (TOaST) designed to address these limitations. Materials and methodsWe reviewed all patients who successfully underwent TOaST thyroidectomy at our institution from November 2017 to November 2018. Demographics, surgical indications, technical details, and perioperative outcomes were recorded in a prospective database and analyzed retrospectively. ResultsFourteen patients underwent TOaST thyroidectomy, with mean follow-up of 17 wk. Mean age was 38 y, and all but one was female. Most cases were cytologically benign or indeterminate nodules. There were no injuries to the recurrent laryngeal or mental nerves. TOaST had no instances of chin pain or specimen disruption, two complications that have been associated with the standard transoral approach. The cosmetic outcomes remained excellent. ConclusionsThis pilot study of TOaST indicates that it is a technically feasible and safe approach to thyroidectomy for selected patients.