Transoral Endoscopic Thyroidectomy (TOETVA)

Purpose of ReviewSince the nineteenth century, the surgical methods used to perform open cervical thyroidectomy have improved significantly, resulting in substantially reduced rates of mortality and morbidity. The most up-to-date techniques today now focus on the need to limit the extent of any visible scarring, which requires that surgeons make their incisions in locations which minimize their likelihood of being noticed.Recent FindingsDuring the past two decades, several remote access approaches have been developed for use in the field of endoscopic and robotic thyroidectomy, and these have proved a popular alternative to open surgery because the results are much more visually appealing (Miccoli et al. J Endocrinol Investig. 22(11):849-51, 1999; Ikeda et al. Surg Endosc Other Interv Tech. 16(1):92-5, 2002; Choe et al. World J Surg. 31(3):601-6, 2007; Wang et al. Surg Endosc. 29(1):192-201, 2015). However, even with these remote techniques, it is still possible to see the scars where the incisions were made; to address this issue, the novel thyroid treatment technique of natural orifice transluminal endoscopic surgery (NOTES) has therefore been developed (Witzel et al. Surg Endosc Other Interv Tech. 22(8):1871-5, 2008; Benhidjeb Surg Endosc. 23(5):1119-20, 2009).SummaryWith this new technique, the problem of scarring is eliminated completely, but while this benefit makes the procedure very attractive, it is still considered to be an experimental form of treatment because of the limitations which applied to the earlier sublingual technique of thyroidectomy (Wilhelm et al. World J Surg. 35(3):543-51, 2011; Karakas et al. Surgery. 150(1):108-15, 2011; Wilhem et al. Transl Cancer Res. 5(7):S1531-0, 2016). The oral vestibular approach has since undergone further development, with the clinical outcomes proving to be superior to earlier techniques (Nakajo et al. Surg Endosc. 27(4):1105-10, 2013; Wang et al. Surg (United States). 155(1):33-8, 2014; Anuwong World J Surg. 40(3):491-7, 2016).