Transoral Vestibular Thyroidectomy: Is the New Era Already Here?

Minimally invasive thyroidectomy sounds non-familiar to the general surgeon. Since conventional open approach has been widely adopted, surgeons in their effort to further improve their skills passed to the new era of the Natural Orifice Transluminal Endoscopic Surgery (NOTES). The widespread adoption of robotics has led to the inevitable usage of robotic technology in simple and more complicated procedures. Although cervical area is limited and difficult to handle the necessary instruments, many efforts have been noted and the new era in minimal invasive thyroidectomy is coming. Transoral vestibular thyroidectomy promises excellent cosmetic results, in accordance with the elimination of complications, such as recurrent laryngeal nerve injury. The safety of the procedure has to be the main thought for the surgeon who perform the technique. A comprehensive search of PubMed Database was conducted for English-language studies using a list of key words. All transoral vestibular thyroidectomies that had intraoperative and postoperative complications were included from January 2000 till December 2018. A total of 11 studies, including 428 patients that underwent transoral thyroidectomy via vestibular approach, were analyzed. Postoperative data and complications were gathered among these studies. Recurrent laryngeal nerve injury was more likely to be discovered during the first postoperative days as transient hoarseness. Small hematomas were noticed, and most of them were definitively treated at the hospital where the injury occurred. Transient hypocalcemia was treated with per os supplements. Transoral vestibular thyroidectomy is a safe and adequate alternative to conventional open approach, with excellent cosmetic results. On the other hand, surgeons must be already experienced and familiar with robotic or endoscopic techniques, so as to overcome the problem of the eliminated space in the central neck area.