Archives of Head and Neck Surgery
Archives of Head and Neck Surgery
Original Article Thyroid diseases and tumors

Transoral endoscopic thyroidectomy by vestibular approach (TOETVA): initial experience in an academic hospital

Antonio Augusto Tupinamba Bertelli, Leonardo Guimarães Rangel, Giancarlo Artese Araujo, Rolando Costa Monteiro , Luiz Claudio Bosco Massarollo, Jonathon Owen Russell, Ralph Patrick Tufano, Antonio José Gonçalves

Downloads: 1
Views: 482


Introduction: Transoral endoscopic thyroidectomy vestibular approach (TOETVA) is being adopted in many centers around the world for many reasons especially because it depends only on laparoscopic instruments. Objective: To describe the initial results of TOETVA after its adoption in a large academic hospital. Methods: Fifteen patients underwent TOETVA and were evaluated regarding its indication, operative time and complications. Results: Nine lobectomies and six total thyroidectomies were performed, with mean operative time of 107 minutes (64-150min). Ten patients did not have any surgical complications and five patients experienced some sort of complication (1 mental nerve temporary numbness, 1 vocal fold temporary paralysis, 1 temporary hypoparathyroidism and 2 small skin burns). We observed a progressive decrease of operative time. Conclusion: The initial results of TOETVA show that it could be instituted safely and effectively in a Brazilian academic center with a short learning curve.


thyroid cancer; papillary; thyroid gland; thyroid nodule; thyroidectomy; endoscopic; remote access thyroidectomy


1. Dionigi G, Lavazza M, Wu CW, Sun H, Liu X, Tufano RP, Kim HY, Richmon JD, Anuwong A. Transoral thyroidectomy: why is it needed? Gland Surg. 2017;6(3):272-6. PMid:28713699.

2. Anuwong A. Transoral endoscopic thyroidectomy vestibular approach: a series of the first 60 human cases. World J Surg. 2016;40(3):491-7. PMid:26546193.

3. Witzel K, von Rahden BH, Kaminski C, Stein HJ. Transoral access for endoscopic thyroid resection. Surg Endosc. 2008;22(8):1871-5. PMid:18163167.

4. Benhidjeb T, Wilhelm T, Harlaar J, Kleinrensink GJ, Schneider TA, Stark M. Natural orifice surgery on thyroid gland: Totally transoral video‐assisted thyroidectomy (TOVAT): Report of first experimental results of a new surgical method. Surg Endosc. 2009;23(5):1119-20. PMid:19263151.

5. Anuwong A, Ketwong K, Jitpratoom P, Sasanakietkul T, Duh Q. Safety and outcomes of the transoral endoscopic thyroidectomy vestibular approach. JAMA Surg. 2018;153(1):21-7. PMid:28877292.

6. Udelsman R, Anuwong A, Oprea AD, Rhodes A, Prasad M, Sansone M, Brooks C, Donovan PI, Jannitto C, Carling T. Trans-oral vestibular endocrine surgery: a new technique in the United States. Ann Surg. 2016;264(6):e13-6. PMid:27649533.

7. Anuwong A, Kim HY, Dionigi G. Transoral endoscopic thyroidectomy using vestibular approach: updates and evidences. Gland Surg. 2017;6(3):277-84. PMid:28713700.

8. Razavi CR, Vasiliou E, Tufano RP, Russell JO. Learning curve for transoral endoscopic thyroid lobectomy. Otolaryngol Head Neck Surg. 2018;159(4):625-9. PMid:30126330.

9. Russell JO, Noureldine SI, Al Khadem MG, Tufano RP. Minimally invasive and remote-access thyroid surgery in the Era of the 2015 American Thyroid Association Guidelines. Laryngoscope Investig Otolaryngol. 2016;1(Dec):175-9. PMid:28894814.

10. Richmon JD, Pattani KM, Benhidjeb T, Tufano RP. Transoral robotic-assisted thyroidectomy: a preclinical feasibility study in 2 cadavers. Head Neck. 2011;33(3):330-3. PMid:20629089.

11. Richmon JD, Holsinger FC, Kandil E, Moore MW, Garcia JA, Tufano RP. Transoral robotic-assisted thyroidectomy with central neck dissection: preclinical cadaver feasibility study and proposed surgical technique. J Robot Surg. 2011;5(4):279-82. PMid:22162981.

5e7decf20e88253c4ee1a447 archives Articles
Links & Downloads

Arch. Head Neck Surg.

Share this page
Page Sections