“Transoral Endoscopic Thyroidectomy/Endoscopic Trans vestibular Approach (ETVA)/ Transoral robotic(TOR )/ Endoscopic Scarless thyroidectomy”
The transoral endoscopic technique, an adaptation of the concept of natural orifice transluminal endoscopic surgery (NOTES) to the neck, is a technique that promises to improve the aesthetic aspect by offering a scarless operation while retaining the advantages of minimally invasive surgery.
Other scarless neck thyroidectomy approaches are
Recommended indications for TOR/ETVA;
Patient history of hypertrophic scarring or motivation to avoid a cervical neck incision.
Thyroid diameter ≤10 cm.
Dominant nodule/tumor ≤6 cm if benign or indeterminate pathology, or dominant nodule ≤2 cm if Bethesda V/suspicious or confirmed DTC.
Thyroid volume up to 45ml.
Benign lesions,multinodular goiter, cytologically indeterminate nodules.
Carefully selected patients with Grave’s disease, nodules that are suspicious for malignancy,
Recommended contraindications to TOR/ETVA;
History of head & neck surgery.
History of head/neck/upper mediastinal irradiation.
Patient unfit for general anesthesia.
Evidence of active clinical hyperthyroidism.
Preoperative recurrent laryngeal nerve palsy.
Lymph node metastasis.
Extrathyroidal extension including tracheal or esophageal invasion.
Substernal thyroidal extension.
Failure to meet indications for TOR/ETVA.