Transoral Endoscopic Thyroidectomy

“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
-Trans- axillary
-Trans-bteast
-Or both.

:diamonds:Recommended indications for TOR/ETVA;

:point_right:Patient history of hypertrophic scarring or motivation to avoid a cervical neck incision.
:point_right:Thyroid diameter ≤10 cm.
:point_right:Dominant nodule/tumor ≤6 cm if benign or indeterminate pathology, or dominant nodule ≤2 cm if Bethesda V/suspicious or confirmed DTC.
:point_right:Thyroid volume up to 45ml.
:point_right:Benign lesions,multinodular goiter, cytologically indeterminate nodules.
:point_right:Carefully selected patients with Grave’s disease, nodules that are suspicious for malignancy,

:diamonds:Recommended contraindications to TOR/ETVA;

:point_right:History of head & neck surgery.
:point_right:History of head/neck/upper mediastinal irradiation.
:point_right:Patient unfit for general anesthesia.
:point_right:Evidence of active clinical hyperthyroidism.
:point_right:Preoperative recurrent laryngeal nerve palsy.
:point_right:Lymph node metastasis.
:point_right:Extrathyroidal extension including tracheal or esophageal invasion.
:point_right:Oral abscesses.
:point_right:Substernal thyroidal extension.
:point_right:Failure to meet indications for TOR/ETVA.