A Scar-Free Surgical Innovation

Thyroid surgery has undergone remarkable transformation in recent decades, shifting from conventional open techniques to minimally invasive, cosmetically appealing approaches. Among the most groundbreaking is Transoral Endoscopic Thyroidectomy, performed via vestibular or submental vestibular access (TOETVA/TOETSMVA). This technique eliminates visible cervical scars, making it an attractive choice for patients seeking both surgical safety and optimal cosmetic outcomes.

What is TOETVA/TOETSMVA?

• TOETVA (Transoral Endoscopic Thyroidectomy Vestibular Approach):
  A minimally invasive approach using small incisions inside the oral vestibule (lower lip area) to access and remove thyroid tissue.

• TOETSMVA (Transoral Endoscopic Thyroidectomy Submental Vestibular Approach):
  A modification where the access is slightly lower, through the submental region, offering a wider working space and improved ergonomics for the surgeon.

Both techniques avoid neck incisions, achieving a “scarless in the neck” result while maintaining the principles of safe thyroid surgery.

Indications

TOETVA/TOETSMVA can be considered for patients with:

• Benign thyroid nodules (<6 cm)

• Differentiated thyroid cancers (low-risk, ≤2 cm, no extrathyroidal extension)

• Multinodular goiter in selected cases

• Patient preference for cosmetic reasons

Contraindications include locally advanced malignancy, extensive prior neck surgery or radiation, and large retrosternal goiters.

Surgical Technique Overview

1. Incisions & Access Creation

   • Three small incisions inside the oral vestibule (TOETVA) or one submental plus vestibular ports (TOETSMVA).

   • CO₂ insufflation creates a working space in the subplatysmal plane.

2. Dissection & Exposure

   • Endoscopic instruments and camera allow magnified visualization of vital structures, including recurrent laryngeal nerves and parathyroid glands.

3. Thyroid Resection

   • Lobectomy, isthmusectomy, or total thyroidectomy performed depending on pathology.

4. Specimen Retrieval

   • Removed via endoscopic bag through oral port without external scarring.

Benefits of TOETVA/TOETSMVA

• Cosmetic Advantage: Completely avoids visible neck scar.

• Patient Satisfaction: Improved self-esteem and quality of life, especially in younger patients.

• Comparable Oncologic Safety: Outcomes similar to conventional open thyroidectomy for selected cases.

• Enhanced Visualization: Endoscopic magnification helps preserve nerves and parathyroids.

Potential Risks and Complications

While safe in experienced hands, possible complications include:

• Mental nerve injury (numbness of lower lip/chin)

• Transient recurrent laryngeal nerve palsy

• Hypocalcemia (temporary or permanent)

• Infection risk due to oral entry

• Subcutaneous emphysema or CO₂-related complications (rare)

Careful patient selection and surgical expertise minimize these risks.