Transoral endoscopic thyroidectomy vestibular approach, adaptation of modern surgical technique in a developing country Authors Ahmad Nawaz Ahmad Department of Otolaryngology, Liaquat National Postgraduate Medical Centre, Karachi, Pakistan Iqra Zakir Department of Otolaryngology, Liaquat National Postgraduate Medical Centre, Karachi, Pakistan Hamdan Ahmed Pasha Department of Otolaryngology, Liaquat National Postgraduate Medical Centre, Karachi, Pakistan DOI: https://doi.org/10.47391/JPMA.6639 Keywords: TOETVA, minimally thyroid surgery Abstract Conventional thyroidectomy has been the standard technique for over 100 years but has the drawback of leaving a scar on the neck. As such, the demand for minimally invasive endoscopic thyroid surgery is rapidly growing as patients are becoming more and more worried about scars; it is more appropriate in patients who want to get surgery done because of odd looking swelling over the neck. TOETVA is safe, feasible, effective, and scar-free alternative to conventional thyroid surgery. We are sharing our first clinical experience in TOETVA in Pakistan with effective outcome in terms of surgical complication and patient satisfaction. Keywords: TOETVA, minimally thyroid surgery, Pakistan. References Yu J-j, Bao S-l, Yu S-l, Zhang D-Q, Loo WTY, Chow LWC, et al. Minimally invasive video-assisted thyroidectomy for the early-stage differential thyroid carcinoma. J Transl Med 2012 Sep (Vol. 10, No. 1, pp. 1-5). DOI: 10.1186/1479-5876-10-S1-S13 Gagner M. Endoscopic subtotal parathyroidectomy in patients with primary hyperparathyroidism. Br J Surg. 1996 Jun; 83(6):875- DOI: 10.1002/bjs.1800830656 Huscher CSG. Endoscopic right thyroid lobectomy. Surg Endosc. 1997; 11:877. DOI: 10.1007/s004649900476 .Miccoli P, Materazzi G. Minimally invasive, video-assisted thyroidectomy (MIVAT). Surg Clin North Am.2004 Jun 1; 84(3):735-41. DOI: 10.1016/j.suc.2004.03.003 Inabnet Iii WB, Jacob BP, Gagner M. Minimally invasive endoscopic thyroidectomy by a cervical approach. Surg Endosc. 2003 Nov; 17(11):1808-11. DOI: 10.1007/s00464-002-8760-7 Cho YU, Park IJ, Choi K-H, Kim SJ, Choi SK, Hur YS, et al. Gasless endoscopic thyroidectomy via an anterior chest wall approach using a flap-lifting system. Yonsei Med J. 2007 Jun 1; 48(3):480-7. DOI: 10.3349/ymj.2007.48.3.480 Ikeda Y, Takami H, Niimi M, Kan S, Sasaki Y, Takayama J. Endoscopic thyroidectomy by the axillary approach. . J Am Coll Surg .2003 Feb 1; 196(2):189-95. DOI: 10.1016/S1072-7515(02)01665-4 Lee J, Chung WY. Current status of robotic thyroidectomy and neck dissection using a gasless transaxillary approach. . Curr Opin Oncol.2012 Jan 1; 24(1):7-15. DOI: 10.1097/CCO.0b013e32834cb813 Choe J-H, Kim SW, Chung K-W, Park KS, Han W, Noh D-Y, et al. Endoscopic thyroidectomy using a new bilateral axillo-breast approach. World J Surg. 2007 Mar; 31(3):601-6. DOI: 10.1007/s00268-006-0481-y Koh YW, Kim JW, Lee SW, Choi EC. Endoscopic thyroidectomy via a unilateral axillo-breast approach without gas insufflation for unilateral benign thyroid lesions. Surg Endosc.2009 Sep; 23(9):2053-60. DOI: 10.1007/s00464-008-9963-3 Tan CT, Cheah WK, Delbridge L. “Scarless”(in the neck) endoscopic thyroidectomy (SET): an evidence-based review of published techniques. World J Surg. 2008 Jul;32(7):1349-57. DOI https://doi.org/10.1007/s00268-008-9555-3 Witzel K, Von Rahden BHA, Kaminski C, Stein HJ. Transoral access for endoscopic thyroid resection. Surg Endosc.2008 Aug; 22(8):1871-5. DOI: 10.1007/s00464-007-9734-6 Wilhelm T, Harlaar JJ, Kerver A, Kleinrensink G-J, Benhidjeb T. Surgical anatomy of the floor of the oral cavity and the cervical spaces as a rationale for trans-oral, minimal-invasive endoscopic surgical procedures: results of anatomical studies. Eur Arch Otorhinolaryngol .2010 Aug; 267(8):1285-90. DOI: 10.1007/s00405-010-1219-x Wilhelm T, Metzig A. Endoscopic minimally invasive thyroidectomy: first clinical experience. Surg Endosc. 2010 Jul; 24(7):1757-8. DOI: 10.1007/s00464-009-0820-9 Anuwong A. Transoral endoscopic thyroidectomy vestibular approach: a series of the first 60 human cases. World J Surg .40(3):491-7. DOI: 10.1007/s00268-015-3320-1 Anuwong A, Kim HY, Dionigi G. Transoral endoscopic thyroidectomy using vestibular approach: updates and evidences. Gland Surg. 2017 Jun; 6(3):277. Chai YJ, Chung JK, Anuwong A, Dionigi G, Kim HY, Hwang KT et al. Transoral endoscopic thyroidectomy for papillary thyroid microcarcinoma: initial experience of a single surgeon. Ann Surg Treat Res. 2017 Aug 1;93(2):70-5.DOI: 10.4174/astr.2017.93.2.70 Menderico GM, Weissenberg AL, BORBA C, Sallani GM, Poy JD. Complications of transoral endoscopic thyroidectomy vestibular approach (TOETVA). Rev Col Bras Cir. 2021 Jan 20; 48. DOI: 10.1590/0100-6991e-20202557. Kim KN, Lee DW, Kim JY, Han KH, Tae K. Carbon dioxide embolism during transoral robotic thyroidectomy: a case report. Head Neck. 2018 Mar; 40(3):E25-8. DOI: 10.1002/hed.25037 Anuwong A, Sasanakietkul T, Jitpratoom P, Ketwong K, Kim HY, Dionigi G, et al. Transoral endoscopic thyroidectomy vestibular approach (TOETVA): indications, techniques and results. Surg Endosc.2018 Jan; 32(1):456-65. DOI: 10.1007/s00464-017-5705-8 Downloads Full Text Article Published 2023-05-15 How to Cite Ahmad Nawaz Ahmad, Zakir, I., & Hamdan Ahmed Pasha. (2023). Transoral endoscopic thyroidectomy vestibular approach, adaptation of modern surgical technique in a developing country. Journal of the Pakistan Medical Association, 73(6), 1288–1290. https://doi.org/10.47391/JPMA.6639 More Citation Formats ACM ACS APA ABNT Chicago Harvard IEEE MLA Turabian Vancouver Download Citation Endnote/Zotero/Mendeley (RIS) BibTeX Issue Vol. 73 No. 6 (2023): JUNE Section CASE SERIES License Copyright (c) 2023 Journal of the Pakistan Medical Association This work is licensed under a Creative Commons Attribution 4.0 International License.