3D Transoral Endoscopic Thyroidectomy
Authors:   Division of General Surgery, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS)  Istituto Auxologico Italiano, Milan, Italy, Frattini Francesco , Casaril Andrea ,   Endocrine Surgery Unit, Pederzoli Hospital, Peschiera del Garda, Verona, Italy, Zhang Daqi ,   Division of Thyroid Surgery, China-Japan Union Hospital of Jilin University, Jilin Provincial Key Laboratory of Surgical Translational Medicine, Jilin Provincial Precision Medicine Laboratory of Molecular Biology and Translational Medicine on Differentiated Thyroid Carcinoma, Changchun City, China, Dionigi Gianlorenzo ,   Division of General Surgery, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS)  Istituto Auxologico Italiano, Milan, Italy, Cestari Andrea ,   Division of General Surgery, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Makay Ozer ,   Department of General Surgery, Division of Endocrine Surgery, Ege University Faculty of Medicine, Izmir, Turkey, Wu Che Wei ,   Department of Otorhinolaryngology—Head and Neck Surgery, International Thyroid Surgery, Center,  Kaohsiung Medical University Hospital, Faculty of Medicine, College of Medicine,  Kaohsiung Medical University, Kaohsiung, Taiwan, Kim Hoon Yub ,   Department of Surgery, Korea University College of Medicine (KUMC) Thyroid Center, Korea University Hospital, Korea University College of Medicine, Seoul, South Korea, Angkoon Anuwong ,   Police General Hospital, Bangkok, Thailand, Tufano Ralph P. ,   Head and Neck Endocrine Surgery, Sarasota Memorial Health Care System, Sarasota, Florida, Cohen Oded ,   Department  of Otolaryngology, Soroka Medical Center, Ben Gurion University of the Negev, Beer-Sheva, Israel, Sun Hui ,   Division of Thyroid Surgery, China-Japan Union Hospital of Jilin University, Jilin Provincial Key Laboratory of Surgical Translational Medicine, Jilin Provincial Precision Medicine Laboratory of Molecular Biology and Translational Medicine on Differentiated Thyroid Carcinoma, Changchun City, China
Published: February 2023

Transoral endoscopic thyroidectomy with vestibular approach (TOETVA) is a feasible new surgical procedure that does not require visible incisions. We describe our experience with three-dimensional (3D) TOETVA. We recruited 98 patients who were willing to undergo 3D TOETVA. Inclusion criteria were: (a) patients with a neck ultrasound (US) with an estimated thyroid diameter of 10cm or less; (b) estimated US gland volume ≤45ml; (c) nodule size ≤50mm; (d) benign tumor, such as thyroid cyst, goiter with one nodule, or goiter with multiple nodules; (e) follicular neoplasia; and (f) papillary microcarcinoma without evidence of metastases. The procedure is performed using a three-port technique at the oral vestibule, a 10mm port for the 30° endoscope, and two additional 5mm ports for dissecting and coagulation instruments. The CO2 insufflation pressure is set at 6mmHg. An anterior cervical subplatysmal space is created from the oral vestibule to the sternal notch and laterally to the sternocleidomastoid muscle. Thyroidectomy is performed entirely 3D endoscopically with conventional endoscopic instruments and intraoperative neuromonitoring. There were 34% total thyroidectomies and 66% hemithyroidectomies. Ninety-eight 3D TOETVA procedures were successfully performed without any conversions. The mean operative time was 87.6 minutes (59–118 minutes) for lobectomy and 107.6 minutes (99–135 minutes) for bilateral surgery. We observed one case of transient postoperative hypocalcemia. Paralysis of the recurrent laryngeal nerve did not occur. The cosmetic outcome was excellent in all patients. This is the first case series of 3D TOETVA.