Abstract: Transoral endoscopic thyroidectomy vestibular approach (TOETVA) is the latest described remote access approach to surgery of the central neck. The unique benefit of TOETVA is that it is completely scarless as incisions are made in the vestibule of the oral cavity. Since the first case series was published in 2016, the number of cases has exponentially grown. Multiple studies have documented the morbidity and quality of life impact of having a visible transcervical scar. In addition, the recent literature has reported increased quality of life with TOETVA as well as improved cosmesis when compared to the traditional open approach and other remote access approaches. These benefits have led to the rapid initial adoption of TOETVA by surgeons, in contrast to slower uptakes seen with the other popular remote access approaches. Currently TOETVA is being performed internationally. As of May 2020, over 1,880 cases from 17 different countries have been reported. We performed a literature review of TOETVA outcomes and report complication rates to be similar to standard open thyroidectomy, with low rates of novel complications such as mental nerve injury (MNI) and carbon dioxide embolism. TOETVA should be considered a safe approach to thyroid surgery as it provides excellent cosmesis while demonstrating non-inferiority in terms of risk to the patient [recurrent laryngeal nerve (RLN) palsy, bleeding, infection, hypoparathyroidism (HP)]. Larger prospective studies should be done in the future to compare TOETVA to traditional thyroidectomy in terms of quality of life, voice outcomes and oncologic equivalency.

Victoria E. Banuchi

Sarita S. Ballakur

Benefits and risks of scarless thyroid surgery

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