Modified Technique in Transoral Endoscopic Thyroidectomy Vestibular Approach (TOETVA).

Abstract

Transoral endoscopic thyroidectomy vestibular approach (TOETVA) is becoming increasingly popular in thyroid surgery.^1-4 following its introduction at Vietnam National Cancer Hospital in 2018,^5,6 we developed modifications to optimize surgical efficiency and patient outcomes. We present the case of a 23-year-old female with right thyroid lobe carcinoma (cT1N0M0). A modified TOETVA technique was employed for right lobectomy. Key modifications included: (1) direct working space creation without epinephrine-saline solution injection or Angkoon's retractor and (2) strategic repositioning of the 5-mm trocar and minimized vestibular trauma during 10-mm trocar placement to reduce mental nerve injury risk. The operative duration for right lobectomy was 55 min. The postoperative course was uneventful, with no cervical edema, minimal pain, and preserved cervical mobility on day one. No complications (vocal cord dysfunction, hypoparathyroidism, hemorrhage, or seroma) were observed. The patient was discharged on postoperative day 2. Our technical modifications demonstrated reduced operative time, diminished postoperative discomfort, and decreased temporary mental nerve injury incidence. The simplified approach using standard laparoscopic instrumentation has enhanced the procedure's accessibility across global healthcare facilities.