Transoral endoscopic thyroidectomy via the vestibular approach (TOETVA) is a surgical technique that, despite requiring enhanced surgical skills, allows for the removal of the thyroid gland without leaving a visible scar on the neck.

Between Nov.2019 and Nov.2023, 36 TOETVA procedures were conducted. The study analyzed patient data, including indications, procedural details, and treatment outcomes, with the goal of assessing outcomes and identifying optimal indications for TOETVA.

36 women (20-74 y.o.)underwent thyroid lobectomy (left-sided:16; right-sided:20) with intraoperative neuromonitoring. Preoperative cytological examination focused on thyroid lesions categorized as Bethesda II-VI, without lymph node involvement. The average operation time was 110 minutes(90-180 minutes). Complications included transient vocal fold paralysis in one patient and a postoperative hematoma in the submandibular area requiring puncture and aspiration on the 10th day post-operation in another patient. Histopathological results included 18 papillary microcarcinomas(pT1aN0), 10 benign lesions, 1 noninvasive follicular thyroid neoplasm, 1 oncocytic carcinoma and 4 lesions of uncertain malignant potential. Two patients underwent classical radicalization due to histopathological findings of pT1bN1a, requiring I131 treatment(5.6%). Three patients underwent submandibular incision for specimen extraction(8.3%). It was required to convert once to the classical method (uncontrolled bleeding). All patients positively evaluated the cosmetic outcome.

TOETVA serves as an alternative to traditional surgery for a select group of patients seeking to avoid neck scars. This procedure is deemed safe, associated with a low risk of complications, and provides excellent cosmetic results, althouhgt because of the equipment used and longer operating time it is more expensive comparing to classical thyroid surgery.