TRANSORAL ENDOSCOPIC THYROIDECTOMY VIA VESTIBULAR APPROACH (TOETVA) FOR PT1 PAPILLARY THYROID CARCINOMA AS AN EFFECTIVE TREATMENT OPTION ENSURING A POSITIVE COSMETIC OUTCOME.

AUTHORS:
P. Góralski (Warsaw, Poland) , L. Panufnik (Warsaw, Poland) , M. Kwapisz (Warsaw, Poland) , J. Galczynski (Warsaw, Poland) , M. Dedecjus (Warsaw, Poland)
Background:
The conventional approach for managing low-risk thyroid carcinoma involves surgical lobe resection without radioiodine therapy, with a watchful ultrasound follow-up. TOETVA emerges as an effective and aesthetically favorable treatment for papillary thyroid microcarcinoma. The aim of the study was to evaluate the effectiveness of TOETVA in treating papillary thyroid microcarcinoma, focusing on outcomes for tumors below 2 cm.
Methods:
Between November 2019 and November 2023, the Department of Endocrine Surgery at the National Institute of Oncology in Warsaw conducted 29 TOETVA procedures for thyroid lesions smaller that 2 cm.
Results:
29 women (aged 28-74 years, BMI 16.9-29.0 km/m2) underwent transoral endoscopic thyroid lobectomy with intraoperative neuromonitoring(14 left-sided,15 right-sided). Preoperative cytological examination focused on thyroid lesions categorized as Bethesda III(7), IV(4), V(18) or VI(1) with no ultrasonographic signs of lymph node involvement. The average operation time was 98,75 minutes(85-120 minutes). Histopathological results included 15 papillary microcarcinomas(pT1aNx-0), 1 papillary microcarcinoma with nodules involvement(pT1aN1), 2 multifocal papillary microcarcinomas(pT1a(m)N0), 1 follicular microcarcinoma(pT1aN0), 2 papillary carcinomas(pT1bN1a) and 8 benign lesions. Conversion to the classical method was not necessary in any case. Complications included transient vocal fold paralysis in one patient(3.6%). Parathyroid tissue was detected in the specimen twice, but without any symptoms of hypofunction in either case. The duration of the hospital stay was 4 days. All patients positively evaluated the cosmetic outcome of the surgery.
Conclusions:
The study suggests that TOETVA may serve as a radical treatment method for low-risk pT1 thyroid cancer, offering positive cosmetic outcomes and minimal complications, demonstrating safety and efficacy in selected cases.