Transoral endoscopic thyroidectomy vestibular approach with intraoperative nerve monitoring.
Transoral endoscopic thyroidectomy by a vestibular approach (TOETVA) is a novel technique for thyroid gland excision. Compared to the transaxillary endoscopic and bilateral axillo-breast approaches, which require substantial dissection to reach the thyroid gland, TOETVA provides the most direct access to the target organ.



The aim of this video is to provide a step-by-step overview of TOETVA and demonstrate how to set up and utilize intraoperative nerve monitoring.



Three incisions are placed in the vestibular region of the oral cavity just below the lower lip for placement of 2 lateral 5-mm trocars and 1 centrally placed 11-mm trocar. Insufflation to 6 mm Hg is used to maintain the working spacing. Using a 2-handed technique and triangulation, the thyroid gland is mobilized, taking care to identify and preserve the relevant cervical anatomy.



TOETVA is safe and feasible and provides an excellent cosmetic outcome with the most confidentially compared to the other remote access endoscopic approaches.
Icahn School of Medicine at Mount Sinai, New York, NY, USA. william.inabnet@mountsinai.org.|Department of Surgery, Mount Sinai Beth Israel, First Ave at 16th St, Baird Hall, 16th Floor, Suite 20, New York, NY, 10003, USA. william.inabnet@mountsinai.org.
William B
WB
Inabnet
Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Hyun
H
Suh
Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Gustavo
G
Fernandez-Ranvier
D006801:Humans; D016343:Monitoring, Intraoperative; D057605:Natural Orifice Endoscopic Surgery / Q000379:methods*; D061226:Recurrent Laryngeal Nerve Injuries / Q000517:prevention & control*; D013965:Thyroidectomy / Q000379:methods*; D020535:Video-Assisted Surgery
Endoscopic; Minimally invasive; Remote access; Thyroidectomy; Transoral