Transoral endoscopic thyroidectomy via vestibular approach: operative steps and video.
In this video we describe transoral endoscopic thyroidectomy vestibular approach (TOETVA). Inclusion criteria are (I) patients who had a ultrasonographically (US) estimated thyroid diameter not larger than 10 cm; (II) US estimated gland volume ≤45 mL; (III) nodule size ≤50 mm; (IV) a benign tumor, such as a thyroid cyst, single-nodular goiter, or multinodular goiter; (V) follicular neoplasm; (VI) papillary microcarcinoma without evidence of metastasis. The procedure is carried out through three-port technique placed at the oral vestibule, one 10-mm port for 30° endoscope and two additional 5-mm ports for dissecting and coagulating instruments. CO2insufflation pressure is set at 6 mmHg. An anterior cervical subplatysmal space is created from the oral vestibule down to the sternal notch, laterally to the sterncleidomuscles. Thyroidectomy is done fully endoscopically using conventional endoscopic instruments and intraoperative neuromonitoring (IONM).
1 Division of General Surgery, Research Center for Endocrine Surgery, Department of Surgical Sciences and Human Morphology, University of Insubria (Varese-Como), 21100 Varese, Italy.
Gianlorenzo
G
Dionigi
Division of Anesthesia, Ospedale di Circolo, Fondazione Macchi, Varese, Italy.
Alessandro
A
Bacuzzi
1 Division of General Surgery, Research Center for Endocrine Surgery, Department of Surgical Sciences and Human Morphology, University of Insubria (Varese-Como), 21100 Varese, Italy.
Matteo
M
Lavazza
1 Division of General Surgery, Research Center for Endocrine Surgery, Department of Surgical Sciences and Human Morphology, University of Insubria (Varese-Como), 21100 Varese, Italy.
Davide
D
Inversini
1 Division of General Surgery, Research Center for Endocrine Surgery, Department of Surgical Sciences and Human Morphology, University of Insubria (Varese-Como), 21100 Varese, Italy.
Vincenzo
V
Pappalardo
1 Division of General Surgery, Research Center for Endocrine Surgery, Department of Surgical Sciences and Human Morphology, University of Insubria (Varese-Como), 21100 Varese, Italy.
Luigi
L
Boni
1 Division of General Surgery, Research Center for Endocrine Surgery, Department of Surgical Sciences and Human Morphology, University of Insubria (Varese-Como), 21100 Varese, Italy.
Stefano
S
Rausei
Department of Endocrine Surgery, Jagiellonian University Medical College, Krakow, Poland.
Marcin
M
Barczynski
Division of Head and Neck Endocrine Surgery, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Ralph P
RP
Tufano
Division of Breast and Endocrine Surgery, Department of Surgery, Minimally Invasive Surgery and Robotic Surgery Center, KUMC Thyroid Center Korea University, Anam Hospital, Seoul, Korea.
Hoon Yub
HY
Kim
Department of Surgery, Police General Hospital, Faculty of Medicine, Siam University, Pathumwan, Bangkok, Thailand.
Angkoon
A
Anuwong
Transoral; instruments and intraoperative neuromonitoring (IONM); thyroidectomy; transoral endoscopic thyroidectomy vestibular approach (TOETVA); vestibular approach