Outcomes of Transoral Endoscopic Thyroidectomy Vestibular Approach (TOETVA): Experience from a Single Center in Iraq

Transoral endoscopic thyroidectomy vestibular approach (TOETVA); is a transluminal natural orifice surgery, truly scar free and involves minimal dissection, thus resulting in excellent cosmetic results in comparison to conventional open thyroidectomy and other endoscopic thyroidectomy procedures. This chapter aimed to describe the outcome, patient satisfaction, and complications after hemithyroidectomy for benign thyroid nodules by TOETVA in comparison with the open approach. This study was conducted in Al-Shiffa General Hospital, Basrah, Iraq from August 2017 to June 2019. Fifty patients with benign thyroid nodules who are candidates for hemithyroidectomy were included in the study; they were divided into two groups according to the method for thyroidectomy which was either conventional open or TOETVA based on the patient's preferences. The results of this study showed that 24 (48%) of them were operated upon by TOETVA, while the remaining 26 (52%) patients have been operated upon by the open thyroidectomy approach. TOETVA reported a longer mean duration of surgery compared to open thyroidectomy (93±8.34 min.) and (48±7.45min.). It reported a higher rate of satisfaction scores in bodily pain (BP), social functioning (SF), and role-emotional (RE), (99.7±0.21), (99.8±0.10) and (99.6±0.13) compared to (78.4±0.22), (44.8±0.64) and (77.3±0.43) for open thyroidectomy. Two cases of temporary recurrent laryngeal nerve palsy were reported in this study. 1(4.16%) case was in TOETVA and 1(3.84%) case was in open thyroidectomy. Other reported complications in this study which were unique for TOETVA, were temporary mental nerve palsy in 1 case (4.16 %), cervical subcutaneous emphysema in 1 case (4.16%), and conversion to open thyroidectomy in 1 case (4.16%).

In conclusion, the transoral endoscopic thyroidectomy vestibular approach is a safe and feasible procedure with an excellent cosmetic outcome and better patient satisfaction. At present, it is a relatively time-consuming procedure and, therefore, candidate patients with a strong motivation for scar-free surgery are recommended.