William B Inabnet1,2, Hyun Suh3, Gustavo Fernandez-Ranvier3. 1. Icahn School of Medicine at Mount Sinai, New York, NY, USA. william.inabnet@mountsinai.org. 2. 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. 3. Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Abstract
BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSION: TOETVA is safe and feasible and provides an excellent cosmetic outcome with the most confidentially compared to the other remote access endoscopic approaches.
BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSION: TOETVA is safe and feasible and provides an excellent cosmetic outcome with the most confidentially compared to the other remote access endoscopic approaches.
Authors: Hong Kyu Kim; Young Jun Chai; Gianlorenzo Dionigi; Eren Berber; Ralph P Tufano; Hoon Yub Kim Journal: World J Surg Date: 2019-04 Impact factor: 3.352