Gasless transoral endoscopic thyroidectomy vestibular approach (gasless TOETVA)

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The transoral endoscopic thyroidectomy vestibular approach (TOETVA) has been the subject of increasing interest from several institutions around the world over the last 2 years. Recently, we successfully performed TOETVA in live human patients without CO2 gas using our newly designed retractable blade.


We reviewed the medical records of 15 consecutive patients who underwent gasless TOETVA using a self-retaining retractor.


We successfully performed 13 thyroid lobectomies and 2 total thyroidectomies in 15 patients. No patient exhibited serious postoperative complications such as recurrent laryngeal nerve palsy and permanent hypocalcemia. One patient developed transient hypocalcemia but recovered within 2 months. No patient developed a wound infection; furthermore, no visible scar or dimpling was evident on the neck of any patient.


Gasless TOETVA provides enough working space and good visibility to perform thyroid surgery without any risk of CO2 gas-related complications.

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This work was supported by the National Research Foundation of Korea (NRF) Grant funded by the Korea government (No. NRF-2014R1A2A2A03004802).

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Correspondence to Yoon Woo Koh.

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Jun‑Ook Park, Yeong Jun Park, Mi Ra Kim, Dong‑Il Sun, Min‑Sik Kim, and Yoon Woo Koh have no conflicts of interest or financial ties to disclose.

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Park, J., Park, Y.J., Kim, M.R. et al. Gasless transoral endoscopic thyroidectomy vestibular approach (gasless TOETVA). Surg Endosc 33, 3034–3039 (2019).

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  • Endoscopy
  • Minimally invasive surgical procedure
  • Thyroid
  • Thyroidectomy
  • Transoral thyroidectomy
  • Transoral