Updates in Surgery

, Volume 69, Issue 2, pp 225–234 | Cite as

Transoral endoscopic thyroidectomy: preliminary experience in Italy

  • Gianlorenzo DionigiEmail author
  • Alessandro Bacuzzi
  • Matteo Lavazza
  • Davide Inversini
  • Luigi Boni
  • Stefano Rausei
  • Hoon Yub Kim
  • Angkoon Anuwong
Original Article
Part of the following topical collections:
  1. Endocrine surgery


Transoral endoscopic thyroidectomy vestibular approach (TOETVA) is a feasible novel surgical procedure that does not need visible incisions. We describe our initial experience with TOETVA. We recruited 15 patients who were willing to undergo TOETVA. Inclusion criteria were (a) patients who had a neck ultrasound (US) with a estimated thyroid diameter not larger than 10 cm; (b) US estimated gland volume ≤45 mL; (c) nodule size ≤50 mm; (d) a benign tumor, such as a thyroid cyst, single-nodular goiter, or multinodular goiter; (e) follicular neoplasm; (f) papillary microcarcinoma without evidence of metastasis. The procedure is carried out through a 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. CO2 insufflation 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 sternocleidomastoid muscle. Thyroidectomy is done fully endoscopically using conventional endoscopic instruments and intraoperative neuromonitoring. There were 34% total thyroidectomies and 66% hemithyroidectomies. All TOETVA procedures were performed successfully with no conversions. The mean operative time was 87.6 (59–118) min for lobectomy and 107.6 (99–135) min for bilateral procedure. We observed one case of transient postoperative hypocalcemia. There was no recurrent laryngeal nerve palsy. The cosmetic result was excellent in all patients. This is the first case series of TOETVA in Italy. TOETVA may provide a method for ideal cosmetic results. The results are encouraging, and we are optimistic about the future expansion of its applicability.


Thyroid surgery Endoscopic thyroidectomy Minimally invasive thyroidectomy 


Compliance with ethical standards

Conflict of interest

The authors have no conflict of interest to disclosure, and no other funding or financial relationship with the surgical industry.

Research involving human participants and/or animals

The study was approved by the institutional ethics committee of Department of Medicine and Surgery, University of Insubria.

Informed consent

All participants were provided the particular details for their surgeries and informed consent obtained from each patient.


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Copyright information

© Italian Society of Surgery (SIC) 2017

Authors and Affiliations

  • Gianlorenzo Dionigi
    • 1
    Email author
  • Alessandro Bacuzzi
    • 2
  • Matteo Lavazza
    • 1
  • Davide Inversini
    • 1
  • Luigi Boni
    • 3
  • Stefano Rausei
    • 1
  • Hoon Yub Kim
    • 4
  • Angkoon Anuwong
    • 5
  1. 1.1st Division of Surgery, Department of Medicine and Surgery, Endocrine Surgery Research CenterUniversity of InsubriaVareseItaly
  2. 2.Division of Anesthesia, Ospedale di CircoloFondazione MacchiVareseItaly
  3. 3.Department of General and Emergency Surgery at the IRCCS – Ca GrandaPoliclinico Hospital in Milan, University of MilanMilanoItaly
  4. 4.Department of SurgeryKorea University College of MedicineSeoulRepublic of Korea
  5. 5.Minimally Invasive and Endocrine Surgery DivisionDepartment of Surgery Police General HospitalBangkokThailand

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