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Feasibility and complications after transoral endoscopic thyroidectomy via vestibular approach (TOETVA) – a single-center first experience case series

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Abstract

Background

This paper reports on the first experience after implementation of a transoral endoscopic thyroidectomy via vestibular approach (TOETVA) as an alternative to (partial) thyroidectomy or isthmusectomy in a single center. Feasibility, implementation and specific complications are addressed.

Methods

All patients who underwent a TOETVA procedure in our center between November 2019 and March 2023 were included. The surgical technique was performed as described by Anuwong et al. All procedures were performed by two dedicated head- and neck surgeons.

Results

A total of 20 patients were included. All patients underwent TOETVA surgery as planned and no conversions were needed. Observed complications were post-operative wound infections (POWI) (2/20; 10%), clinically significant seroma (1/20, 5%) and unilateral hemiparesis of the larynx (3/20; 15%). Permanent mental nerve damage was seen in 3/20 patients (15%), and 4 other patients (20%) experienced transient neuropraxia.

Conclusions

TOETVA is a feasible alternative to (partial) thyroidectomy or isthmusectomy in selected patients. Special care should be taken when placing the trocars in the oral vestibulum to prevent mental nerve damage. Experience and training are essential for implementing the TOETVA procedure.

Trial Registration

This study was registered to ClinicalTrials.gov. Trial registration number: NCT05396703.

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Data availability

No datasets were generated or analysed during the current study.

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Acknowledgements

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Funding

Not applicable.

Due to the nature of this study, the requirement to obtain informed consent was waived by the reviewing ethical committee.

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Author notes

  1. M.A. Spiekerman van Weezelenburg, A. Pijnenburg, J.H.M.B. Stoot and J. van Bastelaar shared co-authors.

Authors and Affiliations

  1. Faculty of Medicine, KU Leuven, Herestraat 49, Leuven, 3000, Belgium

    Sam Kinet

  2. Department of Surgery, Zuyderland Medical Centre, Dr. H. van der Hoffplein 1, Sittard-Geleen, 6162 BG, The Netherlands

    M. A. Spiekerman van Weezelenburg, A. Pijnenburg, J. H.M.B. Stoot & J. van Bastelaar

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  1. Sam Kinet
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  2. M. A. Spiekerman van Weezelenburg
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Contributions

All authors contributed to the conception and design of the study. Material preparation, data collection, and analysis were performed by SK. The first draft of the manuscript was written by SK, and all authors commented on previous versions of the manuscript. All authors have read and approved the final manuscript.

Corresponding author

Correspondence to Sam Kinet.

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Ethical approval

Ethical approval by the METC Z (Medisch Ethische ToetsingsCommissie Zuyderland AND Zuyd Hogeschool, nationally licensed) was granted on February 18, 2021. Approval by the board of directors of Zuyderland MC (the hospital) was granted on February 23, 2021.

Informed consent

Due to the nature of this study, the requirement to obtain informed consent was waived by the reviewing ethical committee.

Competing interests

All authors declare that they do not have any competing interests.

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Kinet, S., van Weezelenburg, M.A.S., Pijnenburg, A. et al. Feasibility and complications after transoral endoscopic thyroidectomy via vestibular approach (TOETVA) – a single-center first experience case series. Langenbecks Arch Surg 409, 158 (2024). https://doi.org/10.1007/s00423-024-03347-3

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