Reply to: Commentary on transoral access for endoscopic thyroid resection by Dionigi et al.

Dr. Dionigi and associates discuss the advantages of modern technologies in endoscopic thyroid resection. Consequently the closest access to the thyroid gland must be the best approach. We agree that, in using this access, adequate antibiotic prophylaxis is necessary for avoiding infections, as experience with transoral access to the hypophysis in neurosurgery has shown [1]. For the clinical inauguration of such a new procedure patient risk must be minimized. So it seems to be best to combine this new transoral approach with procedures that have been proven to be feasible and successful—a so-called hybrid technique—until better instruments for endoscopic thyroidectomy have been developed. Developing such new instruments only makes sense when the technique has been shown to be promising. One such hybrid technique is preparation with a collar access using a 3-mm trocar and a 5-mm camera for creating the suprasternal space under the superficial collar fascia as the anterior collar approach [2] or lateral collar approach [3], then entering this cave via the transoral approach by using an endoscopic obturator under visual control to introduce the third instrument for triangulated preparation followed by transoral removal of thyroid tissue via the axilloscope. Such a procedure could be an important step towards safe endoscopic and minimally invasive thyroid resection in the future.