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Transoral thyroidectomy: a viable surgical option with unprecedented complications—a case series



To report the clinical implications of an initial experience with transoral endoscopic thyroidectomy vestibular approach (TOETVA).


From March to November 2017, five cases of TOETVA were performed. Data reported include patient demographics, indication for surgery, extent of surgery, operative time, the need to convert to cervicotomy, the length of hospital stay and post-operative pain and morbidity. Unconventional complications regarded as specific for TOETVA were reported. The burden of surgery on the patient’s quality of life was evaluated using the 36-item short form (SF-36) health survey 1 month after surgery.


All patients were females with a mean age of 36 years. They all underwent a right-sided hemithyroidectomy for a solitary thyroid nodule measuring on average 3.5 cm in size. The nodule was reported as Bethesda category II (n = 3), III (n = 1), and IV (n = 1) on fine needle aspiration cytology. The mean operative time was 122 min. Conversion to a transverse cervicotomy was required in one case. None of the patients developed post-operative bleeding, and none experienced vocal fold or mental nerve palsy. Surgical site infection did not occur. All patients developed subcutaneous emphysema that resolved within 12–48 h. All patients reported a long-standing bothersome pulling sensation along the surgical track that resulted in a poor outcome in some scales of the SF-36 survey. Flap perforation occurred in one case. The median VAS score was 3.


Patients strongly motivated to undergo a novel surgical procedure tailored to their needs and desires should be properly counselled particularly regarding unconventional procedure-related complications.

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The authors thank Dr. Angkoon Anuwong for his devotion to popularizing and mentoring the procedure.


This study was not founded by any grant.

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The corresponding author SB: study concept and design, data interpretation, article writing, final approval, and accountability for all aspects of the work. MA and MN: data collection and interpretation, drafting, final approval, and accountability for all aspects of the work. CC: data interpretation, final approval, and accountability for all aspects of the work. PM: study design, revision, final approval, and accountability for all aspects of the work.

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Correspondence to S. Bakkar.

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This article does not contain any studies with human participants or animals performed by any of the authors.

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No need for informed consent because of the retrospective nature of the study.

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Bakkar, S., Al Hyari, M., Naghawi, M. et al. Transoral thyroidectomy: a viable surgical option with unprecedented complications—a case series. J Endocrinol Invest 41, 809–813 (2018).

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  • Transoral
  • Endoscopic
  • Thyroid surgery