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J Clin Endocrinol Metab. 2019 Mar 12. pii: jc.2019-00116. doi: 10.1210/jc.2019-00116. [Epub ahead of print]

Transoral Vestibular Thyroidectomy: Current State of Affairs and Considerations for the Future.

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Division of Head and Neck Endocrine Surgery, Department of Otolaryngology - Head & Neck Surgery, Johns Hopkins University School of Medicine.



The transoral endoscopic thyroidectomy vestibular approach (TOETVA) is a recently described procedure for surgical management of select thyroid pathology without the need for a cutaneous scar. TOETVA is far from the first described remote-access approach to the thyroid. In fact, numerous such techniques have been described over the past 20 years, although none have gained wide-spread implementation in North America or Europe. TOETVA, with its rapid growth worldwide and excellent outcomes to date, however, may succeed where these prior described techniques have failed.


The English literature was reviewed using the following keywords: transoral thyroidectomy, remote-access thyroidectomy, minimally-invasive thyroidectomy, and TOETVA. As three recent systematic reviews have been performed in regards to the technique, this manuscript does not seek to provide a fourth such text. Rather, here we summarize salient findings from these reviews and focus on candidates for the procedure, technique-specific characteristics which have led to TOETVA's early success, and prospects for the future.


TOETVA is the only thyroidectomy approach obviating the need for a cutaneous incision, and offers several advantages over prior described remote-access thyroidectomy techniques. These include a favorable anatomic surgical perspective, a comparatively short learning curve, no requirement for expensive instrumentation, and a broad inclusion criterion. These characteristics have facilitated the excellent surgical outcomes to date.


TOETVA is a suitable surgical option for a carefully selected patient population with proven safety and feasibility. The potential value of the procedure outside enhanced cosmesis continues to be defined.


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