OP44 – Transoral Endoscopic Thyroidectomy Vestibular Approach (TOETVA) With Standardized Neural Monitoring: Tips, Value and Limits

      Dionigi, Gianlorenzo1; Lavazza, Matteo1; Pappalardo, Vincenzo1; Inversini, Davide1 1 1st Division of General Surgery, Research Center for Endocrine Surgery, Department of Surgical Sciences and Human Morphology, University of Insubria (Varese-Como)   Background: Transoral endoscopic thyroidectomy vestibular approach (TOETVA) is a feasible novel surgical procedure that does not need visible incisions. We describe our experience with the application of the intraoperative neural monitoring. Methods: 29 patients underwent TOETVA. Inclusion criteria were patients who had a US estimated thyroid diameter not larger than 10cm and gland volume ?45 mL, nodule size ?50mm, a benign tumor, such as a thyroid cyst, single-nodular goiter, or multinodular goiter, follicular neoplasm, papillary microcarcinoma without evidence of metastasis. The procedure is carried out through 3 port technique placed in the oral vestibule, one 10mm port for 30°endoscope and 2 additional 5mm ports for dissecting and coagulating instruments. CO2 insufflation pressure is set at 6mmHg. An anterior cervical subplatysmal space is created from the oral vestibule down to the sternal notch. Thyroidectomy is done fully endoscopically using conventional instruments and standardized intraoperative neuromonitoring (V1, R1, R2, V2). Results:  34% were total thyroidectomies and 66% hemithyroidectomies. All procedures were performed with no conversions. The mean operative time was 87 min (59-118 min) for lobectomy and 107 min (99-135 min) for bilateral procedure. We observed 1 case of transient postoperative hypocalcemia. None recurrent laryngeal nerve palsy. The cosmetic result are excellent. Discussion and Conclusions:  TOETVA may provide a method for ideal cosmetic results. Results are encouraging and we are optimistic about the future expansion of its applicability. IONM is feasible for TOETVA.


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