Scarless Thyroidectomy & Parathyroidectomy by TransOral Endoscopic Vestibular Approach (TOEVA): A Series of the First 37 Cases in Israel

  • Background: The trans-cervical approach has been the primary route of access for thyroid and parathyroid gland since its description by Kocher 140 years ago. Several approaches have been suggested for minimizing the surgical scar but none of them have become common practice. However, Trans-Oral Endoscopic Vestibular Approach . . (TOEVA) for extraction of thyroid or parathyroid tumors has been recently reported as a novel approach. The aim is to show the safety and feasibility of TOEVA for thyroid and parathyroid surgery.

    Methods: Case series of patients who underwent Thyroidectomy and Parathyroidectomy via the transoral endoscopic vestibular approach at our institution. The study was approved by our institutional board IRB

    Results: Thirty-seven patients (23 thyroidectomies and 14 parathyroidectomies) underwent surgery via this approach and were included. Average time of surgery was 3 hours. One patient had transient vocal cord paralysis, second patient had altered sensation of chin and the last patient had seroma that resolved by aspiration. Surgery was successful in all patients with no permanent complications

    Discussion: We report the first series of patients in Israel undergoing TOEVA for thyroid and parathyroid. The learning curve is steep but improving. Surgery was uneventful and safe. The results are comparable to other reports from various centers who adopt this novel technique

    Conclusions: TOEVA were found in this study to be feasible and safe. Larger studies from multiple institutions are required before this approach is approved as an alternative to the traditional trans-cervical approach in select patients


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