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Trans-Oral Endoscopic Thyroidectomy Vestibular Approach (TOETVA)

Tobias Carling, MD, PhD, FACS
Yale School of Medicine

1. Introduction

  1. Discussion of Instruments

2. Patient Preparation

3. Exposure

  1. Create 10 mm Incision
  2. Subplatysmal Dissection towards Sternal Notch
  3. Create Two 5 mm Incisions
  4. Placement of Ports
  5. Placement of Stay Suture

4. Creation of Subplatysmal Flaps

5. Division of Strap Muscles

6. Mobilize around Trachea

  1. Identify Trachea
  2. Mobilize Pyramidal Lobe
  3. Divide and Mobilize Isthmus
  4. Finish Mobilization

7. Mobilization of Left Lobe

  1. Insert Lateral Retracting Suture
  2. Ligate Middle Thyroid Vein

8. Upper & Lower Parathyroid Dissection

  1. Identify Inferior Thyroid Artery

9. Nerve Dissection

10. Division of the Ligament of Berry

11. Extraction

12. Closure

  1. Verification and Summary
  2. Suture Oral Incision

13. Post-op Remarks