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  • Title
  • 1. Introduction
  • 2. Patient Preparation
  • 3. Exposure
  • 4. Creation of Subplatysmal Flap
  • 5. Division of Strap Muscles
  • 6. Preparation of Pretracheal Tissue
  • 7. Mobilization of Left Lobe
  • 8. Identification and Preservation of Superior and Inferior Left Parathyroids
  • 9. Identification of Inferior Thyroid Artery
  • 10. Identification of Left Recurrent Laryngeal Nerve
  • 11. Division of the Ligament of Berry
  • 12. Specimen Extraction
  • 13. Closure
  • 14. Post-op Remarks

Trans-Oral Endoscopic Thyroidectomy Vestibular Approach (TOETVA)

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Courtney Gibson, MD, MS, FACS; Tobias Carling, MD, PhD, FACS
Yale School of Medicine

General SurgeryOtolaryngologyOncologic Surgery

Procedure Outline

Table of Contents

  1. 1. Introduction
    1. 2. Surgical Approach for Thyroid Lobectomy
      1. 3. Closure
        1. Patient positioning
        2. Surgical approach and marking
        1. Secure airway with nasotracheal tube
        2. Make a 10-mm incision at the mid-vestibule (for camera), as well as two 5-mm incisions (working ports) superolaterally, away from mental nerves bilaterally
        3. Perform Veress needle hydrodissection
        4. Pass endoscope through the 10 mm port and insufflate to maximum of 6 mmHg CO2
        5. Develop subplatysmal working space
        6. Identify and divide strap muscles at the median raphe
        7. Elevate and secure the ipsilateral strap muscles with a hanging stitch
        8. Divide thyroid at the midline with a vessel sealing device
        9. Identify and transect the superior thyroid vessels close to the thyroid capsule
        10. Identify and transect the middle thyroid vein for medial mobilization of the thyroid lobe
        11. Identify and preserve the recurrent laryngeal nerve within the tracheoesophageal groove
        12. Identify and transect the inferior thyroid vessels close to the thyroid capsule
        13. Retrieve the specimen through the 10-mm incision using an endobag
        1. Close strap muscles
        2. Close dermis with 5-0 Prolene
        3. Place a chin support (for 24 hours post-op)

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        Authors

        Filmed At:

        Smilow Cancer Hospital at Yale New Haven

        Article Information

        Publication Date
        Article ID243
        Production ID0243
        Volume2021
        Issue243
        DOI
        https://doi.org/10.24296/jomi/243