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  • 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
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Trans-Oral Endoscopic Thyroidectomy Vestibular Approach (TOETVA)


Procedure Outline

  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)