Trans-Oral Endoscopic Thyroidectomy Vestibular Approach (TOETVA)
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Procedure Outline
Table of Contents
- Patient positioning
- Surgical approach and marking
- Secure airway with nasotracheal tube
- 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
- Perform Veress needle hydrodissection
- Pass endoscope through the 10 mm port and insufflate to maximum of 6 mmHg CO2
- Develop subplatysmal working space
- Identify and divide strap muscles at the median raphe
- Elevate and secure the ipsilateral strap muscles with a hanging stitch
- Divide thyroid at the midline with a vessel sealing device
- Identify and transect the superior thyroid vessels close to the thyroid capsule
- Identify and transect the middle thyroid vein for medial mobilization of the thyroid lobe
- Identify and preserve the recurrent laryngeal nerve within the tracheoesophageal groove
- Identify and transect the inferior thyroid vessels close to the thyroid capsule
- Retrieve the specimen through the 10-mm incision using an endobag
- Close strap muscles
- Close dermis with 5-0 Prolene
- Place a chin support (for 24 hours post-op)