Trans-Oral Endoscopic Thyroidectomy Vestibular Approach (TOETVA)

1. Introduction

1. Patient positioning
2. Surgical approach and marking

2. Surgical Approach for Thyroid Lobectomy

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

3. Closure

1. Close strap muscles
2. Close dermis with 5-0 Prolene
3. Place a chin support (for 24 hours post-op)