TOETVA Surgical Approach Appears Efficacious for Benign Thyroid Tumors

"Today, TOETVA is increasingly being applied in many thyroid surgery [centers] worldwide due to its many advantages, such as the ability to access both thyroid lobes, remove central neck lymph nodes and have ideal cosmetic results by leaving no scar on the skin," according to the study authors.

Using a transoral endoscopic thyroidectomy vestibular surgical (TOETVA) approach appeared to be effective in a population of patients with benign thyroid tumors in addition to yielding fewer complications and improved aesthetic results compared with standard open thyroidectomy, according to results from a prospective cohort study published in the Journal of Minimal Access Surgery.¹

Investigators reported an operative time of 77.5 ± 13.3 minutes in the TOETVA cohort compared with 51.5 ± 4.2 minutes in the conventional open thyroidectomy (COT) cohort (P <.001). Moreover, there was little difference between arms with respect to postoperative length of stay, and no patients converted to open surgery.

In the overall study population (n = 200), there were no instances of postoperative bleeding. Additionally, there was no statistically significant difference in the rate of transient hypothyroidism following surgery in the TOETVA and COT arms, respectively (3% vs 2%; P = .651); the same was observed for the transient recurrent laryngeal nerve injury rate (5% vs 4%; P = .733).

“Open surgery is a conventional method for treating benign thyroid [tumors] when surgery is indicated, but this method leaves a scar on the neck permanently,” the study’s authors wrote.¹ “In 2016, Anuwong reported good outcomes for 60 patients [who received TOETVA], which represented a breakthrough in endoscopic surgery worldwide.² Today, TOETVA is increasingly being applied in many thyroid surgery [centers] worldwide due to its many advantages, such as the ability to access both thyroid lobes, remove central neck lymph nodes and have ideal cosmetic results by leaving no scar on the skin.”

The prospective cohort study included 100 patients who received TOETVA and 100 who received COT for benign disease between June 2018 and December 2021. Patients were selected based on interest in scarless surgery and whether they had favorable characteristics that would make them potential candidates for TOETVA; this included motivation to avoid cervical scars, symptomatically benign nodules of less than 6 cm, cytologically indeterminate nodules, an estimated thyroid diameter of less than 10 cm on ultrasound, an estimated gland volume of less than 45 mL, symptomatic Hashimoto’s thyroiditis, and Grave’s disease. Importantly, non-favorable TOETVA features included substernal goiters, previous neck and chin surgery, and previous neck radiation.

Investigators reported that patients with a single benign nodule or multinodules with localization in 1 lobe underwent thyroid lobectomy. Additionally, those with multinodules in 2 lobes underwent total thyroidectomy.

Within the TOETVA group, 92 patients received thyroid lobectomy, and 8 received total thyroidectomy compared with 90 patients and 10 patients in the COT cohort, respectively.

Most patients in the TOETVA cohort reported feeling very satisfied (82%; P <.001) with their surgical procedure followed by satisfied (10%) and normal (8%). Additionally, the majority of patients in the COT cohort felt satisfied (57%), very satisfied (37%), and normal (8%) following surgery. No patients in either cohort were dissatisfied with their surgical procedure.

“TOETVA is a safe and effective method, with a low complication rate and optimal aesthetic results compared [with] traditional surgery to treat benign thyroid tumors,” the study authors concluded.¹

References

1. Quy Xuan N, Duy Quoc N, Duong The L, et al. Transoral endoscopic thyroidectomy vestibular approach versus conventional open thyroidectomy for the treatment of benign thyroid tumours: a prospective cohort study. J Min Acc Sur. Published online January 9, 2024. doi:10.4103/jmas.jmas_197_23
2. Anuwong A. Transoral endoscopic thyroidectomy vestibular approach: a series of the first 60 human cases. World J Surg. 2016;40(3):491-497. doi:10.1007/s00268-015-3320-1