Our Summary

This research study looked at a method of performing thyroid surgery called Trans Oral Endoscopic Thyroidectomy through Vestibular Approach (TOETVA). This approach means that the surgeon operates through the mouth, which avoids leaving any visible scars.

The study followed 53 patients who had this type of surgery between July 2017 and June 2021. Most of the patients (98.1%) were women and the average age was 44. The main reason for the surgery was a thyroid nodule, which is a small lump in the thyroid.

The team performed different types of thyroid surgeries, including removing one lobe of the thyroid (lobectomy), removing the entire thyroid (total thyroidectomy), and dissecting the central neck. The time it took for the surgeries varied, but on average, patients stayed in the hospital for 2 days.

There were some complications after surgery. Four patients experienced dysphonia (voice changes), but only two of those were confirmed to be due to nerve damage. One of these cases was permanent. Among those who had their entire thyroid removed, about 18% experienced temporary low calcium levels (hypoparathyroidism), but none had permanent issues. All patients experienced temporary numbness in the chin after surgery.

In conclusion, the study showed that this new method of performing thyroid surgery through the mouth is safe and effective for the right patients. It also offers the best cosmetic results since it leaves no visible scars. However, this approach can cause some temporary complications.

FAQs

  1. What is the Trans Oral Endoscopic Thyroidectomy through Vestibular Approach (TOETVA)?
  2. What were the main complications experienced by patients after undergoing TOETVA surgery?
  3. How long was the average hospital stay for patients who underwent the TOETVA procedure?

Doctor’s Tip

One helpful tip a doctor might tell a patient about thyroidectomy is to follow post-operative care instructions carefully. This may include taking prescribed medications, monitoring for signs of complications like difficulty breathing or swallowing, and attending follow-up appointments with your healthcare provider. It’s also important to be patient with the healing process and give your body time to recover fully. If you have any concerns or questions, don’t hesitate to reach out to your healthcare team for guidance and support.

Suitable For

Patients who are typically recommended for thyroidectomy include those with thyroid nodules that are suspicious for cancer, those with large goiters causing symptoms such as difficulty swallowing or breathing, those with hyperthyroidism that does not respond to medication, and those with thyroid cancer. The TOETVA approach may be particularly beneficial for patients who are concerned about visible scarring and who are suitable candidates for this minimally invasive technique. However, it is important for patients to discuss the risks and benefits of this approach with their healthcare provider to determine if it is the best option for them.

Timeline

Before the thyroidectomy:

  • Patient experiences symptoms related to a thyroid condition, such as a thyroid nodule, hyperthyroidism, or thyroid cancer
  • Patient undergoes diagnostic tests, such as blood tests, ultrasound, and fine needle aspiration biopsy, to determine the need for surgery
  • Patient consults with an endocrinologist and a surgeon to discuss treatment options and risks
  • Patient undergoes pre-operative preparations, including blood work, imaging tests, and medication adjustments

After the thyroidectomy:

  • Patient undergoes the TOETVA surgery, which is performed through the mouth to avoid visible scars
  • Surgery may involve removing one lobe of the thyroid (lobectomy), the entire thyroid (total thyroidectomy), or dissecting the central neck
  • Patient stays in the hospital for an average of 2 days
  • Patient may experience complications such as dysphonia (voice changes), temporary low calcium levels (hypoparathyroidism), and temporary numbness in the chin
  • Patient follows up with the surgeon for post-operative care and monitoring
  • Patient may need to take thyroid hormone replacement medication for the rest of their life to manage thyroid function

Overall, the TOETVA approach to thyroid surgery offers a safe and effective option for patients, with the benefit of minimal scarring. Temporary complications can occur, but the majority of patients in the study did not experience long-term issues.

What to Ask Your Doctor

  1. What are the potential risks and complications associated with a thyroidectomy performed through the mouth?

  2. How long does the recovery process typically take after a thyroidectomy through the mouth?

  3. Will I need to take any medications or supplements after the surgery, such as thyroid hormone replacement or calcium supplements?

  4. How often will I need to follow up with you after the surgery?

  5. Are there any specific dietary or activity restrictions I should follow after the surgery?

  6. What are the chances of experiencing permanent side effects, such as voice changes or low calcium levels, after this type of surgery?

  7. How does this method compare to traditional thyroidectomy in terms of outcomes and recovery time?

  8. Are there any specific criteria or conditions that make me a good candidate for this type of thyroid surgery?

  9. Will I still need to undergo regular thyroid function tests after the surgery?

  10. Can you provide me with information on other patients who have undergone thyroidectomy through the mouth, so I can learn about their experiences and outcomes?

Reference

Authors: Moreno Llorente P, Pascua-Solé M, García Barrasa A, Francos Martínez JM, Muñoz de Nova JL, Fernández Ranvier G, Vidal Fortuny J. Journal: Cir Esp (Engl Ed). 2023 Jan;101(1):35-42. doi: 10.1016/j.cireng.2022.07.010. Epub 2022 Jul 25. PMID: 35896141