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Surgical Innovation
April 2018

Transoral Endoscopic Thyroidectomy—An Emerging Remote Access Technique for Thyroid Excision

Author Affiliations
  • 1Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
JAMA Surg. 2018;153(4):376-377. doi:10.1001/jamasurg.2017.5306

The transoral endoscopic thyroidectomy vestibular approach (TOETVA) represents a new remote access endoscopic technique for thyroid gland excision. Remote access or “hidden scar” endoscopic thyroid surgery comprises a constellation of approaches to the thyroid gland in which incisions are strategically placed in inconspicuous locations away from the neck and a laparoscopic camera is used to visualize the operative field.1-3 While several large case series have shown the efficacy of the transaxillary endoscopic thyroidectomy (TET), retroauricular, and bilateral axillo-breast approach (BABA) techniques, the Achilles’ heel of these approaches is the considerable dissection that is required to gain access to the thyroid gland, which leads to increased operative time. Moreover, these operations are often performed using a robotic platform that raises a host of health care concerns, such as increased cost, lack of standardized training and credentialing, and compromised access to care based on availability of the robotic system.