Transoral endoscopic thyroidectomy vestibular approach with intraoperative nerve monitoring

William B. Inabnet, Hyun Suh, Gustavo Fernandez-Ranvier

Research output: Contribution to journalArticlepeer-review

43 Scopus citations


Background: Transoral endoscopic thyroidectomy by a vestibular approach (TOETVA) is a novel technique for thyroid gland excision. Compared to the transaxillary endoscopic and bilateral axillo-breast approaches, which require substantial dissection to reach the thyroid gland, TOETVA provides the most direct access to the target organ. Methods: The aim of this video is to provide a step-by-step overview of TOETVA and demonstrate how to set up and utilize intraoperative nerve monitoring. Results: Three incisions are placed in the vestibular region of the oral cavity just below the lower lip for placement of 2 lateral 5-mm trocars and 1 centrally placed 11-mm trocar. Insufflation to 6 mm Hg is used to maintain the working spacing. Using a 2-handed technique and triangulation, the thyroid gland is mobilized, taking care to identify and preserve the relevant cervical anatomy. Conclusion: TOETVA is safe and feasible and provides an excellent cosmetic outcome with the most confidentially compared to the other remote access endoscopic approaches.

Original languageEnglish
Pages (from-to)3030
Number of pages1
JournalSurgical Endoscopy
Issue number7
StatePublished - Jul 1 2017

Bibliographical note

Publisher Copyright:
© 2016, Springer Science+Business Media New York.


  • Endoscopic
  • Minimally invasive
  • Remote access
  • Thyroidectomy
  • Transoral

ASJC Scopus subject areas

  • Surgery


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