← All decks
General Surgery
Transoral Endoscopic Thyroidectomy via Vestibular Approach (TOETVA)
Built from Atlas of Thyroid Surgery
What’s inside
3 sections · 41 slides
Overview
- TOETVA overview
- Neck scar after open thyroidectomy
- Open thyroidectomy versus TOETVA
- Remote-access approaches before TOETVA
Procedure
From positioning and port placement to closure.
- Procedure at a glance
- Patient positioning
- Patient positioning in mild neck hyperextension
- Airway and nerve monitoring setup
- Operating room team and monitor position
- Operative setup before transoral incisions
- Three vestibular incisions
- Lower-lip vestibular access
- Creating the working space
- Route of the transoral approach
- Hydrodissection beneath the platysma
- Subplatysmal hydrodissection and dilation
- Three-port setup
- Three 5-mm port setup
- Insufflation and instruments
- Subplatysmal dissection to the sternal notch
- Exposing the thyroid
- Midline division of the strap muscles
- Mobilizing the strap muscles
- Mobilizing the strap muscles from the thyroid capsule
- Sequence of vessel ligation
- Sealing the middle thyroid vessels
- Dissecting the superior lobe
- Identifying the recurrent laryngeal nerve
- Inferior thyroid vessels
- Inferior thyroid artery and parathyroid gland
- Contralateral lobe and specimen
- Completed thyroid dissection
- Endocatch bag for specimen removal
- Monitoring the recurrent laryngeal nerve
- Closing the incisions
- Strap muscle and mucosal closure
- Postoperative recovery
Tips and Pitfalls
Practical points that make the procedure safer.
- Tips for a safe TOETVA
- TOETVA at a glance
- References
- Atlas of Thyroid Surgery