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General Surgery
Transoral Endoscopic Total Thyroidectomy via Vestibular Approach (TOETVA)
Built from Atlas of Thyroid Surgery
What’s inside
7 sections · 45 slides
Introduction
What TOETVA is, how it developed, and why it is used
- What TOETVA is
- The scarless nature of the approach
- Development of the transoral route
- Two transoral access routes
- Sublingual and vestibular access routes
- Adoption and evidence
- Advantages of TOETVA
Patient selection
Indications, limits, and exclusion criteria
- Indications for TOETVA
- Limits for less experienced surgeons
- Exclusion criteria
Operative setup
Positioning, marking, incision, and working space
- Procedure at a glance
- Position and room setup
- Operating room arrangement for TOETVA
- Skin marking
- Surface landmarks marked on the neck
- Oral disinfection
- Incision plan
- Intraoral incisions
- Reducing mucosal bleeding
- Creating the working space
- Insufflation and trocar placement
- Trocar placement
- Flap boundaries
- Camera angulation for the lower view
Gland dissection
Midline to poles, with nerve preservation
- Midline dissection
- Isthmus handling
- Lateral dissection
- Exposing a high upper pole
- Lateral retraction of the strap muscles
- Opening Joll's space
- Upper pole vessel ligation
- Upper pole resection
- Finding the recurrent laryngeal nerve
- Protecting the nerve from heat
- Recurrent laryngeal nerve identification
- Lower pole ligation and gland removal
Completion and recovery
Retrieval, closure, and aftercare
- Specimen retrieval
- Specimen retrieval with an endobag
- Contralateral resection
- Closure
- Recovery and discharge
Key points
What to remember about TOETVA
- Key takeaways
References
Sources cited in the text
- References
- References (continued)
- Atlas of Thyroid Surgery