Context: The transoral endoscopic thyroidectomy vestibular approach (TOETVA) is a recently described procedure for surgical management of select thyroid pathology without the need for a cutaneous scar. TOETVA is far from the first described remote-access approach to the thyroid. In fact, numerous such techniques have been described over the past 20 years, although none have gained wide-spread implementation in North America or Europe. TOETVA, with its rapid growth worldwide and excellent outcomes to date, however, may succeed where these prior described techniques have failed.
Evidence acquisition: The English literature was reviewed using the following keywords: transoral thyroidectomy, remote-access thyroidectomy, minimally-invasive thyroidectomy, and TOETVA. As three recent systematic reviews have been performed in regards to the technique, this manuscript does not seek to provide a fourth such text. Rather, here we summarize salient findings from these reviews and focus on candidates for the procedure, technique-specific characteristics which have led to TOETVA's early success, and prospects for the future.
Evidence synthesis: TOETVA is the only thyroidectomy approach obviating the need for a cutaneous incision, and offers several advantages over prior described remote-access thyroidectomy techniques. These include a favorable anatomic surgical perspective, a comparatively short learning curve, no requirement for expensive instrumentation, and a broad inclusion criterion. These characteristics have facilitated the excellent surgical outcomes to date.
Conclusions: TOETVA is a suitable surgical option for a carefully selected patient population with proven safety and feasibility. The potential value of the procedure outside enhanced cosmesis continues to be defined.
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