Strategies for superior thyroid pole dissection in transoral thyroidectomy: a video operative guide

Surg Endosc. 2020 Aug;34(8):3711-3721. doi: 10.1007/s00464-020-07577-6. Epub 2020 May 7.


Background: The dissection of the superior thyroid gland pole is challenging when using the in TransOral Endoscopic Thyroidectomy Vestibular Approach (TOETVA) due to (a) the cranio-caudal approach, (b) cranial-caudal view, and (c) the restriction of maneuverability inside the narrow neck air pocket.

Methods: In this paper and operative video guide, a series of TOETVA's tips and tricks are presented with an emphasis on the strategies for a safe approach to the superior thyroid gland pole structures.

Results: Management of the upper thyroid pole structures includes: (a) use of a 5 mm/30°-45° endoscope; (b) retraction ports up to the limit of the lower jaw edge; (c) lateral retraction of 1/3 of the cranial strap muscles; (d) isthmectomy; (e) cutting the sternothyroid muscle cranially for 1 cm; (f) retraction of the thyroid upwards and laterally; (g) monitoring the external branch of the superior laryngeal nerve, and (h) sealing individual vessel branches.

Conclusion: Access to the superior thyroid pole space through the TOETVA approach presents some challenges, particularly when accessing thyroid vessels or nodules located or displaced more cranially. Strategies that enhance a critical view of the superior thyroid gland structures can protect them from damage and have the potential to improve the safety of the TOETVA and decrease potential conversion rates.

Keywords: Intraoperative neuromonitoring; Superior laryngeal nerve; Transoral endoscopic thyroidectomy; Vestibular approach.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Dissection
  • Humans
  • Natural Orifice Endoscopic Surgery / methods*
  • Thyroid Gland / surgery*
  • Thyroidectomy / methods*
  • Video-Assisted Surgery / methods*