Transoral endoscopic thyroidectomy vestibular approach

Abstract

In the last two decades, different types of extra-cervical approaches have been described in endocrine surgery, mainly for thyroidectomy, to achieve better cosmetic outcomes. These approaches transfer the classic incision described by Kocher, to inconspicuous locations, yet they necessitate of extensive surgical dissections. It was the development of the vestibular approach that changed the treatment paradigm, as it is the only approach free of visible scars, with a safety profile and overall outcomes comparable to traditional techniques. Furthermore, the shorter distance between the access point and the thyroid gland, obviates the need for extensive dissections, such as those used in other remote approaches. The vestibular transoral endoscopic thyroidectomy uses a conventional laparoscopic instrument via the oral vestibule, through the premandibular space, which is insufflated with CO₂. This technique is considered safe and reproducible. This review article aims to describe the surgical technique, in order to provide information relevant to routine clinical practice.