How transoral thyroid surgery works
The full name is transoral endoscopic thyroidectomy, vestibular approach, or TOETVA. "Vestibular" means the space between your lower lip and gums. The surgeon works through that space to reach the thyroid from above, guided by a small camera.
Step by step
1
You are fully asleep under general anesthesia.
2
The surgeon makes three small openings inside the lower lip: one in the center, about 1 to 2 cm, and two smaller ones near the corners of the mouth.
3
A thin camera and slim instruments pass under the skin of the chin down to the thyroid.
4
Carbon dioxide gas gently lifts the skin to make a working space.
5
The surgeon removes part or all of the thyroid, protecting the voice nerves and the parathyroid glands.
6
The tissue comes out through the central opening, and the openings are closed with dissolving stitches.
How it compares
Where the cut is
Traditional: Front of the neck, usually 4 to 6 cm
Transoral: Inside the lower lip, three small openings
Visible scar
Traditional: Yes, on the neck
Transoral: None on the skin
What is removed
Traditional: Same
Transoral: Same
Typical hospital stay
Traditional: Same day or overnight
Transoral: Usually same day (outpatient); an overnight observation stay is optional
Common temporary effects
Traditional: Neck soreness, swallowing discomfort
Transoral: Chin and neck soreness, temporary chin firmness, swelling
Other "remote access" approaches use openings in the armpit, chest or behind the ear. They avoid a front-of-neck scar but leave a scar elsewhere. Transoral surgery avoids a skin scar altogether.