[SCARLESS THYROIDECTOMY AND PARATHYROIDECTOMY BY TRANSORAL ENDOSCOPIC TRANSVESTIBULAR APPROACH (TOETVA): THE FIRST SERIES CASES IN ISRAEL].

Introduction: The transcervical approach has been the primary route of access for thyroid and parathyroid glands since its description by Kocher 140 years ago. Several approaches have been suggested for minimizing the surgical scar but none of them have become common practice. Thus, a role for a new novel technique still exists for improving surgical esthetic outcome. Trans-oral endoscopic trans-vestibular approach (TOETVA) has recently been reported as a novel approach for the extraction of thyroid or parathyroid tumors.

Aims: To show the safety and feasibility of TOETVA for thyroid and parathyroid surgery in Israel.

Methods: Case series of patients who underwent TOETVA at our institution. The study was approved by our Institutional Board IRB retrospectively.

Results: Ten patients (5 thyroidectomies and 5 parathyroidectomies) underwent TOETVA and were included in the study. The average time of surgery was 3.3 hours. One patient had transient vocal cord paralysis, a second patient had altered sensation of chin and a third patient had seroma that was resolved by aspiration. Surgery was successful in all patients and complete resection of the thyroid lobe as well as the parathyroid adenomas was achieved. No permanent complications were encountered.

Conclusions: In this study TOETVA was found to be feasible and safe for the resection of selected thyroid and parathyroid tumors.

Discussion: We report the first series of patients in Israel undergoing TOETVA for thyroid and parathyroid tumors. The learning curve is steep and improving. Surgery was uneventful and safe. The results are comparable to other reports from various centers which adopted this novel technique.