Transoral Endoscopic Thyroidectomy Vestibular Approach (TOETVA) for Thyroid Nodules: A Series of the First 10 Patients in a Single Institution


  • Lawrence Y. Maliwat Quirino Memorial Medical Center; Bataan General Hospital and Medical Center
  • Rowald Rey G. Malahito Quirino Memorial Medical Center; Amang Rodriguez Memorial Medical Center
  • Erasmo Gonzalo D.V. Llanes Quirino Memorial Medical Center



TOETVA, thyroidectomy, transoral, endoscopic, minimally invasive



Objective: To present the perioperative data of patients with solitary or multinodular goiter and/ or papillary thyroid carcinoma who underwent Transoral Endoscopic Thyroidectomy Vestibular Approach (TOETVA) in a single tertiary medical center.


Design: Case series

Setting: Tertiary Government Hospital

Participants: Records of 10 patients who underwent TOETVA from June 2018 to July 2019 (9 thyroid lobectomies, 1 total thyroidectomy) were reviewed. Outcomes and measures included conversion to open surgery, operative time, intraoperative blood loss, size of the thyroid gland, postoperative hospital stay, visual analogue pain scores (VAS), and postoperative complications.

Results: None of the 10 patients were converted to an open procedure. The average preoperative thyroid size was 4.73 cm in widest diameter using thyroid ultrasound (±1.88 cm, range 3.6 to 6.5 cm). Mean operative time for thyroid lobectomy and total thyroidectomy was 4 hours and 29 minutes and 4 hours and 15 minutes, respectively. Mean intraoperative blood loss was 140 ml (±47.96 ml, range 80 to 200 ml) for thyroid lobectomy and 100 ml for total thyroidectomy. The average intraoperative size of the thyroid gland measured in widest diameter (larger lobe for total thyroidectomy) was 4.48 cm (±0.919 cm, range 3 to 5.5 cm). Median postoperative hospital stay was 2 days (±1.55 days, range 2 to 12 days). Mean VAS pain scores for postoperative days 1, 2, 3, and 7 were 5, 3, 2, and 0, respectively. Transient recurrent laryngeal nerve injury (of 3 months duration) occurred in 1 patient. Two cases had surgical site infection, 2 had wound dehiscence, 1 had seroma and 1 had skin burn as a complication. None had hypocalcemia or mental nerve injury in the series.

Conclusions: TOETVA was replicated in the local setting and a presentation of the perioperative data of all the patients who underwent this novel technique, the indications, as well as surgical and patient outcomes, were described.

Keywords: TOETVA; thyroidectomy; transoral; endoscopic; minimally invasive


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How to Cite

Maliwat L, Malahito RR, Llanes EG. Transoral Endoscopic Thyroidectomy Vestibular Approach (TOETVA) for Thyroid Nodules: A Series of the First 10 Patients in a Single Institution. Philipp J Otolaryngol Head Neck Surg [Internet]. 2020 May 17 [cited 2024 Jul. 17];35(1):39-45. Available from: