Advantages of TOETVA: A Remote Access Approach

Abstract

Transoral endoscopic thyroidectomy vestibular approach (TOETVA) emerges as a minimally invasive surgery. Its trajectory since inception has been marked by a steady rise in publications, slightly curtailed by the COVID-19 pandemic. This surge bears testament to scholars' interest in this transformative technique. Initial studies of TOETVA showcased its safety and comparability with existing endoscopic methods. Notably, early complications, typical in pioneering endeavors, such as bruising, skin burns, and perforations, were documented. Anuong's comprehensive assessment of >200 TOETVA cases against open surgery illuminated intriguing parallels in complications and hospital stays, albeit with prolonged operative times and reduced postoperative pain. In subsequent studies with a cohort of 200 cases, TOETVA's statistical analyses showcased its risk parity with the transcervical approach, irrespective of variables such as gender, cancer, or Graves' status. The statistical outlier lay in the prolonged operative time for TOETVA, a trade-off for its distinctive benefits. Global adoption was palpable in Li et al.'s compilation up to 2022.1 This worldwide embrace was mirrored in the Brazilian experience, as numerous groups documented their journey, from initiation in a low-income setting to traversing the learning curve while safeguarding patient safety. Optical augmentation took center stage, from magnifying glasses amplifying surgeons' sight to robotic and endoscopic approaches boasting up to 10-fold optical zoom. The panorama extended into futuristic realms, as augmented reality and artificial intelligence promised to reshape thyroid surgery. Augmented reality platforms envisioned predicting parathyroids, nerves, and lymph nodes. Artificial intelligence offered real-time guidance, from shortening learning curves to identifying critical structures. In conclusion, TOETVA's adoption stands affirmed and resonates globally. Aesthetic concerns reconcile diverse populations. Magnification transcends optics, whereas robotic platforms enrich the endoscopic landscape. This landscape lays a foundation for future technologies. No competing financial interests exist. No funding was received for this article. Runtime of video: 10 mins 54 secs