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Surgeons Remove Thyroid Gland by Making 3 Small Incisions Inside the Mouth Underneath Lower Lip

Endoscopic transoral thyroidectomy is part of a near-scarless endoscopy evolution.

Published: December 2, 2016

Category: Outpatient Surgery > ENT
LIP SERVICE The thyroid gland is extracted through an 11-mm incision.

If you want to remove the thyroid gland without leaving behind an unsightly scar on the front of the neck, try working through a small incision on the inside of the patient's lower lip. That's the route a team of innovative surgeons took at Mount Sinai Beth Israel Hospital in Manhattan during the first transoral endoscopic thyroidectomy by a vestibular approach (TOETVA) performed in the state of New York and only the third performed in the United States.

TOETVA involves placing a central 11-mm trocar and 2 lateral 5-mm trocars in the lower lip and inserting the endoscopic camera through the central incision to create a working space. After the gland is incised, it's placed in a specimen bag and removed through the central incision.

"There's no sign that the patient has undergone surgery, because the incisions are hidden behind the lip," says William Inabnet III, MD, the lead surgeon on the MSBI team.

The procedure is part of an evolving group of remote access or hidden scar endoscopic thyroid surgeries that aim to improve post-op cosmesis. Dr. Inabnet's team also specializes in other remote access thyroidectomies: the transaxillary approach, which involves making an incision in the armpit, and the bilateral axillary breast approach, which involves 4 small incisions in the chest.

"We now have the ability to approach the gland from below through the chest, from the side through the armpit or from above through the mouth," says Dr. Inabnet. "The transoral route provides the closest path from the incision to the thyroid gland and is a natural addition to our growing program of minimally invasive techniques."

Dr. Inabnet says the transoral approach is best suited for smaller nodules and early-stage papillary thyroid cancer. Check out this intraoperative video for a detailed view and technical explanation of a transoral endoscopic thyroidectomy.

Daniel Cook

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