Transoral Thyroid Surgery (TOETVA)

The scar resulting from thyroid surgery can be obvious and embarrassing, especially for younger patients or people prone to keloid scar formation.

Transoral Thyroid Surgery (Scarless Thyroidectomy)

Unlike scars from almost all other types of surgery, the scar from thyroid surgery is difficult conceal due to its prominent location on the lower neck.

Suren is the first surgeon in Victoria to perform transoral endoscopic thyroidectomy, an advanced minimally-invasive technique that places the incisions behind the lower lip, leaving no visible scars on the patient’s neck. This technique has recently been adopted in leading centres around the world as a safe, cost-effective alternative to traditional open thyroid surgery. While long-term data is still pending, studies to date have shown that it is as safe as traditional thyroid surgery techniques in appropriately selected patients.

What Is Transoral Thyroid Surgery?

Transoral endoscopic thyroidectomy vestibular approach (TOETVA) is a cutting-edge, scarless technique that allows the thyroid to be removed through small incisions inside the lower lip—leaving no scar on the neck.

It is ideal for select patients with:

• Small to medium thyroid nodules

• Localised thyroid cancer

• Benign goitres or cysts

• Cosmetic concerns about scarring

Advantages of TOETVA

• No visible neck scar

• Shorter recovery

• Less postoperative pain

• Excellent cosmetic outcome

Is my thyroid condition suitable for Transoral Endoscopic Thyroidectomy?

In patients who are particularly motivated to avoid a surgical scar on the neck, Suren is currently performing transoral endoscopic thyroidectomy for benign symptomatic thyroid nodules up to four centimetres in size, and asymptomatic thyroid nodules up to three centimetres with indeterminate cytology (i.e. patients who require a diagnostic hemithyroidectomy). Some smaller thyroid cancers up to two centimetres may also be suitable for the transoral approach. Each case is assessed on an individual basis with careful consideration given to both patient factors and thyroid factors to detemine if a patient’s thyroid condition can be safely managed with this revolutionary technique.

What does the procedure involve?

• General anaesthetic (you are fully asleep)

• Three incisions placed on the inside of the lower lip

• Endoscopic (“keyhole”) surgery to remove the thyroid gland

• One or two-night stay in hospital

What are the risks of Transoral Endoscopic Thyroidectomy?

The Transoral technique carries the same risks as open surgery:

• Injury to the nerve to the voice box (the recurrent laryngeal nerve), which may result in a hoarse voice (1%)

• Injury to the parathyroid glands, resulting in low calcium levels, which may require long-term calcium supplementation (<1%)

• Post-operative bleeding, which may require a return to the operating theatre for further surgery (<1%)

A recent study has shown no significant difference in complication rates between the open and transoral approaches, although long-term data is limited at this stage.

There are additional complications unique to the transoral approach. These are:

• Injury to a nerve resulting in a numb patch of skin over the side of the chin or lower lip (1%)

• The need to convert to traditional open thyroidectomy (1%)

Am I a Candidate for Scarless Thyroid Surgery?

Suitability is determined by:

• Patient’s motivation to avoid scars on the neck

• Nodule size and location

• Cancer risk profile

• Absence of extensive lymph node involvement

• General health status

Suren’s Expertise in Transoral Surgery

Suren was the first surgeon in Melbourne to perform this innovative procedure and has undergone advanced international training in transoral and transaxillary endoscopic thyroidectomy.