Safe access for transoral endoscopic thyroidectomy vestibular approach: an anatomical and ultrasound-based study

Since the successful development and clinical introduction of transoral endoscopic thyroidectomy (TOET) in 2008 and 2009, some modifications of the access have been published, of which the vestibular approach (TOETVA) has gained the most widespread use. However, in addition to the known mostly temporary damage to the mentalis nerve, this approach is associated with new specific complications: in addition to skin perforations this is – most seriously – damage to the marginalis mandibula branch of the facial nerve.

Therefore we performed an anatomical study of two specimens and an ultrasound examination on 20 volunteers to investigate whether there are dangerous or safe areas of incisions in the anterior vestibule of mouth.

It was shown that a lateral incision approximately 5 to 10 mm from the vestibular fold and anterior incision about 5 mm from it promises the lowest risk of accidental complications, both in terms of vascular and neural structures.

Considering the proposed incision sites, vestibular access in the TOET is a safe alternative to the sublingual access route.

Instrumente wurden durch die Firma Karl STORZ, Tuttlingen zur Verfügung gestellt.

Publication History

Article published online:
10 June 2020