An innovative endoscopic thyroidectomy procedure. Toetva (trans-oral endoscopic thyroidectomy with vestibular approach) arrives at Gemelli in Rome, to remove the thyroid without scars: a few weeks ago the endocrine surgeons of the Capitoline hospital performed a removal operation through the mouth. The procedure was invented in Southeast Asia (Thailand), where neck scarring constitutes a major cultural stigma. The patient who underwent this operation a few weeks ago is well and is very satisfied with the results.
“There are over 1,500 thyroidectomy operations carried out every year at the Gemelli Polyclinic – recalls Marco Raffaelli, director of the Uoc of Endocrine and Metabolic Surgery of the Agostino Gemelli Irccs University Polyclinic Foundation and professor of General Surgery at the Catholic University of the Sacred Heart, Rome campus – of these at least half are for thyroid tumors, which can also arise in very young people. And there are many, especially young women, who have a certain reluctance to approach this type of operation, for fear that it could leave a visible scar on the neck. For this reason, our offer has been enriched over the years with procedures that do not leave visible scars on the neck, such as transaxillary robotic surgery, with the da Vinci robot. And it is in this wake that we have decided to expand our surgical offer with Toetva”.
“The majority of thyroidectomy operations – continues Raffaelli – will continue to be carried out through the well-tested traditional surgical technique and with the minimally invasive video-assisted technique, which generally leaves a small scar (a couple of cm). But for those who don't want scars on their neck, we can offer robotic surgery via the trans-axillary approach and from today also via Toetva, to try to offer the patient in front of us the surgery best suited to their needs”.
The Toetva technique is relatively recent – it was born in 2014 – and to be able to use it it is necessary to carry out training courses and simulations (cadaver lab), because it is an intervention that has some peculiarities in the type of approach. In short, you can't improvise. “As the European Society of Endocrine Surgery – continues Raffaelli – we have also organized training courses in Turkey on this innovative procedure, in collaboration with the University of Izmir and with the patronage of the Catholic University of the Sacred Heart and Policlinico Gemelli, since we are involved as teachers.”
Toetva currently remains a procedure performed in few centers in Italy and around the world, has limited indications and requires careful patient selection. For example, those with very large thyroids or those previously operated on or irradiated on the neck are excluded – the experts recall – The procedure is carried out under general anesthesia and with nasal or oro-tracheal intubation. Three small incisions are made inside the mouth, under the lower lip, through which the endoscopic instruments are introduced and the thyroidectomy procedure is then performed, then removing the thyroid from the mouth. The surgery lasts at least a couple of hours. Among the possible complications is damage to the mental nerve, with loss of sensation in the chin.
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