Gasless transoral endoscopic thyroidectomy vestibular approach (gasless TOETVA)

Background: The transoral endoscopic thyroidectomy vestibular approach (TOETVA) has been the subject of increasing interest from several institutions around the world over the last 2 years. Recently, we successfully performed TOETVA in live human patients without CO₂ gas using our newly designed retractable blade. Methods: We reviewed the medical records of 15 consecutive patients who underwent gasless TOETVA using a self-retaining retractor. Results: We successfully performed 13 thyroid lobectomies and 2 total thyroidectomies in 15 patients. No patient exhibited serious postoperative complications such as recurrent laryngeal nerve palsy and permanent hypocalcemia. One patient developed transient hypocalcemia but recovered within 2 months. No patient developed a wound infection; furthermore, no visible scar or dimpling was evident on the neck of any patient. Conclusion: Gasless TOETVA provides enough working space and good visibility to perform thyroid surgery without any risk of CO₂ gas-related complications.