Remove the thyroid without scarring

Remove the thyroid without scarring


Offer patients the entire possible range of surgical techniques for thyroidectomy, even the ‘state of the art’ ones. This is the philosophy of the Gemelli endocrine surgeons who, a few weeks ago, performed surgery to remove the thyroid through the mouth. The technical name is Toetva (trans-oral endoscopic thyroidectomy with vestibular approach) and it is a procedure invented in Southeast Asia (Thailand), where scars on the neck constitute an important cultural stigma.

“There are over 1,500 thyroidectomy operations carried out every year at the Gemelli Polyclinic – recalls the professor Marco Raffaelli, director of the Uoc of Endocrine and Metabolic Surgery of the Fondazione Policlinico Universitario Agostino Gemelli IRCCS and Professor of General Surgery at the Catholic University of the Sacred Heart, Rome campus – of these at least half for thyroid tumors, which can arise even in very young. 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 patient who underwent this operation a few weeks ago is well and is very satisfied with the results.

“The majority of thyroidectomy operations – continues Professor 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 (born in 2014) and 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 Endocrinosurgery – continues Professor 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 the Gemelli Polyclinic, 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. Its plus is that it does not leave any visible scar, since the incisions are made in the oral cavity. But it is not for all patients: for example, those with very large thyroids or those who have previously undergone surgery or irradiation on the neck are excluded. 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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