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Transoral Thyroid Surgery; the Trans-Oral Scarless Thyroid Operation

Trans-Oral thyroid surgery is one of two types of scarless thyroid surgery where a thyroid growth or tumor can be removed leaving no scars on the neck whatsoever. The thyroid is removed using scopes that are placed in the mouth while the patient is under anesthesia. This is a very new technique that less than a dozen surgeons in the US perform. Transoral thyroid surgery can be a great operation for some patients with small to moderate size thyroid masses.

What is Trans-Oral Thyroid Surgery?

Transoral thyroid surgery is an advanced operation to remove part or all of the thyroid using scopes that are inserted into cuts on the inside of the lower lip. The goal is to remove a thyroid mass or nodule without leaving any scar on the scin of the neck.

Traditional thyroid surgery is performed through a large incision in the skin of the neck that leads to a readily visible scar in the neck. Although most of the incision scars heal well over time, a significant number of patients express concern or have self-consciousness about their neck scars even years after surgery. Furthermore, certain patients may form prolonged undesirable scars. With increasing concern for patients quality of life measures, various scarless or remote-access thyroid surgery techniques have been developed over the past two decades. Among the various approaches, the transoral thyroid surgery technique became one of the most commonly performed scarless techniques.

When Was Trans-Oral Thyroid Surgery Invented?

Transoral thyroid surgery was first performed in the US in 2016. Since then, over a short period of time, the popularity of the technique grew, and the approach has been disseminated more broadly throughout the country. The familiarity of the endoscopic tools and relatively short learning curve facilitated the adaptation. Furthermore, growing awareness and interest in scarless thyroid surgery by patients served as a great motivation for endocrine surgeons. Dr. Suh and his team were one of the first surgeons to have performed the transoral thyroid surgery in the country.

The initial transoral technique was developed where incisions were made under the tongue or the floor of the month. This led to unintended complications and prolonged healing. Thus, the technique has adapted the inside and under the lip incision which was initially described in 2011. Then starting in 2014, this technique was mastered and propagated by Anuwong Angkoon from Thailand.

Is an Operating Robot Used During Trans-Oral Thyroid Surgery?

No, a robot is not used for transoral thyroid surgery. It is performed using scopes like are used to remove gallbladders. There have been some attempts to use a robot, but it has not proven to be helpful because there is limited space inside the lower lip and over the chin poses a unique challenge as well as a higher rate of complications. Thus, transoral surgery in the US (and elsewhere in the world) does not use a robot.

Robotic thryoid surgery is a completely different operation from transoral thyroid surgery. Robotic thyrroid surgery is much better for most patients with thyroid masses than transoral thyroid surgery. Read more about Robotic Thyroid Surgery on other pages of this website.

Transoral thyroid surgery is considered to be unique in that compared to other scarless techniques that use hidden or remote skin incisions, the transoral technique only has mucosal incisions in the oral cavity. However, essentially all scarless techniques use either a hidden scar or a minimally invasive scar that heals well without leaving a scar on the neck.

Technical name of the transoral technique: The transoral thyroid surgery technique is often referred to as the transoral endoscopic thyroidectomy vestibular approach (TOETVA) surgery. Currently, the transoral thyroid surgery techniques are limited to benign thyroid indications and small < 2cm thyroid cancer cases. For selective group of patients with small burden of thyroid cancer in the lymph nodes around the thyroid gland, a minor lymph node surgery may be appropriate.

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