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Scarless Thyroid Surgery

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Understanding Trans-Oral Endoscopic Thyroidectomy Vestibular Approach (TOETVA)

What Is TOETVA?

Trans-Oral Endoscopic Thyroidectomy Vestibular Approach (TOETVA) is an innovative surgical technique where the thyroid gland is removed through three tiny incisions inside the mouth, leaving NO visible scar on the neck.

This technique was developed by Dr. Angkoon Anuwong at the Police General Hospital in Bangkok. Dr. Anuwong has performed the most TOETVA procedures in the world and has trained many surgeons worldwide in this method.

Why TOETVA?

The main benefit of TOETVA is cosmetic — it allows for thyroid surgery without leaving a visible scar on the neck. However, it’s not just about appearance. The technique offers:

  • A clear, magnified view of the surgical area, which helps in precisely identifying important structures like the laryngeal nerves (which control your voice) and the parathyroid glands (which regulate calcium levels).
  • The same surgical steps as traditional open thyroid surgery, but done with specialized endoscopic (camera-assisted) tools.

Is TOETVA Safe?

Some surgeons have raised valid concerns about the safety and logic of TOETVA. Traditional open thyroidectomy has been refined over many years and is considered the gold standard for thyroid surgery. Any new technique must be as safe as the traditional method, especially in terms of:

  • Protecting the laryngeal nerves (to avoid voice changes)
  • Preserving the parathyroid glands (to prevent calcium imbalances)

During my time observing and learning TOETVA with Dr. Anuwong’s team in Bangkok, I found that:

  • The endoscopic camera provides an excellent, magnified view, making it easier to identify and protect critical structures.
  • The surgical steps are very similar to traditional surgery, just performed through a different approach.

However, TOETVA is not for every surgeon. To perform it safely, a surgeon needs to be highly experienced in both thyroid surgery and endoscopic (minimally invasive) techniques.

The Big Question: Why Not TOETVA?

Instead of asking, “Why would anyone choose TOETVA?”, perhaps the better question is, “Why not?”

If TOETVA can be done:

  • As safely and effectively as traditional thyroid surgery
  • With no visible scar on the neck

Then it makes sense that both surgeons and patients would consider this option.

What’s Next?

The responsibility now lies with us, the surgical community, to determine whether TOETVA is just a trend or truly a breakthrough in thyroid surgery. Ongoing research and real-world experience will help us answer this question in the years to come.

For patients considering thyroid surgery, it’s important to discuss all options with a qualified endocrine surgeon to determine the best approach based on your individual needs and medical condition.