Al Bisher Hassan M, Khidr Alaa M, Alkhudair Badria H, Alammadi Fatema S, Ibrahim Arwa H
Imam Abdulrahman Bin Faisal University, King Fahad University Hospital, Department of Surgery, Saudi Arabia.
Imam Abdulrahman Bin Faisal University, King Fahad University Hospital, Department of Anesthesia, Saudi Arabia.
Int J Surg Case Rep. 2020;70:75-77. doi: 10.1016/j.ijscr.2020.04.014. Epub 2020 May 7.
There has been increased interest in applying the principles of minimally invasive surgery in thyroid surgery which was promoted by Miccoli and his colleagues in 1999. Different surgical techniques since then were introduced, transcervical and extracervical approaches.
A 33-year-old Saudi female presented with a swelling over the left side of her neck and dysphagia for three years. The patient underwent transoral endoscopic left thyroid lobectomy, isthmusectomy and sampling of the central compartment via vestibular approach (TOETVA). To the best of our knowledge, this is the first case underwent TOETVA successfully in Saudi Arabia and gulf cooperation council countries.
TOETVA is a novel promising procedure, an adaptation of the concept of natural orifice transluminal endoscopic surgery (NOTES) with advantages of scar-less result in excellent cosmesis while retaining the advantages of minimally invasive surgery and the potential value of the procedure outside the enhanced cosmesis continuous to be defined. The cosmetic superiority in avoiding visible scarring must be balanced against operative time, post-operative hospital stays, increased expense, surgical training, and steep learning curve required. The technique is novel, some thyroid surgeons opted for longer postoperative observation to exclude complications. As experience and confidence in the procedure increase, the length of stay should decrease dramatically.
This procedure is feasible and safe with excellent cosmetic result. It is in its initial stage in Saudi Arabia, gulf cooperation council countries and it has a potential to be performed more frequently in near future.
1999年米科利及其同事推动了在甲状腺手术中应用微创手术原则，此后人们对其兴趣日益浓厚。从那时起，引入了不同的手术技术，包括经颈和经颈外入路。
一名33岁的沙特女性，左侧颈部肿胀伴吞咽困难三年。患者接受了经口内镜下左侧甲状腺叶切除术、峡部切除术及通过前庭入路（TOETVA）对中央区进行取材。据我们所知，这是沙特阿拉伯和海湾合作委员会国家首例成功接受TOETVA手术的病例。
TOETVA是一种前景广阔的新手术，它是自然腔道内镜手术（NOTES）概念的一种应用，具有无瘢痕、美容效果极佳的优点，同时保留了微创手术的优势，而该手术在美容效果之外的潜在价值仍有待确定。避免可见瘢痕的美容优势必须与手术时间、术后住院时间、费用增加、手术培训以及所需的陡峭学习曲线相权衡。该技术尚新，一些甲状腺外科医生选择延长术后观察时间以排除并发症。随着对该手术的经验和信心增加，住院时间应会大幅缩短。
该手术可行且安全，美容效果极佳。它在沙特阿拉伯、海湾合作委员会国家尚处于初始阶段，在不久的将来有更频繁开展的潜力。
