Minimally Invasive Thyroidectomy

The evolution of thyroid surgery and its progress toward minimally invasive techniques have changed greatly over the past 30 years, from simple reduction of incision length to the use of robotic and endoscopic remote access approaches. Current innovations aim to decrease neck scarring while maintaining the low complication rates of traditional open surgery. One of the new approaches to thyroid surgery, inspired by the rise of natural orifice endoscopic surgery (NOTES), is the transoral endoscopic thyroidectomy-vestibular approach (TOTEVA). The surgery was first published in 2011 by Richmond et al. Published outcomes with patients were reported in 2016 by Anuwong et al. This new approach is well received by endocrine surgeons and gaining widespread acceptance, with drastically increasing case numbers. This chapter reviews the history of the procedure, its indications, surgical steps, and a discussion on its benefits and safety.