What Is Transoral Thyroid Surgery?

Transoral thyroid surgery is one of the thyroid surgery methods performed without creating an externally visible incision scar in the neck area. Since the thyroid gland is accessed through the mouth in this method, no visible scar remains on the neck after surgery. It may be considered especially for patients who do not want an incision scar on the neck, have aesthetic concerns, and have medically suitable characteristics.

Transoral thyroid surgery is also medically known as TOETVA. TOETVA stands for “Transoral Endoscopic Thyroidectomy Vestibular Approach.” This method refers to accessing the thyroid gland through the mouth with an endoscopic approach.

This surgical method is not applied in every thyroid disease. The size of the thyroid nodule, the nature of the disease, the size of the gland, previous surgeries, the patient’s general health condition, and whether the operation can be performed safely from a technical perspective are evaluated together. Therefore, transoral thyroid surgery should be planned not only because it is a scarless method, but also according to its suitability for the patient.

How Is Transoral Thyroid Surgery Performed?

In transoral thyroid surgery, small entry points are created inside the mouth to reach the thyroid gland. The surgical procedure is performed without making an incision in the neck skin. In this way, no surgery-related scar is visible on the neck when viewed externally.

In the TOETVA method, entry points are generally created in the intraoral area between the lower lip and the gum. Through this approach, the thyroid gland is reached endoscopically through the mouth rather than through the neck area.

Special surgical instruments and imaging systems are used during the operation. While the diseased area in the thyroid gland is removed, the nerves related to the vocal cords, the parathyroid glands, and surrounding tissues are carefully protected. As in conventional thyroid surgery, the main goal is to safely remove the diseased tissue.

The fact that the method is performed through the mouth does not mean that the operation is simpler. On the contrary, patient selection, surgical experience, and anatomical evaluation are highly important in this method. Therefore, the decision for transoral thyroid surgery should be made together with a detailed examination and imaging results.

Is Transoral Thyroid Surgery a Scarless Thyroid Surgery?

Transoral thyroid surgery is considered among scarless thyroid surgery methods because it does not leave an externally visible incision scar on the neck. The term “scarless” here refers to the absence of a visible neck incision on the skin. Since the entry points are located inside the mouth, no surgery-related change is expected in external appearance.

For this reason, TOETVA is also considered one of the methods within the scope of scarless thyroid surgery. Access through the mouth ensures that the surgical scar is not visible in the neck area.

However, the term scarless thyroid surgery does not mean that the method is suitable for everyone. In some patients, conventional thyroid surgery performed with a neck incision may be safer and more appropriate. This distinction is made according to the type of disease, the characteristics of the nodule, and the surgical goal.

Scarless thyroid surgery may be an important option, especially for patients with aesthetic expectations. However, the priority should always be the safe performance of the surgery and the correct treatment of the thyroid disease.

Comparison of Transoral Thyroid Surgery and Conventional Thyroid Surgery

Who Is Suitable for Transoral Thyroid Surgery?

Transoral thyroid surgery is a method that can be applied in selected patient groups. The thyroid nodule must be within certain size limits, the disease must have suitable characteristics, and risks related to surrounding tissues must be at an acceptable level. Not every thyroid nodule or every goiter condition is suitable for this method.

Different surgical methods may be preferred in patients who have previously undergone neck surgery, those with a significantly enlarged goiter, certain cancer types, or cases with suspected spread to surrounding tissues. Therefore, the suitability of transoral thyroid surgery should be determined by evaluating the patient’s examination findings and disease characteristics together.

The patient’s expectations are also important in this process. Patients who do not want a scar on the neck may be interested in this method; however, aesthetic expectation alone is not sufficient for decision-making. The surgery must also be the correct option for the disease.

Is Transoral Thyroid Surgery Risky?

Transoral thyroid surgery, like other thyroid surgery procedures, may carry certain risks. In thyroid surgeries, nerves that may affect the vocal cords, the parathyroid glands responsible for calcium balance, the risk of bleeding, and the possibility of infection are carefully evaluated.

Since access is made through the mouth in this method, oral hygiene, infection control, and postoperative care become especially important. The patient may be given special recommendations regarding oral care, nutrition, and medication use in the postoperative period.

Patient selection and surgical planning are also important in the TOETVA technique. This transoral approach may make the surgical process riskier if preferred in unsuitable patients. Therefore, the limitations of the method should be considered as well as its advantages.

Risk assessment is not based only on the surgical technique. The patient’s age, additional diseases, the type of thyroid disease, the location of the nodule, and the scope of surgery are evaluated together. In suitable patients, transoral thyroid surgery can be performed safely with proper planning.

Recovery Process After Transoral Thyroid Surgery

The recovery process after transoral thyroid surgery may vary depending on the patient’s general health condition, the scope of the procedure, and the characteristics of the thyroid disease. In the first days, sensitivity inside the mouth, discomfort while swallowing, mild swelling, or a feeling of pressure in the throat may occur. These complaints usually decrease during the follow-up period.

Attention should be paid to intraoral care after surgery. Diet, oral hygiene, use of prescribed medications, and follow-up appointments are important parts of the recovery process. It may be necessary to avoid hard, irritating, or intraorally challenging foods for the period recommended by the doctor.

The time needed to return to daily life varies from person to person. Some patients may return to daily activities in a short time, while others may need a more careful resting period. In cases such as voice change, increasing pain, fever, marked swelling, difficulty breathing, or foul-smelling discharge inside the mouth, medical evaluation should be sought without delay.

Does a Scar Remain After Transoral Thyroid Surgery?

Since no incision is made on the neck skin in transoral thyroid surgery, an externally visible surgical scar is not expected. Since the entry points are inside the mouth, the scar is not noticeable in external appearance. For this reason, the method is frequently researched by patients who do not want an incision scar in the neck area.

One of the main goals of the TOETVA method is to perform thyroid surgery without creating a visible incision on the neck. Therefore, transoral thyroid surgery is one of the methods frequently considered by patients looking for scarless thyroid surgery.

However, as with every surgical procedure, the recovery process may vary according to individual characteristics. Healing of the intraoral entry points, compliance with care recommendations, and not missing follow-up appointments are important. Although an externally invisible access route is used, the postoperative care process should be followed carefully.

For Which Thyroid Diseases Is Transoral Thyroid Surgery Considered?

Transoral thyroid surgery may be considered in some benign thyroid nodules, suitable goiter cases, and selected thyroid diseases. However, not every nodule or every thyroid enlargement is suitable for this method.

In patients with suspected thyroid cancer, the decision is made in more detail. The type of cancer, the possibility of spread, its relationship with lymph nodes, and whether surgical margins can be safely achieved are evaluated. In some cases, conventional thyroid surgery may be a more appropriate option.

Therefore, in thyroid surgery planning, the characteristics of the disease should be determined before choosing the method. The correct surgical approach is important both for the treatment of the disease and for the postoperative process.

What Should Be Considered Before Transoral Thyroid Surgery?

Before surgery, thyroid ultrasound, blood tests, hormone levels, and other examinations deemed necessary are evaluated. If there is a nodule, its structure, size, and biopsy result are important in surgical planning. In addition, the patient’s medications, existing diseases, and previous surgeries are also taken into consideration.

Oral and dental health is also important in the transoral method. If there is an active infection in the mouth, gum disease, or a condition that may affect the surgical area, these may need to be evaluated first. The preoperative preparation process should be carefully planned so that the method can be applied safely.

In patients planned for TOETVA, the suitability of the intraoral entry points, infection risk, and compliance with the postoperative care process are also evaluated. These preparations help transoral thyroid surgery proceed more safely.

The patient’s expectations should also be clarified before surgery. The absence of a scar on the neck is an important advantage; however, the medical necessity, safety, and suitability of the surgery for the disease should be prioritized.

Frequently Asked Questions About Transoral Thyroid Surgery

What is TOETVA?
TOETVA is the medical abbreviation used to describe endoscopic thyroid surgery performed through the mouth. In this method, the thyroid gland is accessed through the mouth rather than the neck, so an externally visible incision scar is not expected.

Does transoral thyroid surgery leave a permanent scar?
Since no incision is made on the neck skin in transoral thyroid surgery, an externally visible scar is not expected. Because the entry points are inside the mouth, it may provide an aesthetic advantage.

Is transoral thyroid surgery suitable for everyone?
No. The decision is made by evaluating the size of the nodule, the type of disease, previous surgeries, and the patient’s general health condition.

Can the voice change after transoral thyroid surgery?
In thyroid surgeries, the nerves related to the vocal cords are carefully protected. However, the risk of temporary or rarely permanent voice changes is explained to the patient during the surgical evaluation.

Is hospitalization required after transoral thyroid surgery?
The length of hospital stay varies depending on the scope of the procedure and the patient’s condition. In some patients, short-term follow-up may be sufficient.

Is transoral thyroid surgery painful?
After surgery, there may be sensitivity inside the mouth, discomfort while swallowing, and mild pain. This process can be controlled with medications and care recommendations advised by the doctor.

Can goiter surgery be performed with transoral thyroid surgery?
This method may be considered in some goiter patients with suitable characteristics. However, different surgical methods may be preferred for large goiters or risky conditions.

How is nutrition after transoral thyroid surgery?
In the early period, soft foods that do not strain or irritate the mouth may be recommended. The diet should be planned according to the personalized recommendations given after surgery.