What is transoral surgery?
Transoral surgery is a new surgical approach to the thyroid that allows thyroidectomy of one side or the entire gland in the same surgical procedure and without visible external cytorrhage, since it is performed through an incision in the posterior aspect of the lower lip. Like conventional surgery, it is performed under general anesthesia.
Why is transoral surgery performed?
Although its origin and development comes from Asian countries, where the presence of scars on the neck is a stigma, in Spain it is indicated in those patients who do not want to have sequelae of surgery, with the presence of visible external scar and can also be an indication for those patients who make keloids. There are some studies that also report a lower rate of pain compared to open or conventional surgery, which in itself is not very painful.
What does transoral surgery consist of?
It consists of the introduction of 3 trocars: one of 10 mm and 2 of 5 mm in the back of the lower lip, through which the specialist in General Surgery and Endocrine Surgery generates a space under the skin of the neck to access the thyroid gland.
In one of the trocars a 10 mm optic is placed, which allows the image to be magnified 2 cm from the working area. In the other two trocars or ports, the instruments that allow the endoscopic surgery are introduced.
Preparation for transoral surgery
No special preparation is required. However, we insist on intensifying the oral hygiene the previous days. The most important thing is to properly select the patients, offering this surgery to patients in whom the specialist is sure that he will be able to perform an effective and safe surgery. During this surgery, in addition to maintaining the excellent results already obtained with open surgery with respect to the treatment and care of the recurrent nerve and parathyroid glands, the patient can be offered the absence of scarring.
Care after surgery
In the first 24 hours after surgery the patient can eat liquid food and the consistency and texture of the food will be increased in the following days.
Alternatives to this treatment
The most important alternative is still conventional surgery which, in many cases, is performed with minimally invasive surgery, i.e. with a scar of less than 3 cm.
Video-assisted anterior approach surgery (MIVAT) has many limitations in terms of the size and volume of the thyroid nodule that can be removed by this approach and, in addition, it leaves an external scar.
Another endoscopic approach is the transaxillary approach, which offers the absence of scar in the neck, although it is performed in the axillary fold, which is more esthetic. This route was tested in 2016 for the first time in Spain and, after a few cases, we decided to abandon it, since it does not allow us to perform surgery on more than one side of the thyroid and needs to make a long route before reaching the thyroid.