Transoral surgery: operating on the thyroid through the mouth, with no visible scar

Transoral surgery is a new thyroid surgical technique that allows to perform thyroidectomy of one side or the whole gland in the same procedure and without visible external scar, since it is performed through an incision in the back of the lower lip, in the mouth. As with conventional surgery, it is performed under general anesthesia for greater patient comfort.

Why is transoral surgery performed?

Although its origin and development comes from Asian countries, where the presence of scars on the neck are a stigma, in Spain it is indicated in those patients who do not want to have sequelae of surgery, with visible external scar and may also be indicated for those patients who make keloids. There are some studies that, in addition, show 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 makes 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 area to be treated. In the other two trocars or ports, the instruments that allow the endoscopic surgery are introduced.

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Preparation for transoral surgery

No special preparation is necessary. It is important to intensify oral hygiene the days prior to surgery. The most important thing is to select patients properly, offering this technique to patients in whom the specialist is sure that he will be able to perform an effective and safe surgery. During 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 absence of scarring is added.

Care after surgery

During the first 24 hours after surgery the patient should eat liquid food, the consistency and texture of the food will increase in the following days.

Alternatives to this treatment

The most effective alternative is still conventional surgery which, in many cases, is performed with minimally invasive surgery: with a scar of less than 3 cm.

Video-assisted anterior approach surgery (MIVAT) has many limitations with respect to the size and volume of the thyroid nodule that can be removed by this approach, which also leaves an external scar.

Another endoscopic approach is the transaxillary approach, which leaves no scar in the neck. However, it is performed in the crease of the armpit, which is more esthetic. This route was first tested in Spain in 2016 and, after a few cases it was abandoned, since it does not allow surgery to be performed on more than one side of the thyroid and needs to make a long route before reaching the thyroid.