Scarless Endoscopic Thyroid and Parathyroid Gland Surgeries

Transoral Endoscopic Vestibular Approach for Thyroidectomy – TOETVA, and Transoral Endoscopic Vestibular Approach for Parathyroidectomy – TOEPVA are the most innovative technology in the field of head and neck surgeries in Israel. The surgeries are performed without an external incision using an endoscope.

To pioneer this method, Professor Avi Hefetz undertook training with leading experts such as Dr. Ralph Tufano at Johns Hopkins Hospital and Dr. Angkoon Anuwong in Bangkok, both renowned for their contributions to this field. Upon returning, Prof. Hefetz introduced the technique to Israel and the Middle East, successfully performing numerous surgeries, totaling approximately 120, with outstanding outcomes.
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Endoscopic surgery method

The endoscopic operation is performed through a small incision in the lower lip (about 1.5 cm) through which a camera is inserted and two endoscopic tools near it, with the help of which the excision is performed. The thyroid and parathyroid gland surgeries are performed under general anesthesia.

The surgical risks depend on the size of the resection and are the same as for throat surgery. With the endoscopic method, it is even possible to reduce the risk of hoarseness in thyroid surgeries (according to the inventors of the method).

In one lobe resection, the main risk is damage to the recurrent nerve on the same side. The damage is manifested by hoarseness and appears in about 1%-2% of patients only.

In a complete resection of the thyroid gland, more common that there will be a decrease in the level of calcium in the blood that requires taking calcium pills. This phenomenon appears in about 25% of patients and in most of them the treatment with calcium pills can be stopped after a short time. As with any other surgery in the body, there may be minor and temporary complications such as: local infection or bleeding and these can usually be treated quickly and efficiently.

After the surgery, the pain is minimal (similar to neck surgery) and the patient is discharged the next day without restrictions. Since there is no neck incision, there is no scar or other sign of the surgical operation.

Thyroidectomy endoscopic surgery

For thyroidectomy, excising the affected lobe is the initial step, followed by rapid pathological examination which takes about 15 minutes (at the time of surgery) to determine further action.  If the pathological answer to the tumor is positive, then according to the parameters mentioned earlier, the patient should usually proceed with the resection of the additional lobe of the gland. If the pathological answer is not absolute and clear, the operation should be finished and be satisfied with the resection of this lobe only.

Parathyroidectomy surgery

In parathyroid gland surgery, once the pathological gland is identified, the operation is relatively simple, and it is removed through the same incision, with meticulous attention paid to preserving surrounding structures.

Through this incision, we immediately reach the pathological gland that was located even before the operation and cut it in its entirety with the tumor (which actually includes the entire gland). After the resection, we confirm with a pathologist that we have indeed removed the thyroid gland (and not an enlarged lymph node, which can resemble the thyroid gland (parathyroid). If necessary, the level of the PTH hormone in the blood must be checked during the operation and then you can know that the level has decreased to normal, already during the operation and to make sure that we did the best we could.

The risks of surgery are rare and manifest mainly in damage to the nerves of the vocal cords and hoarseness (less than 1%). Other complications are even rarer.

The incision in the surgery performed by us is sewn from the inside, so that there are no stitches on the outside. A drain is not used in these patients and the patient is discharged home the same day or the next morning (according to his personal preference).

The calcium level drops to normal immediately the next morning and the entire problem is completely resolved.