A SINGLE SURGEON'S EXPERIENCE IN DEFINING THE LEARNING CURVE FOR TRANSORAL ENDOSCOPIC THYROIDECTOMY -VESTIBULAR APPROACH (TOETVA).

Cosmetic outcome is one of the essential objectives in the surgical management of thyroid diseases. To improve that; many new technologies has been proposed, among these; mini-invasive and natural orifice thyroidectomy. Transoral endoscopic thyroidectomy-vestibular approach (TOETVA) is the most recent natural orifice approach to the thyroid and parathyroid glands.; Aim - to report the learning curve for Transoral endoscopic thyroidectomy -vestibular approach (TOETVA) for a senior surgeon already had experience in conventional thyroid and minimal access surgery.; From December 2017 to October 2019, ten patients were included in the study and serially grouped into two groups; five in each. They were prospectively observed for the operative time, Intra- and postoperative complications, hospital stay and functional assessment. ; When compared with group (1); operative time saving in group (2) was about 35 minutes. No case was converted to conventional surgery. Accidental mucosal and skin lesions while introducing the surgical trocars were observed in the first two cases only.; Recurrent laryngeal nerve was identified in nine cases; even that, transient palsy was noticed in two cases of group (1) only. One patient from each group experiences lower paresthesia. Even if it is not routine; the use of drain decreased significantly in the last five cases.; All the patients developed post-operative subcutaneous emphysema and ecchymosis and resolved spontaneously on 1 and 10 days respectively.; After five Transoral endoscopic thyroidectomy-vestibular approach (TOETVA), a senior surgeon who had adequate basic experiences in conventional thyroidectomy and minimal access surgery can safely masters the technique of the surgery with satisfactory operative times, and a decreasing rate of intra- and postoperative complications. Exposure to more cases would reduce the learning curve.