Comparing transoral endoscopic thyroidectomy approaches : CO2 insufflation versus gasless technique

Abstract

Transoral endoscopic thyroidectomy vestibular approach (TOETVA) offers a scar-free alternative to traditional thyroidectomy but poses risks when performed with CO2 insufflation, particularly the risk of CO2 embolism. This manuscript compares CO2 -insufflated TOETVA with the gasless technique, which uses novel retractors to create a working space, thus minimising insufflationrelated complications. While CO2 insufflation enhances visualisation, it presents physiological risks that limit its use in patients with cardiopulmonary concerns. The gasless approach, though requiring specialised equipment and training, mitigates these risks and may extend TOETVA candidacy. This comparison highlights patient selection considerations and the evolving techniques that enhance safety in minimally invasive thyroid surgery. Further research on long-term outcomes will help refine TOETVA methods.