Balloon Dilators for Fast and Safe Flap Dissection in Transoral Endoscopic Vestibular Approach Thyroidectomy Vestibular Approach (TOETVA)

Creating working space while performing thyroid surgery via a transoral endoscopic thyroidectomy vestibular approach (TOETVA) can be technically challenging. We describe our experiences using a balloon dilator for easy and rapid flap dissection during TOETVA. Methods The medical records of patients who underwent surgery for thyroid diseases via a TOETVA were retrospectively reviewed and divided into two groups: the Routine group included patients who underwent routine flap dissection using conventional laparoscopic instruments without the use of a balloon dilator, and the Spacemaker group included patients who underwent flap dissection using a balloon dilator. The working space formation time, defined as the time from first insertion of an instrument into a trocar until the time of the completion of working space formation, and clinical outcomes were analyzed and compared between groups. Results A total of 39 patients (6 males and 33 females) were included in the study, with 26 patients in the Routine group and 13 patients in the Spacemaker group. There were no differences in patient demographics between groups. Flap dissection time was significantly longer in the Routine group compared to the Spacemaker group (8.0±2.8 minutes vs. 5.3±2.1 minutes, P=0.004). No excessive bleeding events or conversion to open surgery occurred during surgery in either group. There were also no postoperative bleeding events or infections in either group. Conclusion Balloon dilators can provide a fast, efficient, and safe flap dissection method for working space formation during thyroid surgery with TOETVA.