Lessons learned from a faulty transoral endoscopic thyroidectomy vestibular approach

Background: Transoral endoscopic thyroidectomy via vestibular approach (TOETVA) is currently considered the most promisingly scarless approach to the thyroid and has gained more acceptance. Materials and Methods: We described a case of faulty TOETVA. Results: The faulty TOETVA resulted in pneumomediastinum, diffuse subcutaneous emphysema, prolonged surgery, and anesthesia. Conclusions: The important technical considerations during TOETVA, including the use of external retraction, the identification of the subplatysmal plane of dissection, CO 2 insufflation settings, the learning curve, and patient selection, were described and discussed.