Scarless Thyroid Surgery (TOETVA): Removing the Thyroid Without a Scar — A Surgeon's Guide

When patients are told they need thyroid surgery, one of their first worries — after "is it cancer?" — is often: "Will I have a scar on my neck?"

Traditional thyroid surgery leaves a horizontal scar across the front of the neck — typically 6–10 cm long. For most patients, this scar fades well over time. But for many — particularly younger patients, women, and those in public-facing professions — the visibility of a neck scar is a significant concern.

I am pleased to tell those patients that there is now an alternative: TOETVA — Trans-Oral Endoscopic Thyroidectomy Vestibular Approach. The entire thyroid is removed through three tiny incisions inside the lower lip — hidden completely inside the mouth — leaving absolutely no visible scar on the neck.

What is TOETVA?

TOETVA (Trans-Oral Endoscopic Thyroidectomy Vestibular Approach) is a technique for removing the thyroid gland — either partially (hemithyroidectomy) or completely (total thyroidectomy) — through the mouth. Three small incisions of 5–10 mm each are made inside the lower lip (in the vestibule of the mouth, between the gum and the lip). The camera and instruments are passed through these openings to operate on the thyroid in the neck — without any external incision at all.

Who is Suitable for TOETVA?

TOETVA is suitable for:

• Thyroid cancer (differentiated — papillary and follicular thyroid cancer) of appropriate size
• Benign thyroid nodules (goitre) requiring surgery
• Thyroid cysts requiring removal
• Hyperthyroidism requiring surgical treatment (Graves' disease, toxic nodular goitre)
• Patients who are particularly concerned about a visible neck scar

Is TOETVA Safe? Is the Cancer Control the Same?

Published studies comparing TOETVA to conventional open thyroidectomy show equivalent oncological outcomes — the same amount of thyroid tissue removed, the same lymph node clearance, and the same rates of cancer control. The technique has been validated in large centres including Dr. Anuwong's centre in Bangkok and major Asian cancer hospitals.

The key safety considerations are:

• Recurrent laryngeal nerve injury (risk of voice change): experienced surgeons use nerve monitoring — risk comparable to conventional open surgery (<1% permanent in experienced hands)
• Parathyroid gland injury (risk of calcium drop): also comparable to open surgery with careful technique
• Carbon dioxide absorption: a small amount of gas is used to create working space — carefully monitored by the anaesthesia team

What Happens During TOETVA Surgery?

You will be under general anaesthesia. Three tiny cuts (5–10 mm) are made inside your lower lip. A camera is passed through the central cut; instruments through the side cuts. Gas (CO₂) is gently instilled to create working space under the skin of the neck, allowing the surgeon to access and remove the thyroid gland. The operation typically takes 1.5–2.5 hours for a total thyroidectomy.

The thyroid is removed through the central lip incision, which is then closed with dissolvable stitches. There are no external stitches and no neck wound to dress at home.

Recovery After TOETVA

• Hospital stay: Most patients discharged the next day
• Diet: Soft diet for 5–7 days while the mouth heals (idli, curd rice, soups — no hard or crunchy foods)
• Mouth care: Antiseptic mouthwash 3–4 times daily for the first week
• Return to work: Most patients return to desk work within 1 week
• Pain: Mild discomfort in the chin and lower lip area — resolves within a week. Overall pain is comparable to or less than conventional neck surgery
• Appearance: No external wound. No dressing. No visible scar — ever.

How is TOETVA Different from Other Scarless Thyroid Techniques?

Several approaches have been developed for scarless thyroid surgery — axillary (armpit), breast, retroauricular (behind the ear), and trans-oral. The trans-oral approach (TOETVA) is now considered superior because:

• It does not require a long tunnel from the armpit or breast — avoiding the large flap dissection of those techniques
• It is truly scarless — no scar anywhere on the body
• Recovery is faster than the axillary or breast approaches
• The access to the thyroid is more direct

Is Scarless Thyroid Surgery Available in Coimbatore?

Yes — I perform TOETVA at KG Hospital, Coimbatore. I was trained directly by Dr. Angkoon Anuwong in Bangkok — the surgeon who pioneered and developed this technique, and who has performed more TOETVA operations than anyone else in the world. If you have thyroid disease requiring surgery and would prefer no neck scar, I invite you to come for a consultation to see if TOETVA is right for you.