Transoral Endoscopic Parathyroidectomy Vestibular Approach (TOEPVA)—Choosing the Right Patient

Purpose of Review: Parathyroidectomy is the surgical treatment for primary hyperparathyroidism. A single parathyroid adenoma is the most common cause of primary hyperparathyroidism (PHPT) making it amenable to a focused surgery whereby the putative hyperfunctional parathyroid gland is excised. Recent Findings: Parathyroid surgery, like thyroid surgery, is typically performed through a cervical incision usually measuring 4–5 cm. Though most surgical scars heal well over time, the presence of a scar may affect a patient’s quality of life (Goldfarb and Casillas, Thyroid. 26(7):923–32, 2016; Choi et al., Ann Dermatol. 26(6):693–9, 2014). Surgeons may perceive scars differently and more favorably than patients. Variables such as scar length do not always correlate with patient satisfaction (Arora et al., Int J Surg. 25:38–43, 2016; Toll et al., Eur Arch Otorhinolaryngol. 269(1):309–13, 2012; Linos et al., Surgery 153(3):400–7, 2013). Summary: Remote access approach to the parathyroid: Remote access approaches such as transoral and axillo-bilateral-breast approaches have been proposed to access the suspected hyperfunctional parathyroid gland similar to the thyroid to avoid a scar in the neck (He et al., J Laparoendosc Adv Surg Tech. 25(4):311–3, 2015). Transoral endoscopic thyroidectomy vestibular approach (TOETVA) for thyroidectomy introduced by Anuwong is gaining popularity as a remote access approach with feasibility demonstrated by several groups (Dionigi et al., J Endocrinol Invest. 40(11):1259–63, 2017; Russell et al., Thyroid. 28(7):825–829, 2018; Anuwong et al., Surg Endosc. 32(1):456–65, 2018). Focused parathyroid surgery may also be completed via this approach (TOEPVA) (Sasanakietkul et al., Surg Endosc. 31(9):3755–63, 2017).