Special Considerations: Obesity, Reoperation to Transoral Endocrine, and Neck Surgery

  • Pornpeera Jitpratoom
  • Thanyawat Sasanakietkul
  • Isariya Jongekkasit
  • Rohit Ranganath
  • Angkoon Anuwong


Transoral endoscopic thyroidectomy vestibular approach (TOETVA) has been employed as one surgical modality approach for multiple thyroid and parathyroid disease conditions with good results. The indication and patient selection is extended by the experience of surgeon, especially when considering including obesity patient and reoperation. With such special consideration, the surgeon must know the impact of body composition on the operation, consequences of previous neck surgery, and anesthetic consideration that affect the surgery. Many aspects of obesity have many influences on the outcome of surgery form preoperative/perioperative and postoperative care which will be discussed in detail. Reoperation is challenging due to the quality of the tissue and anatomy variation due to postoperative early fibrosis. The properly trained surgeon should be facile with the approach, know when is the right time to do the reoperation, and also understand specific consideration about how to perform reoperative TOETVA.


Transoral endoscopic thyroidectomy TOETVA Special consideration Reoperation Fibrosis Obesity Endoscopic neck surgery 



We would like to express our gratitude to Raksit Kituncharoen, M.D., and Thanadeth Vongjarukorn, M.D., for their excellent illustrations that greatly improved this manuscript.


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Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Pornpeera Jitpratoom
    • 1
  • Thanyawat Sasanakietkul
    • 1
  • Isariya Jongekkasit
    • 1
  • Rohit Ranganath
    • 2
  • Angkoon Anuwong
    • 1
  1. 1.Minimally Invasive and Endocrine Surgery Division, Department of SurgeryPolice General HospitalBangkokThailand
  2. 2.Division of Head and Neck Endocrine Surgery, Department of Otolaryngology-Head and Neck SurgeryJohns Hopkins University School of MedicineBaltimoreUSA

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