Transoral Endoscopic Thyroidectomy Vestibular Approach (TOETVA)

The Department of Radiation and Surgical Treatment of Head and Neck Diseases at the A. Tsyb Medical Radiological Research Centre (MRRC) – the branch of the FSBI “National Medical Research Radiological Centre” (NMRRC) of the Ministry of Health of the Russian Federation has integrated a unique technology into its work – transoral endoscopic surgical interventions by vestibular access, the so-called TOETVA (thyroidectomy through the vestibule of the mouth). This technique has proved to be an excellent alternative to the neck incision, which has no disadvantages and unpleasant side effects for the patient. In children, the first operation in Russia with this access was performed on June 21, 2022.

Advantages

Minimal traumatization
High precision
Reduced blood loss
Reduced pain and need for analgesics
Rapid social rehabilitation and cosmetic results

Transoral endoscopic approach

The removal surgery was first performed about two years ago and has proven to be an effective alternative to the standard intervention (through a neck incision), which has a number of undeniable advantages.

The uniqueness of this technique lies in the absence of scars on the visible areas of the skin, thanks to which doctors ensure a high quality of life for patients. It is also about safety, because the work takes place on endoscopic equipment with high magnification, which allows visualizing vital structures – the recurrent laryngeal nerve, parathyroid glands. National Medical Research Radiological Centre of the Ministry of Health of Russian Federation is the first in the country to introduce this technique not only in adults, but also in children. During the surgical master class, several surgical interventions were performed at once, which allowed the participants to learn all the subtleties of the surgical process.

Patient route

The decision to use the TOETVA technique is made by the doctor after performing an ultrasound examination, during which the possibility of using this method is assessed, and after the consultation with an endocrinologist. Children can be referred to A. Tsyb Medical Radiological Research Centre (MRRC) – branch of the National Medical Research Radiological Centre (NMRRC) of the Ministry of Health of the Russian Federation, by their attending physician.

Scientific Work

The department staff actively engage in scientific work. The department hosts masterclasses and advanced training programs. The team has developed unique, proprietary methodological guidelines for physicians, including:

Radiation and combined treatment of laryngeal cancer (Monograph).
Method for treating vasomotor rhinitis (Certificate of authorship);
Hypoxic radiotherapy for patients with malignant neoplasms (Methodological guidelines);
Combined treatment of primary locally advanced laryngeal cancer (Methodological guidelines);
Laryngeal cancer. Chapter 4: Therapeutic Radiology. A guide for physicians;
Organ-preserving treatment of laryngeal and oropharyngeal cancer, recurrences, and complications (Guide);
Combined treatment of operable locally advanced (Stage III–IV) laryngeal, laryngopharyngeal, nasal cavity, and paranasal sinus cancer, involving preoperative concentrated radiation therapy alongside polychemotherapy and radiomodifiers, followed by immediate surgical intervention (Methodological guidelines);
Conservative and combined treatment of patients with malignant tumors of the larynx and laryngopharynx using independent or preoperative radiation therapy in conjunction with polychemotherapy and low-intensity infrared laser radiation radiomodification (Certificate of authorship);
Conservative and combined treatment of malignant tumors of the larynx, laryngopharynx, nasal cavity, and paranasal sinuses using independent or preoperative radiation therapy combined with polychemotherapy and radiomodification with a constant magnetic field (Certificate of authorship);
Combined chemoradiotherapy for patients with malignant tumors of the nasopharynx and oropharynx, involving simultaneous radiation and polychemotherapy (Methodological guidelines);
Method for fixing the eyeball after maxillary removal (Certificate of authorship);
Method for assessing radiosensitivity in head and neck cancer (Certificate of authorship);

Treatment of Head and Neck Diseases

Thanks to the coordinated efforts of experienced oncological surgeons with extensive expertise in treating cancer, the department performs surgeries of any complexity. The following diseases are treated in the department:

Malignant neoplasms of the nasal cavity and paranasal sinuses (squamous cell carcinoma, inverted papilloma, esthesioneuroblastoma, sarcoma, adenocarcinoma, adenoid cystic carcinoma, melanoma, hemangiopericytoma, malignant papilloma, and others);
Malignant neoplasms of the nasopharynx (squamous cell carcinoma, poorly differentiated carcinoma, nasopharyngeal-type carcinoma);
Malignant neoplasms of the oropharynx: tumors of the soft and hard palate, palatine tonsils, tongue root (excluding secondary manifestations of lymphoproliferative diseases);
Malignant neoplasms of the laryngopharynx (squamous cell carcinoma);
Malignant neoplasms of the larynx (squamous cell carcinoma, laryngeal papillomatosis, malignant laryngeal papillomas, and other epithelial and non-epithelial (sarcoma) tumors).
Surgical treatment of certain forms of malignant laryngeal tumors is performed using a micro-endoscopic surgical video system. This technology enhances the precision of interventions while reducing trauma, ultimately improving the functional outcomes of treatment and patients’ quality of life;
Metastatic involvement of regional lymph nodes in malignant processes in the organs of the head and neck.