TOETVA (Transoral Endoscopic Thyroidectomy Vestibular Approach) is removal of the thyroid using an endoscope passed through the mouth. Three small incisions are made inside the lower lip vestibule, and instruments are passed down to the thyroid in the neck. Its hallmark is that there is no visible skin scar anywhere on the body. It was conceived and developed in Thailand.

Who is suitable for TOETVA?

Patients with benign thyroid nodules generally up to about 6 cm, moderately sized goiter, and selected early thyroid cancer. The surgeon assesses nodule size, biopsy results and anatomy individually.

Performed by an expert surgeon on appropriately selected patients, TOETVA is safe with complication rates comparable to open surgery, supported by extensive published research worldwide.

Transoral Thyroidectomy (TOETVA): What It Is, Benefits, Who Suits

Contents
What is TOETVA Origin in Thailand How it works Benefits Who is suitable Safety Recovery FAQ

What Is TOETVA

TOETVA stands for Transoral Endoscopic Thyroidectomy Vestibular Approach — thyroid surgery performed with an endoscope through three small incisions hidden inside the lower lip vestibule (oral vestibule), creating a channel down to the thyroid in the neck. The gland can be removed with no visible skin scar anywhere on the body (scarless).

In short: TOETVA is thyroid surgery done through the mouth — no neck incision, no visible scar — ideal for those concerned about scarring and appearance, while maintaining safety comparable to standard surgery.

Born in Thailand — A Source of National Pride

TOETVA was conceived and developed in Thailand by Dr. Angkoon Anuwong, a surgeon at Police General Hospital and a committee member and public-relations officer of the Thai Endocrine Surgeons Society. His first human series was published in international journals and became a reference technique studied and practised by surgeons worldwide.

Today surgeons from around the world travel to Thailand to observe and train in TOETVA, and Dr. Angkoon is regularly invited as a lecturer and proctor to teach and demonstrate the operation in many countries — one of Thailand's medical innovations exported to the world.

For in-depth information, an experience of over 6,800 cases, outcome statistics and direct consultation or booking with the technique's originator, visit → drangkoon.com — Dr. Angkoon, endoscopic thyroid surgery

How TOETVA Is Performed

Under general anesthesia, the surgeon makes three small incisions (about 5–10 mm) inside the lower lip vestibule.
A working space is created under the skin from the chin down to the neck.
An endoscope and small instruments are inserted, with a magnified view on a high-definition monitor.
The thyroid is carefully dissected and removed, using nerve monitoring to protect the laryngeal nerve and parathyroid glands.
The specimen is removed through the mouth and the internal incisions are closed with dissolvable sutures.

Benefits of TOETVA

✨No visible skin scar

No scar on the neck or anywhere on the body — all incisions are hidden inside the mouth.

🎯Magnified, clear view

The endoscope magnifies the nerves and parathyroid glands, allowing meticulous dissection.

⚡Fast recovery, less pain

Most patients go home within 1–2 days and return to daily life quickly.

💙Cosmetic confidence

Especially valued by women, younger patients and those whose work involves meeting people.

Who Is — and Isn't — Suitable

Suitable

Benign thyroid nodules generally up to about 6 cm
Moderately sized goiter (typically gland volume up to ~45 mL)
Selected early thyroid cancer, without clear invasion
Those who prioritize having no scar

Consider other options

Very large mass or goiter
Cancer with clear spread to lymph nodes or nearby organs
Prior neck surgery or radiation (in some cases)
Oral health issues or anatomical limitations

* These are general guidelines; the final decision rests with an expert surgeon on an individual basis.

Safety and Evidence

TOETVA is supported by extensive publications in international journals confirming that, when performed by a trained surgeon on appropriately selected patients, complication rates such as hoarseness and low calcium are comparable to open surgery. A technique-specific issue is temporary chin numbness, which usually resolves within a few weeks.

Recovery

After surgery, patients take soft food and maintain oral hygiene as advised. The internal incisions heal quickly with no sutures to remove, and swelling of the chin and neck subsides within 1–2 weeks. Follow-up on pathology and hormone levels guides ongoing care.

Frequently Asked Questions

What is TOETVA?

Thyroid removal via an endoscope through the mouth — three small incisions in the lower lip vestibule, with instruments passed down to the thyroid. Its hallmark is no visible skin scar. It was pioneered in Thailand.

Does TOETVA leave a scar?

No visible skin scar — all incisions are inside the mouth, hidden and healing well.

Who is suitable?

Patients with benign nodules up to about 6 cm, moderately sized goiter, and selected early cancer. The surgeon assesses each case individually.

Is it safe?

In expert hands with suitable patient selection, safety and complication rates are comparable to open surgery, with extensive published evidence.

Where can I have TOETVA and who do I consult?

Consult an endocrine surgeon trained in the technique. For the originator, Dr. Angkoon Anuwong, see drangkoon.com.

This page is general information, not individual medical advice. Please consult an endocrine surgeon to assess suitability for your case.

Transoral Thyroidectomy (TOETVA)