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Transoral and submental thyroidectomy using intraoperative nerve stimulation and indocyanin green fluorescence imaging
  1. Fadi Alnehlaoui1 and
  2. Salman Yousuf Guraya2
  1. 1Zulekha Hospital LLC, Sharjah, UAE
  2. 2Clinical Sciences Department, College of Medicine, University of Sharjah, Sharjah, UAE
  1. Correspondence to Professor Salman Yousuf Guraya; salmanguraya{at}


There is a recent proliferation of clinical studies about the minimally invasive scarless thyroid surgery. The transoral endoscopic thyroidectomy vestibular approach (TOETVA) carries a great potential for being scarless surgery via a short dissection flap. However, TOETVA has limitations in extracting larger thyroid tumours via the transoral vestibular incision and due to its potential damage to the branches of the mental nerve. The rapidly evolving surgical innovations have now introduced transoral and submental thyroidectomy (TOaST) approach that allows extraction of large thyroid tumours with less flap dissection and minimal postoperative pain. We present a 39-year-old man with a large multinodular goitre. The patient was euthyroid with moderate to severe compression symptoms of difficulty in breathing and swallowing. We performed a TOaST procedure using intraoperative neuromonitoring and indocyanin green fluorescence imaging with an uneventful recovery. This is a first case report from the middle east region that will pave the way to large clinical trials to determine the efficacy and safety of TOaST.

  • thyroid disease
  • endoscopy
  • surgery
  • thyroiditis

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  • Contributors Patient was under the care of FA. Operated by FA and SYG. Report was written by SYG and FA.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.