• Yufei Chen, Kathryn Chomsky-Higgins, Iheoma Nwaogu, Carolyn D Seib, Jessica E Gosnell, Wen T Shen, Quan-Yang Duh, and Insoo Suh.
• Section of Endocrine Surgery, Department of Surgery, University of California , San Francisco, San Francisco, California.
• J Laparoendosc Adv Surg Tech A. 2018 Nov 1; 28 (11): 1374-1377.

BackgroundMinimally invasive and remote access thyroid surgery has been evolving with the transoral endoscopic thyroidectomy vestibular approach (TOETVA) emerging as a true "scarless" thyroidectomy. In this study, we describe a hybrid transoral and submental thyroidectomy (TOaST) technique for thyroid lobectomy.Materials And MethodsA TOaST right thyroid lobectomy was performed for a 4 cm cytologically benign right thyroid nodule. Initial incision was made in the submental region with two additional 5 mm lateral ports inserted transorally. Right thyroid lobectomy proceeded via standard TOETVA with intact specimen extraction via the submental incision.ResultsThe patient was discharged home on postoperative day 1. Final pathology showed a 4.2 cm follicular adenoma. Cosmetic results and patient satisfaction were excellent.DiscussionThis is the first reported case of a hybrid TOaST technique. It aims to maintain the principles and advantages of TOETVA while addressing its limitations related to large tumor extraction, mental nerve injury, and chin sensory changes. The shorter distance of dissection required may reduce postoperative pain. This approach may expand the indications for transoral thyroidectomy while maintaining excellent cosmetic outcomes.

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