History and Evolution of Transoral Thyroidectomy Approach

The era of thyroid surgery in Europe started in the late nineteenth century by pioneers like Kocher, Billroth, and Halsted. At that time, patients’ survival was the main objective. After developing dissection devices, tools for hemostasis, and the intraoperative nerve monitoring system, patient safety became the main aim in thyroid surgery. Today it is a highly standardized technique and one of the safest procedures in surgery with very low morbidity. The next quest was to achieve cosmetically better results—through smaller neck incisions and remote access approaches to avoid a neck scar. As the first group who initiated the transoral access to the thyroid, we report on our personal experience and conceptual design in dealing with this innovative approach that was part of our Natural Orifice Surgery (NOS/NOTES) project, which is the next step in the evolution of minimally invasive surgery. Transoral thyroidectomy by the vestibular approach is now a safe method that represents a breakthrough for the patient and a paradigm shift in the history of thyroid surgery toward a “scarless” surgery.