7th International Thyroid NOTES Conference  ·  Bangkok, Thailand ✉ Secretariat 📍 Police General Hospital & Chulalongkorn University
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What is TOETVA? Transoral Endoscopic Thyroidectomy Vestibular Approach

A complete guide to scarless thyroid surgery through the mouth — the technique at the heart of the International Thyroid NOTES Conference.

Quick answer

TOETVA (Transoral Endoscopic Thyroidectomy Vestibular Approach) is a scarless thyroid operation performed through three small incisions inside the lower lip. The thyroid is removed entirely through the mouth, leaving no visible scar on the neck. It was pioneered by Dr. Angkoon Anuwong in Bangkok in 2016 and is now performed in more than 45 countries.

The technique

Transoral Endoscopic Thyroidectomy Vestibular Approach — TOETVA — is a form of Natural Orifice Transluminal Endoscopic Surgery (NOTES) applied to the thyroid gland. Instead of the traditional collar incision across the front of the neck, the surgeon makes three tiny incisions inside the oral vestibule (the space between the lower lip and the gum).

Through these ports, an endoscope and specialised instruments are advanced beneath the skin of the neck to create a working space over the thyroid. The gland is dissected under high- definition endoscopic vision and delivered through the mouth. Because every incision is hidden inside the lip, the operation is truly scarless.

TOETVA at a glance

  • Full name: Transoral Endoscopic Thyroidectomy Vestibular Approach
  • Access: three incisions inside the lower lip (oral vestibule)
  • Visible scar: none
  • Pioneer: Dr. Angkoon Anuwong, Bangkok, Thailand (2016)
  • Global adoption: performed in 45+ countries
  • Related: TORT (robotic version), thyroid ablation (non-surgical)

Why patients and surgeons choose it

  • No neck scar — a decisive cosmetic and psychological benefit, especially for younger patients and those prone to keloid
  • Comparable safety — similar recurrent-laryngeal-nerve and parathyroid preservation to open surgery in trained hands
  • Central access — the midline transoral route reaches both thyroid lobes
  • High patient satisfaction — strong quality-of-life outcomes reported across international series

TOETVA, TORT and thyroid ablation

The conference covers the full spectrum of modern scarless and minimally-invasive thyroid care. TOETVA is the endoscopic transoral operation; TORT (Transoral Robotic Thyroidectomy) performs the same approach with a surgical robot; and ultrasound-guided thermal ablation (microwave / radiofrequency) treats selected nodules without any incision at all. Choosing the right option for the right patient is a central theme of the scientific program.

Learning TOETVA

Safe adoption depends on structured training: understanding the anatomy, patient selection, nerve monitoring, and hands-on practice before operating independently. The International Thyroid NOTES Conference was created precisely for this — pairing lectures and live 4K surgery with soft-cadaver hands-on workshops led by the world’s most experienced transoral surgeons.

See the 2026 scientific program →

Frequently asked questions about TOETVA

What does TOETVA stand for?
TOETVA stands for Transoral Endoscopic Thyroidectomy Vestibular Approach — an endoscopic operation that removes the thyroid gland through the mouth via the oral vestibule (the space behind the lower lip), leaving no external scar.
Who invented TOETVA?
TOETVA was developed by Dr. Angkoon Anuwong at Police General Hospital in Bangkok, Thailand. His landmark case series, published in 2016, established the technique, and he has since performed the world’s largest series — more than 6,000 cases.
How is TOETVA performed?
Three small incisions (about 5–10 mm) are made inside the lower lip. Through these, an endoscope and instruments create a working space under the skin of the neck down to the thyroid. The gland is dissected and removed through the mouth. Because the incisions are inside the lip, there is no visible scar.
Is TOETVA safe?
In experienced hands, TOETVA has a safety profile comparable to conventional open thyroidectomy for appropriately selected patients, with similar rates of nerve and parathyroid preservation. Careful patient selection and proper training are essential — which is the purpose of this conference.
What is the difference between TOETVA and TORT?
TOETVA uses an endoscope (a camera and hand-held instruments). TORT — Transoral Robotic Thyroidectomy — performs the same transoral, scarless approach using a surgical robot for enhanced dexterity and 3D vision. Both remove the thyroid through the mouth with no neck scar.
Who is a candidate for scarless (transoral) thyroid surgery?
TOETVA is commonly offered for benign thyroid nodules and goiters up to a certain size, and for selected low-risk thyroid cancers. Suitability depends on nodule size, gland volume and individual anatomy; a surgeon trained in the technique makes the final assessment.

Advance your transoral thyroid surgery

Join surgeons from around the world at the International Thyroid NOTES Conference in Bangkok.

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