{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T16:38:29Z","timestamp":1781887109451,"version":"3.54.5"},"reference-count":32,"publisher":"BMJ","issue":"8","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2021,7,1]]},"published-print":{"date-parts":[[2021,8]]},"abstract":"<jats:p>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.<\/jats:p>","DOI":"10.1136\/bcr-2021-243306","type":"journal-article","created":{"date-parts":[[2021,8,23]],"date-time":"2021-08-23T13:31:43Z","timestamp":1629725503000},"page":"e243306","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Transoral and submental thyroidectomy using intraoperative nerve stimulation and indocyanin green fluorescence imaging"],"prefix":"10.1136","volume":"14","author":[{"given":"Fadi","family":"Alnehlaoui","sequence":"first","affiliation":[{"name":"Zulekha Hospital LLC, Sharjah, UAE"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5183-023X","authenticated-orcid":false,"given":"Salman Yousuf","family":"Guraya","sequence":"additional","affiliation":[{"name":"Clinical Sciences Department, College of Medicine, University of Sharjah, Sharjah, UAE"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2021,8,23]]},"reference":[{"key":"2025082709363942000_14.8.e243306.1","doi-asserted-by":"publisher","DOI":"10.1007\/s004649900476"},{"key":"2025082709363942000_14.8.e243306.2","doi-asserted-by":"crossref","first-page":"4749","DOI":"10.1007\/s00464-018-6221-1","article-title":"Treatment of differentiated thyroid cancer: can endoscopic thyroidectomy via a chest-breast approach achieve similar therapeutic effects as open surgery?","volume":"32","author":"Qu","year":"2018","journal-title":"Surg Endosc"},{"key":"2025082709363942000_14.8.e243306.3","doi-asserted-by":"crossref","first-page":"2199","DOI":"10.1002\/lary.27749","article-title":"Analysis of neuromonitoring signal loss during retroauricular versus conventional thyroidectomy","volume":"129","author":"Ban","year":"2019","journal-title":"Laryngoscope"},{"key":"2025082709363942000_14.8.e243306.4","doi-asserted-by":"publisher","DOI":"10.1007\/s00464-019-06826-7"},{"key":"2025082709363942000_14.8.e243306.5","doi-asserted-by":"crossref","first-page":"376","DOI":"10.1001\/jamasurg.2017.5306","article-title":"Transoral endoscopic Thyroidectomy-An emerging remote access technique for thyroid excision","volume":"153","author":"Inabnet","year":"2018","journal-title":"JAMA Surg"},{"key":"2025082709363942000_14.8.e243306.6","doi-asserted-by":"publisher","DOI":"10.1007\/s40618-019-01071-0"},{"key":"2025082709363942000_14.8.e243306.7","doi-asserted-by":"publisher","DOI":"10.1007\/s00464-019-06743-9"},{"key":"2025082709363942000_14.8.e243306.8","doi-asserted-by":"crossref","first-page":"1374","DOI":"10.1089\/lap.2018.0146","article-title":"Hidden in Plain Sight: Transoral and Submental Thyroidectomy as a Compelling Alternative to \"Scarless\" Thyroidectomy","volume":"28","author":"Chen","year":"2018","journal-title":"J Laparoendosc Adv Surg Tech A"},{"key":"2025082709363942000_14.8.e243306.9","doi-asserted-by":"crossref","first-page":"1796","DOI":"10.1007\/s00464-020-07576-7","article-title":"An easier option for \u201cinvisible scar\u201d thyroidectomy: hybrid-transoral endoscopic thyroidectomy submental access (H-TOETSA)\u2014experience on twenty-two consecutive patients","volume":"35","author":"Perigli","year":"2021","journal-title":"Surg Endosc"},{"key":"2025082709363942000_14.8.e243306.10","doi-asserted-by":"publisher","DOI":"10.1007\/s00464-017-5705-8"},{"key":"2025082709363942000_14.8.e243306.11","doi-asserted-by":"crossref","unstructured":"Perigli G , Cupellini C , Cianchi F , et al . Hybrid transoral endoscopic thyroidectomy submental approach. VideoEndocrinology 2019;6.doi:10.1089\/ve.2018.0145","DOI":"10.1089\/ve.2018.0145"},{"key":"2025082709363942000_14.8.e243306.12","doi-asserted-by":"crossref","first-page":"1514","DOI":"10.1007\/s00268-019-05360-w","article-title":"Foley balloon facilitates creation of working space in transoral thyroidectomy","volume":"44","author":"Liang","year":"2020","journal-title":"World J Surg"},{"key":"2025082709363942000_14.8.e243306.13","doi-asserted-by":"crossref","first-page":"444","DOI":"10.1177\/1553350618785281","article-title":"How I do it: new dissector device allows for effective operative field in transoral endoscopic thyroid surgery using vestibular approach","volume":"25","author":"M\u00fcller","year":"2018","journal-title":"Surg Innov"},{"key":"2025082709363942000_14.8.e243306.14","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1016\/j.jss.2019.05.019","article-title":"Technical Innovation in Transoral Endoscopic Endocrine Surgery: A Modified \"Scarless\" Technique","volume":"243","author":"Suh","year":"2019","journal-title":"J Surg Res"},{"key":"2025082709363942000_14.8.e243306.15","doi-asserted-by":"publisher","DOI":"10.1111\/j.1445-2197.2012.06247.x"},{"key":"2025082709363942000_14.8.e243306.16","doi-asserted-by":"publisher","DOI":"10.1089\/lap.2018.0587"},{"key":"2025082709363942000_14.8.e243306.17","doi-asserted-by":"crossref","first-page":"591522","DOI":"10.3389\/fsurg.2020.591522","article-title":"Transoral endoscopic thyroidectomy via submental and vestibular approach: a preliminary report","volume":"7","author":"Fu","year":"2020","journal-title":"Front Surg"},{"key":"2025082709363942000_14.8.e243306.18","doi-asserted-by":"crossref","DOI":"10.1016\/j.oraloncology.2020.104617","article-title":"Feasibility and efficacy of intraoperative neural monitoring in remote access robotic and endoscopic thyroidectomy","volume":"103","author":"Ji","year":"2020","journal-title":"Oral Oncol"},{"key":"2025082709363942000_14.8.e243306.19","doi-asserted-by":"crossref","first-page":"589","DOI":"10.1308\/rcsann.2019.0087","article-title":"Intraoperative nerve monitoring during thyroidectomy: evaluation of signal loss, prognostic value and surgical strategy","volume":"101","author":"G\u00fcr","year":"2019","journal-title":"Ann R Coll Surg Engl"},{"key":"2025082709363942000_14.8.e243306.20","doi-asserted-by":"crossref","first-page":"340","DOI":"10.1002\/hed.25451","article-title":"Feasibility of indocyanine green fluorescence imaging for intraoperative identification of parathyroid glands during thyroid surgery","volume":"41","author":"van den Bos","year":"2019","journal-title":"Head Neck"},{"key":"2025082709363942000_14.8.e243306.21","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1001\/jamasurg.2017.3366","article-title":"Safety and outcomes of the transoral endoscopic thyroidectomy vestibular approach","volume":"153","author":"Anuwong","year":"2018","journal-title":"JAMA Surg"},{"key":"2025082709363942000_14.8.e243306.22","doi-asserted-by":"crossref","first-page":"688","DOI":"10.1016\/j.sjbs.2017.10.024","article-title":"The impact and effectiveness of faculty development program in fostering the faculty's knowledge, skills, and professional competence: a systematic review and meta-analysis","volume":"26","author":"Bilal","year":"2019","journal-title":"Saudi J Biol Sci"},{"key":"2025082709363942000_14.8.e243306.23","first-page":"51","article-title":"The cutting-edge training modalities and educational platforms for accredited surgical training: a systematic review","volume":"22","author":"Forgione","year":"2017","journal-title":"J Res Med Sci"},{"key":"2025082709363942000_14.8.e243306.24","first-page":"434","article-title":"Carcinoid tumors of the appendix. our experience in a university hospital","volume":"26","author":"Guraya","year":"2005","journal-title":"Saudi Med J"},{"key":"2025082709363942000_14.8.e243306.25","first-page":"1111","article-title":"Malignant duodenocolic fistula. various therapeutic surgical modalities","volume":"25","author":"Guraya","year":"2004","journal-title":"Saudi Med J"},{"key":"2025082709363942000_14.8.e243306.26","doi-asserted-by":"publisher","DOI":"10.1007\/s00268-020-05874-8"},{"key":"2025082709363942000_14.8.e243306.27","doi-asserted-by":"publisher","DOI":"10.1016\/j.oraloncology.2020.104871"},{"key":"2025082709363942000_14.8.e243306.28","doi-asserted-by":"crossref","first-page":"259","DOI":"10.20945\/2359-3997000000380","article-title":"Trans oral endoscopic thyroidectomy vestibular approach (TOETVA) in Brazil: safety and complications during learning curve","volume":"65","author":"Bertelli","year":"2021","journal-title":"Arch Endocrinol Metab"},{"key":"2025082709363942000_14.8.e243306.29","doi-asserted-by":"crossref","DOI":"10.1016\/j.surg.2021.05.003","article-title":"Prevention of transoral thyroidectomy complications: an analysis of surgical outcomes in 423 consecutive series","author":"You","year":"2021","journal-title":"Surgery"},{"key":"2025082709363942000_14.8.e243306.30","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1007\/s12020-018-1539-y","article-title":"Hybrid techniques and patients' safety in implementing transoral sublingual thyroidectomy","volume":"60","author":"Witzel","year":"2018","journal-title":"Endocrine"},{"key":"2025082709363942000_14.8.e243306.31","doi-asserted-by":"crossref","first-page":"E25","DOI":"10.1002\/hed.25037","article-title":"Carbon dioxide embolism during transoral robotic thyroidectomy: a case report","volume":"40","author":"Kim","year":"2018","journal-title":"Head Neck"},{"key":"2025082709363942000_14.8.e243306.32","doi-asserted-by":"crossref","DOI":"10.3389\/fimmu.2021.587146","article-title":"The relevance of a physical active lifestyle and physical fitness on immune defense: mitigating disease burden, with focus on COVID-19 consequences","volume":"12","author":"Filgueira","year":"2021","journal-title":"Front Immunol"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2021-243306","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T16:36:49Z","timestamp":1756312609000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2021-243306"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,8]]},"references-count":32,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2021,8,23]]},"published-print":{"date-parts":[[2021,8]]}},"alternative-id":["10.1136\/bcr-2021-243306"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2021-243306","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,8]]}}}