Anesthesiologist perspectives for the transoral approach

Thyroidectomy is the main endocrine surgical procedure carried out in the world. Recently, transoral endoscopic thyroidectomy vestibular approach (TOETVA) has showed its beneficial results. The main intraoperative challenges are to avoid events such as pneumothorax and pneumomediastinum due to air insufflation. The anesthetist has to be aware about intraoperative alarming signals and promptly alert surgical staff. Additionally, an adequate preoperative assess is essential to investigate and to treat uncontrolled health status. The primary objective of postoperative pain management is to diminish patient discomfort guarantying an optimal analgesia during speech, chewing and swallowing into postoperative period. A practical approach is described in this manuscript.