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. 2019 Jun 27;9:9365. doi: 10.1038/s41598-019-45779-8

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© The Author(s) 2019

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.

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TOETVA procedure. (A) Surgery is initiated with a 10 mm incision in the center of the oral vestibule just above the inferior labial frenulum for the 10 mm trocar insertion. (B) Two 5 mm trocars are then inserted at the lateral incisions. (C) The dissection is in the subplatysmal plane above the strap muscles. The boundaries of the subplatysmal working space are defined as follows: inferior border at the sternal notch, lateral borders at the edges of the sternocleidomastoid muscles, and superior border at the thyroid cartilage. Dissection of the thyroid lobe is then continued. (D) RLN is identified at the laryngeal insertion and dissected parallel to the trachea and downwards to the trachea.