Who is a good candidate for TOETVA, and who should avoid it?

Ideal candidates are patients with benign thyroid nodules, small thyroid cancers (typically ≤2 cm), or selected cases of Graves’ disease who desire no neck scar. Contraindications include large goiters (>4–5 cm), substernal extension, suspected aggressive thyroid cancer, prior neck surgery or radiation, and active oral infections. A thorough preoperative evaluation, including ultrasound and sometimes biopsy, is essential to confirm suitability. Patients with poor oral hygiene or limited mouth opening may also be excluded.