Endocrine Patients' Views on Transoral Endoscopic Thyroidectomy via Vestibular Approach (TOETVA)

Area of Science:

• Endocrinology
• Surgical Oncology
• Patient-Reported Outcomes

Background:

• Transoral Endoscopic Thyroidectomy Vestibular Approach (TOETVA) adoption is limited in the Western hemisphere.
• Understanding patient perceptions of TOETVA is crucial for its wider acceptance and application.
• Patient preferences significantly impact the choice between traditional thyroidectomy (TT) and newer minimally invasive techniques like TOETVA.

Purpose of the Study:

• To evaluate how endocrine patients in the United States perceive the risks and benefits of TOETVA.
• To identify factors influencing patient preference between TT and TOETVA.
• To inform clinical discussions and patient-centered decision-making regarding thyroidectomy procedures.

Main Methods:

• A cross-sectional study utilizing a de novo email survey sent to patients treated between 2018 and 2020.
• Patients rated the impact of TOETVA risks and benefits on their preference for TT versus TOETVA on a 1-10 scale.
• Multivariate analysis was employed to identify independent predictors of patient preference, with statistical significance set at p < 0.05.

Main Results:

• A total of 422 patients responded (3.2% response rate), with 76.0% being female and 34.1% diagnosed with thyroid cancer.
• Significant differences in TT vs. TOETVA preference were observed across age, race, education, cancer diagnosis, and prior surgery history.
• Key independent predictors of preference included attitudes towards operative time, outcome data, pain, travel for care, African American race, and prior surgery history.

Conclusions:

• Patient perceptions of TOETVA's risks and benefits are highly individualized and influenced by various demographic and clinical factors.
• Factors such as operative time, perceived outcome data, pain levels, and travel considerations significantly shape patient preferences.
• Tailoring discussions about TOETVA versus TT based on these patient-specific perceptions is essential for optimal shared decision-making in thyroid surgery.