Transoral Endoscopic and Minimally Invasive Thyroidectomy

Area of Science:

• Endocrine Surgery
• Surgical Oncology
• Minimally Invasive Surgery

Background:

• Transoral endoscopic thyroidectomy vestibular approach (TOETVA) is a scarless thyroid surgery technique gaining popularity.
• Comparisons with minimally invasive nonendoscopic thyroidectomy (MINET) regarding safety, cost, and pathological evaluation are ongoing.

Purpose of the Study:

• To compare surgical outcomes, pathological considerations, and cost profiles between TOETVA and MINET.
• To evaluate the safety and efficacy of TOETVA versus MINET in oncoplastic thyroidectomy.

Main Methods:

• A propensity-matched cohort study of 420 patients undergoing oncoplastic thyroidectomy was conducted.
• 720 patients were initially included, with propensity score matching creating balanced cohorts of 210 patients for TOETVA and MINET.
• Outcomes measured included operative duration, neuromonitoring alerts, parathyroid preservation, postoperative pain, specimen integrity, complications, and costs.

Main Results:

• TOETVA had longer operative times (127.9 vs 68.1 minutes) and higher costs ($4680 vs $2734) compared to MINET.
• TOETVA demonstrated fewer intraoperative neuromonitoring alerts and better parathyroid preservation rates.
• Postoperative pain was slightly higher with TOETVA, and specimen disruption was more frequent (12.9% vs 3.8%).

Conclusions:

• TOETVA offers favorable cosmetic outcomes and improved nerve and parathyroid preservation.
• However, TOETVA is associated with longer operative times, increased costs, and a higher risk of specimen disruption.
• These findings highlight the need for careful patient selection and further prospective evaluation of TOETVA.