Outcomes in Surgical Management of Graves' Disease: Transcervical Versus Transoral Thyroidectomy

To compare surgical outcomes of patients with Graves' disease undergoing total thyroidectomy through the transoral endoscopic thyroidectomy vestibular approach versus the transcervical approach.

Retrospective cohort study.

Tertiary care academic institution.

Patients were offered a choice of either approach, undergoing surgery between September 2016 (when TOETVA was first offered) and March 2024. Patients were excluded if they were under 18 years old or received a neck dissection or re-operation. Collected data includes demographics, clinical and surgical variables, pathology, and postoperative complications.

In total, 152 transcervical and 81 transoral cases were included. The transoral group was younger (36.1 vs 45.3 years, P < .0001) and had more females (95.1% vs 77.0%, P = .0003) but had comparable body mass index to the transcervical group. There were no significant differences in the median maximum lobe size (5.9 (transcervical) vs 5.6 (transoral) cm, P = .647). Complication rates were similar between groups. Of the minor complications, temporary hypoparathyroidism was the most prevalent with 12 (7.9%) cases in the transcervical and 7 (8.6%) in the transoral groups. There were 2 (1.3%) and 4 (5.0%) cases of major complications in transcervical and transoral groups, respectively. Multivariable regression for age, sex, length of admission, and surgery duration confirmed no significant associations between approach and complication rates.

Transcervical and transoral approaches for surgical management of Graves' disease show statistically comparable rates of minor and major complications, even early in the learning curve. The choice of approach should involve shared decision-making between surgeon and patient, as highly motivated patients may not be excellent candidates.