[A clinical study of transoral endoscopic thyroidectomy vestibular approach for papillary thyroid carcinoma with...

Objective: To evaluate the feasibility of the transoral endoscopic thyroidectomy vestibular approach (TOETVA) for papillary thyroid carcinoma (PTC) with a tumor diameter>2 cm. Methods: This is a retrospective case series study. Clinical data of 60 patients with PTC who underwent TOETVA were collected from the Department of Thyroid Surgery of the First Affiliated Hospital of Zhengzhou University,the Department of General Surgery of Haicang Hospital Affiliated to Xiamen Medical College,and the Department of General Surgery of Zhongshan Hospital Affiliated to Xiamen University between January and December 2025. The study comprised 11 males (18.3%) and 49 females (81.7%),with an age of (30.2±9.0) years (range:8 to 59 years). Among them, 10 cases underwent bilateral thyroid lobectomy with bilateral central zone lymph node dissection, while 50 cases underwent unilateral thyroid lobectomy with ipsilateral central zone lymph node dissection. Postoperative follow-up was conducted via outpatient visits and telephone calls, with the cutoff date set at March 31,2026. Results: All 60 procedures were successfully completed under endoscopy,with no conversion to open surgery. Postoperative pathological examination confirmed PTC in all patients,including 50 cases of unilateral carcinoma and 10 cases of bilateral carcinoma. The maximum diameter (M(IQR) of the primary lesion was 25.6 (9.2) mm (range: 21 to 46 mm). Intraoperatively,recurrent laryngeal nerve invasion was observed in 4 cases,muscle invasion in 5 cases,and esophageal invasion in 1 case. The mean operative time was (94.1±16.4) min (range: 55 to 125 min). The postoperative serum calcium level was (2.17±0.17) mmol/L (range: 1.79 to 2.62 mmol/L),and the parathyroid hormone (PTH) level was 31.85 (13.46) pg/ml (range: 6.3 to 70.8 pg/ml). The drainage volume on the first postoperative day was 70.0 (55.0) ml (range: 4 to 130 ml), and the duration of drainage was 3 (1) d (range: 2 to 5 d). The number of harvested central compartment lymph nodes was 14 (6) (range: 2 to 37),with 3 (5) positive nodes (range: 0 to 32 positive nodes); the central compartment lymph node metastasis rate was (41.5±29.1)% (range:0 to 100%). The postoperative hospital stay was 6 (2) d (range: 4 to 10 d). No complications such as lymphatic leakage,choking on drinking water,or postoperative hemorrhage occurred. Two patients developed transient hypoparathyroidism,and their PTH levels normalized at the 1-month postoperative follow-up. Two patients experienced transient hoarseness,all of whom recovered within 6 months after surgery. During follow-up,1 patient was diagnosed with lateral cervical lymph node metastasis at 1-year postoperative re-examination and underwent lateral cervical lymph node dissection; no tumor residue or recurrence was detected in the remaining cases. Conclusion: Transoral endoscopic thyroidectomy via the vestibular approach is feasible for PTC with a maximum tumor diameter>2 cm, and yields satisfactory preliminary outcomes.