Transoral Endoscopic Thyroidectomy for Bilateral Papillary Thyroid Carcinoma: Early Outcomes From a Vietnamese Center

Transoral endoscopic thyroidectomy via the vestibular approach (TOETVA) has emerged as a scarless, remote-access surgical technique for thyroid cancer. However, evidence regarding its feasibility and oncologic safety in bilateral papillary thyroid carcinoma (PTC) remains limited.

We conducted a prospective study at a single high-volume endocrine surgery center in Vietnam from January 2020 to July 2024. Patients with clinically and cytologically confirmed bilateral PTC (tumor size < 20 mm) underwent TOETVA with total thyroidectomy and bilateral central lymph node (CLN) dissection. Outcomes assessed included operative time, complications, lymph node yield, and early oncologic outcomes. Risk stratification and radioactive iodine (RAI) therapy were applied per 2015 American Thyroid Association guidelines.

A total of 30 patients (96.7% female, mean age 33.1 years) were included. The average operative time was 104.0 min, and mean blood loss was 16.3 mL. Transient complications included hypoparathyroidism (10.0%) and recurrent laryngeal nerve injury (13.3%); no permanent complications were observed. CLN metastasis was found in 46.7% of cases. Among 10 patients who received RAI therapy, all had favorable responses. At a median follow-up of 35 months, no structural recurrence or distant metastasis has been detected.

TOETVA may represent a feasible surgical option for selected patients with bilateral PTC ≤ 20 mm, yielding acceptable surgical morbidity and encouraging early oncologic outcomes without visible scarring. The technique is particularly suitable for experienced endocrine surgeons. Further multicenter studies are warranted to confirm these findings.