Voice outcomes following robotic transoral, robotic retroauricular, and open hemithyroidectomy

Considering the favourable prognosis of thyroid tumours, the importance of quality of life, including functional and voice outcomes, is critically important. The impact of remote-access thyroidectomy on postoperative voice function remains unclear, and direct comparative data across major approaches are limited. This study compared patient-reported and objective voice outcomes following robotic transoral (TO), robotic retroauricular (RA), and open hemithyroidectomy.

This retrospective observational cohort study included patients undergoing hemithyroidectomy between January 2022 and August 2025. Voice outcomes were evaluated preoperatively and at 3 months postoperatively using the Voice Handicap Index-10 and acoustic analysis. Between-group comparisons and multivariable general linear modelling were performed to identify factors associated with postoperative voice outcomes.

A total of 150 patients were analysed (RA: 58; TO: 37; open: 55). Baseline VHI-10 and acoustic parameters were comparable across groups. The RA group demonstrated significantly higher postoperative VHI-10 scores and greater VHI-10 change scores compared with TO and open approaches (p < 0.01). No significant differences were observed in postoperative acoustic parameters, including jitter, shimmer, noise-harmonic ratio, soft phonation index, pitch range, or fundamental frequency. Female subgroup analysis demonstrated similar findings. On multivariable analysis, postoperative VHI-10 remained to be only affected by the type of surgical approach.

All three surgical approaches showed comparable objective acoustic voice parameters. However, TO and open hemithyroidectomy were associated with better patient-perceived voice outcomes at 3 months compared with RA. When clinical conditions are comparable, TO may be considered as a viable robotic approach in patients who prioritise short-term subjective voice outcomes.