Postoperative Voice Changes Over Time Following Endoscopic or Robotic Hemithyroidectomy

Postoperative voice impairment is a common concern after thyroidectomy. However, postoperative voice recovery and its association with clinicopathologic factors remain unclear in robotic and endoscopic approaches. This study evaluated postoperative changes over time in perceptual, acoustic, aerodynamic, and patient-reported voice outcomes and identified recovery patterns according to clinicopathologic factors in both surgical approaches.

We retrospectively reviewed 1106 patients who underwent minimally invasive thyroidectomy for thyroid malignancy between 2018 and 2025. Among them, 704 patients who underwent remote-access thyroidectomy were included, of whom 334 underwent endoscopic hemithyroidectomy and 370 underwent robotic hemithyroidectomy. Voice outcomes were assessed using perceptual, acoustic Multi-Dimensional Voice Program (MDVP) and pitch-related parameters, aerodynamic parameters, and the Thyroidectomy-related Voice and Symptom Questionnaire. Evaluations were performed preoperatively and at predefined postoperative intervals (<1 month, 1-3 months, and ≥3 months). Longitudinal changes in voice outcomes were analyzed across these time points according to clinicopathologic factors, including Body Mass Index (BMI), Central Neck Dissection (CND) status, and tumor size.

Perceptual voice parameters worsened during the early postoperative period in both groups but recovered by 3 months. However, the F-high parameter did not fully recover by 3 months (P = 0.002 and P < 0.001, respectively), whereas other MDVP and pitch-related parameters returned to baseline levels. Aerodynamic parameters also recovered after 3 months in both groups. Significant improvement in clinically relevant voice impairment over time was observed in patients with BMI <18.5 and 18.5-24.9, those who did not undergo CND, and those with tumors ≤ 1 cm.

Voice function typically deteriorates in the early postoperative period following both robotic and endoscopic thyroidectomy but generally recovers to near-baseline levels within 3 months. Significant improvement in clinically relevant voice impairment over time was observed in patients with BMI