Surgical outcomes of modified versus conventional transoral endoscopic thyroidectomy vestibular approach for papillary thyroid carcinoma.

[BACKGROUND] Transoral endoscopic thyroidectomy via the vestibular approach (TOETVA) offers superior cosmetic outcomes but is associated with prolonged operative time and mental nerve injury. We have implemented a modified TOETVA technique and compared its surgical outcomes with the conventional approach in early-stage papillary thyroid carcinoma (PTC).

[METHODS] This retrospective study included 505 consecutive patients with T1aN0M0 PTC who underwent TOETVA hemithyroidectomy with ipsilateral central neck dissection between January 2022 and March 2025. Patients were divided into conventional (n = 447) and modified (n = 58) TOETVA groups. Propensity score matching (1:2) was performed based on age, sex, tumor size, and tumor location. Operative time, postoperative pain, length of hospital stay, and complications were compared.

[RESULTS] After matching, 150 patients were analyzed (92 conventional vs. 58 modified). The modified group demonstrated a significantly shorter operative time (67.84 ± 6.36 vs. 84.78 ± 13.18 min; p < 0.001) and hospital stay (2.62 ± 0.56 vs. 3.86 ± 1.13 days; p < 0.001). Postoperative pain scores were significantly lower in the modified group on postoperative days 1, 3, and 5 (all p < 0.001). The incidence of transient mental nerve injury was reduced (1.7% vs. 9.8%; p = 0.032). No patients required conversion to open surgery or experienced permanent recurrent laryngeal nerve injury or permanent hypoparathyroidism.

[CONCLUSIONS] The modified TOETVA technique is a safe and effective alternative for early-stage PTC. It may improve perioperative outcomes while maintaining a low complication rate.