Technical and therapeutic evaluation of endoscopic treatment of early papillary thyroid cancer through oral vestibular approach.
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BACKGROUND: The transoral endoscopic thyroidectomy vestibular approach (TOETVA) is an innovative scarless surgical technique for thyroid carcinoma. However, there is limited safety data from extensive experiences in single institutions. This study evaluates the safety and outcomes of TOETVA through a large-scale, single-institution experience. METHODS: We conducted a retrospective cohort study of 612 consecutive patients with papillary thyroid carcinoma who underwent TOETVA between January 2019 and February 2025. The primary endpoints were operative safety and complication rates. RESULTS: The cohort predominantly consisted of females (95.6%) with a mean age of 32.7 years. Procedures included 580 hemithyroidectomies (94.8%) and 32 total thyroidectomies (5.2%), all with central neck dissection. The mean operative time was 86.9 min, and the conversion rate to open surgery was 0.3%. Temporary recurrent laryngeal nerve dysfunction occurred in 4.7% of patients, while permanent injury was recorded in 0.4%. Among total thyroidectomy cases, 15.6% experienced temporary hypocalcemia, with no permanent cases. Transient mental nerve dysfunction affected 8.8% of patients, all resolving within 3 months. With a mean follow-up of 31.9 months, only one patient (0.16%) experienced regional recurrence. CONCLUSIONS: This large series suggests that TOETVA is a safe and effective surgical approach for carefully selected patients with papillary thyroid carcinoma. However, these findings are derived from a highly selected low-risk population and should not be generalized to older patients, larger tumors, aggressive histologic variants, or clinically advanced disease.