Randomized Controlled Trial of Transoral Endoscopic Thyroidectomy Vestibular Approach (TOETVA) Versus Open Thyroidectomy: A Comparative Study of Efficacy and Complications.

Abstract

Background: Minimally invasive thyroid surgery has evolved significantly, offering improved cosmetic and clinical outcomes¹. Transoral Endoscopic Thyroidectomy Vestibular Approach (TOETVA) is a scar-free alternative to conventional open thyroidectomy (OT)². This study aims to compare the safety and clinical outcomes of TOETVA and OT in patients with benign thyroid nodules, incorporating data from a randomized controlled trial (RCT).

Methods: A single-blind randomized controlled trial was conducted on patients with thyroid nodules ≤8 cm. Patients were randomized to undergo either TOETVA or conventional thyroidectomy. Postoperative pain had been evaluated using VAS on days 1 and 2. A 3-month follow-up was performed to evaluate complications, including recurrent laryngeal nerve (RLN) palsy, bleeding, and infection.

Results: Seventy patients were randomized to undergo either TOETVA or conventional thyroidectomy. The baseline characteristics, including age and thyroid nodule size, were comparable between groups. The mean operative time was longer in the TOETVA group (99 vs. 75 minutes, P < .001) and the pain score on the second postoperative day (0.74 vs. 1.86, P < .001). At the 3-month follow-up, complications in the TOETVA group included one case of transient RLN palsy, one case of mental nerve injury, and one case of subcutaneous emphysema. No complications were reported in the OT group.

Conclusion: TOETVA is associated with reduced postoperative pain and improved cosmetic outcomes compared to conventional thyroidectomy in the management of benign thyroid nodules.