Is transoral endoscopic thyroidectomy via vestibular approach safe for total thyroidectomy compared to open thyroidectomy? A propensity-score matched cohort study of 101 matched patient pairs with papillary thyroid carcinoma.

Abstract

Abstract Background Transoral endoscopic thyroidectomy via vestibular approach (TOETVA) has become increasingly popular in the treatment of papillary thyroid cancer. This study aimed to describe the safety and feasibility of total thyroidectomy between the TOETVA and open thyroidectomy (OT) approaches for the treatment of patients with papillary thyroid cancer (PTC). Methods We retrospectively reviewed 780 consecutive patients suffering from PTC that had undergone total thyroidectomy using TOETVA (n = 107) and OT (n = 673) between April 2016 and October 2021 at our institute. Afterward, A total of 101 matched patients’ surgical outcomes were compared using propensity score matching (PSM) analysis. Results Before PSM, the patients in the TOETVA group were younger (p < 0.001), had a lower BMI (p < 0.001) and a greater female population (p < 0.001). After PSM, the TOETVA group was associated with significantly longer operative time (p < 0.001), greater blood loss (p < 0.001), total drainage amount (p < 0.001), higher WBC count (p < 0.001) and CRP (p < 0.001), better cosmetic satisfaction (p < 0.001) and quality of life (p < 0.001) and lower scar self-consciousness (p < 0.001). There was no statistical difference between the groups in the attenuation or disappearance of RLN signal, rate of parathyroid autotransplantation and bilateral lymph node dissection, the positivity of lymph node metastasis, number of dissected lymph nodes and positive lymph nodes, multifocality, postoperative level of blood calcium and PTH, rate of PTH < 15ng/mL, VAS score, duration of hospital stay, complications, mean TSH-stimulated Tg level before RAI, mean Tg level without TSH stimulation, and the proportion of serum Tg level of < 1. Conclusion TOETVA is a safe and feasible technique for better cosmetic effects and similar surgical outcomes compared to conventional open surgery for the studied patients that required total thyroidectomy.