Transoral endoscopic thyroidectomy vestibular approach as a safe and feasible alternative to open thyroidectomy: a systematic review and meta-analysis

BACKGROUND: Transoral endoscopic thyroidectomy vestibular approach (TOETVA) is a scarless alternative to open thyroidectomy (OT). This systematic review and meta-analysis aimed to synthesize evidence comparing the intraoperative and postoperative outcomes of TOETVA and OT. METHODS: A systematic literature search of PubMed, Web of Science, the Cochrane Library, and Google Scholar was performed to identify studies comparing the outcomes of TOETVA and OT published before February 2023. The outcomes of interest were operative time, intraoperative blood loss, hospital stay, postoperative pain, number of central lymph nodes retrieved, number of metastatic central lymph nodes, and incidences of transient and permanent recurrent laryngeal nerve injury, transient and permanent hypocalcemia, hematoma, and infection. RESULTS: Thirteen studies published between 2016 and 2022, involving a total of 2889 patients (TOETVA, n=1085; OT, n=1804) were included in this systematic review and meta-analysis. Meta-analysis showed that the TOETVA group had a significantly longer overall operative time (weighted mean difference [WMD] 55.19; 95% CI, 39.15, 71.23; P<0.001), longer hospital stay (WMD, 0.27; 95% CI, 0.14, 0.39; P<0.001), and lower pain scores on postoperative day 1 (WMD, −1.41; 95% CI, −2.79, −0.03; P=0.04) than the OT group. Other intraoperative and postoperative outcomes were not significantly different between the groups. CONCLUSION: TOETVA has a similar safety profile to OT with less postoperative pain, making it an appropriate and more cosmetically appealing alternative to OT for select patients.