Surgical Results of Transoral Endoscopic Thyroidectomy Vestibular Approach (TOETVA) Compared to Open Thyroidectomy in Patient with Benign Thyroid Nodule

Background: Transoral endoscopic thyroidectomy vestibular approach (TOETVA) is an innovative technique to perform thyroidectomy which provides excellent cosmetic and surgical outcomes. Methods: Between June 2018 to January 2020 all patients pathological diagnosis with benign thyroid nodule in Chiangrai Prachanukroh Hospital were reviewed retrospectively. TOETVA and Open thyroidectomy were performed in 55 cases per each group, respectively. Patient baseline characteristics and surgical results, including postoperative pain, estimate blood loss, operative time, length of hospital stay and postoperative complications, were investigated and compared. Results: TOETVA and open thyroidectomy was performed on 110 consecutive patients. The baseline characteristics were similar in both groups. The mean postoperative visual analog scale for pain score in the first three days was comparable for both groups (4.43 [2.01] vs 3.73 [2.5], P=0.126). Mean estimate blood loss was not statistically different for both groups (20 [76.19] vs 30 [44.28] ml, P=0.302). But the median operative time was longer for the TOETVA group compared to the open thyroidectomy group (120 [61.55] vs 60 [33.70] mins, P=0.00003). Mean length of stay was comparable for both groups (3.7 [0.98] vs 3.43 [1.05] days, P=0.072). For the postoperative complication, 3 patients (5.45%) in TOETVA and 6 patients (10.91%) in open thyroidectomy group has recurrent laryngeal nerve injury. One patient (1.82%) had hypocalcemia in both groups. In TOETVA group, one patient (1.82%) had wound infection and one patient (1.82%) had transient mental nerve injury. Conclusion: TOETVA is an effective and safe surgical approach for benign thyroid nodule with excellent cosmetic outcome. This technique is a reasonable optional treatment for patients who demanded a scarless wound. The surgical outcomes and complication rates were similar but TOETVA is associated with longer operative time.