A comparative study of transoral and submental versus vestibular endoscopic thyroidectomy in patients with papillary thyroid carcinoma.

BACKGROUND

Transoral endoscopic thyroidectomy vestibular approach (TOETVA) is widely adopted for its cosmetic advantage but is associated with postoperative oral discomfort and mental nerve injury. This study aimed to evaluate whether a modified technique, transoral and submental endoscopic thyroidectomy (TOaST), improves perioperative outcomes in patients with papillary thyroid carcinoma (PTC).

METHODS

A retrospective study was conducted on 136 patients with PTC who underwent either TOaST (n = 51) or TOETVA (n = 85). Key outcomes included operative time, time to oral intake, postoperative pain, swallowing function, incidence of chin numbness, complications, and cosmetic satisfaction.

RESULTS

TOaST was associated with shorter operative time (123.05 ± 19.45 vs. 143.89 ± 22.68 min, P < 0.001), earlier oral intake (3.12 ± 0.82 vs. 5.22 ± 1.49 h, P < 0.001), and lower pain scores at 24 and 48 h (P < 0.001). Swallowing function on day 3 was better in the TOaST group (P < 0.001). Chin numbness occurred in 17.6% of TOETVA patients but none in the TOaST group (P = 0.001). Overall complication rates and cosmetic satisfaction were similar between the groups.

CONCLUSIONS

TOaST demonstrates advantages in surgical efficiency, pain control, and early functional recovery without compromising aesthetic results, making it a favorable alternative to TOETVA in selected PTC patients.