Transoral endoscopic thyroidectomy vestibular approach for pT1b papillary thyroid carcinoma: surgical and oncological outcomes.

OBJECTIVES

Evidence regarding efficacy and oncological safety of Transoral Endoscopic Thyroidectomy Vestibular Approach (TOETVA) for papillary thyroid carcinoma (PTC) with tumor size 1-2 cm remains limited. This study evaluates the surgical and oncological outcomes of TOETVA in patients with pT1b PTC.

METHODS

We conducted a cohort study of 50 consecutive patients with pT1b PTC who underwent TOETVA between January 2019 and December 2024 at Our Hospital. Clinical characteristics, surgical outcomes, and long-term oncological results were evaluated. All procedures were performed by a single experienced endoscopic surgeon. Patients were followed for recurrence and complications.

RESULTS

The cohort comprised predominantly female patients (96 %) with mean age 30.5 ± 7.1 years. Mean tumor size was 17 ± 4.6 mm. Lobectomy with isthmusectomy and central neck dissection was performed in 44 patients (88 %) with mean operative time of 85.4 ± 7.5 min, while total thyroidectomy with central neck dissection was performed in 6 patients (12 %) with mean operative time of 122.5 ± 5.2 min. Occult central lymph node metastases were identified in 15 patients (30 %). Mean lymph node yield was 4.2 ± 2.2 nodes. Temporary mental nerve injury occurred in 2 patients (4.0 %) and temporary recurrent laryngeal nerve palsy in 2 patients (4.0 %), all resolving within 3 months. No permanent complications were observed. During mean follow-up of 29.6 months (range 2.4-64.4), no recurrences were detected, and all patients reported satisfactory cosmetic outcomes.

CONCLUSIONS

TOETVA represents a safe and effective approach for managing pT1b PTC, demonstrating excellent surgical outcomes and patient satisfaction with minimal complications.