Is drain placement necessary in transoral endoscopic thyroidectomy via vestibular approach?

BACKGROUND

Transoral Endoscopic Thyroidectomy via Vestibular Approach (TOETVA) offers a scar-free alternative for thyroid surgery. Traditionally, drains are used to prevent hematoma, seroma, and infection, yet the need for routine drain placement in TOETVA remains uncertain.

METHODS

We conducted a retrospective cohort study of TOETVA patients from August 2021 to September 2024 at a single tertiary center. Patients were divided into drain and non-drain groups. All patients underwent unilateral TOETVA, with or without central lymph node dissection. Key outcomes included operative time, postoperative pain, hospital stay, and complications. Propensity score matching (PSM) was applied to minimize selection bias. Statistical significance was set at p < 0.05.

RESULTS

A total of 408 TOETVA patients were included, with 214 in the drain group and 194 in the non-drain group. After PSM, 174 matched pairs were analyzed. Operative time, pain scores, hematoma, seroma, and infection rates were comparable between groups. However, the non-drain group had a significantly shorter hospital stay (3.38 ± 0.94 vs. 4.37 ± 1.02 days, p < 0.001). No significant differences in hospitalization costs were observed.

CONCLUSION

Routine drain placement may not be necessary in TOETVA patients, as omission of drains did not increase complication rates and was associated with shorter hospitalization in our cohort. Prospective multicenter studies are required to validate the optimal criteria for selective drain use.