Efficacy and safety of transoral endoscopic thyroidectomy vestibular approach of papillary thyroid carcinoma: a network meta-analysis.

BACKGROUND

This network meta-analysis aimed to systematically evaluate the efficacy and safety of the transoral endoscopic thyroidectomy vestibular approach (TOETVA) compared with open thyroidectomy (OT) and the endoscopic thyroidectomy via axillary breast approach (ABA) for treating papillary thyroid carcinoma (PTC).

MATERIALS AND

METHODS

Five databases (PubMed, Embase, Web of Science, Cochrane Library, and Scopus) were systematically searched from inception to January 31, 2026, for clinical studies comparing at least two of the three thyroidectomy approaches (TOETVA, OT, ABA) in patients with PTC. A network meta-analysis was conducted using RStudio (version 2025.05.1). Standardized mean differences and odds ratios with 95% confidence intervals were calculated. Statistical significance was set at P < 0.05.

RESULTS

A total of 28 studies involving 8,047 patients were included. In this cohort, 1,623 patients underwent TOETVA, 5,605 underwent OT, and 819 underwent ABA. The network meta-analysis revealed the following findings: (1) Surgical efficiency: Both OT and ABA were associated with shorter operative times than TOETVA (MD = -73.85 minutes, P < 0.001; MD = -30.59 minutes, P < 0.001). (2) Postoperative recovery: OT was superior to TOETVA in terms of shorter postoperative hospital stay (MD = -0.49 days, P = 0.042) and lower drainage volume (MD = -58.03 mL, P = 0.012), while no significant differences were observed between ABA and TOETVA for these two outcomes. (3) Tumor radicality: No statistically significant differences were found among the three approaches regarding the number of lymph nodes dissected, the number of metastatic lymph nodes, or postoperative recurrence rate. (4) Nerve protection: No differences were observed among the three approaches in terms of temporary or permanent recurrent laryngeal nerve (RLN) injury. However, OT was superior to TOETVA in sensory nerve protection (OR = 0.09, P = 0.010). (5) Parathyroid function: TOETVA was superior to OT in preventing temporary hypoparathyroidism (OR = 0.48, P = 0.023). (6) Other complications: No significant differences were found among the three approaches in terms of bleeding, hematoma, seroma, or infection.

CONCLUSIONS

TOETVA, OT, and ABA all demonstrated safe and reliable clinical efficacy for PTC. TOETVA represents a safe and feasible alternative to OT, offering comparable surgical and oncological outcomes with the added benefits of better parathyroid protection.