Pros and Cons of Transoral Endoscopic Thyroidectomy Via Vestibular Approach: A Comparative Study

Objective: The objective of this study was to explore the feasibility and safety of transoral endoscopic thyroidectomy via vestibular approach (TOETVA) compared with endoscopic thyroidectomy via bilateral areola approach (ETBAA) in the treatment of patients with benign thyroid nodules. Materials and Methods: From January 2017 to December 2018, 60 patients who received TOETVA were enrolled as the research group; 65 patients who underwent ETBAA were included as the control group. A retrospective study was performed using the clinical data for these cases. All patients were diagnosed with benign nodules by preoperative examinations. Parameters including surgical trauma, complications, cosmetic satisfaction, and postoperative discomfort were compared between the 2 groups. Results: All operations were completed without incident. There were significant differences in operation time (137.8 +/- 18.7 vs. 95.7 +/- 17.2 min), intraoperative blood loss (16.8 +/- 9.1 vs. 24.6 +/- 16.6 mL), drainage volume (123.1 +/- 20.9 vs. 153.6 +/- 40.2 mL), C-reactive protein level (7.2 +/- 5.2 vs. 9.0 +/- 4.7 mg/L), drainage time (3.2 +/- 0.6 vs. 3.9 +/- 1.3 d), postoperative hospital stay (3.3 +/- 0.8 vs. 4.1 +/- 1.5 d), and sense of skin tension on the neck (0% vs. 10.8%) between the TOETVA and ETBAA groups (P<0.05). There were no significant differences in pain score, incidence of recurrent laryngeal nerve injury, transient hypoparathyroidism, infection, inadvertent parathyroidectomy, or swallow discomfort between the 2 groups. The cosmetic satisfaction score in the TOETVA group was significantly higher than that in the ETBAA group at 1 month after surgery (9.8 +/- 0.5 vs. 9.4 +/- 0.9, P<0.05), but at 3 months after the operation, the difference was not statistically significant. Conclusions: TOETVA was accompanied by less surgical trauma and skin tension on the neck than ETBAA, and the cosmetic effect of this approach was better than that of ETBAA in the early postoperative period. TOETVA for benign thyroid nodules is safe and feasible. However, there are disadvantages with TOETVA, such as a long surgical period. More cases and further research are needed to delve further into this approach.