Transoral endoscopic thyroidectomy vestibular approach versus open thyroidectomy in surgical resection of the thyroid: a systematic review and meta-analysis

Background: The increasing incidence of thyroid nodules and thyroid cancer, particularly among women, has driven the evolution of minimally invasive thyroidectomy techniques. The transoral endoscopic thyroidectomy vestibular approach (TOETVA) has emerged as a promising alternative to conventional open thyroidectomy (OT). This study aimed to compare operative time, blood loss, drainage volume, lymph node yield, and postoperative complications between TOETVA and OT. Methods: A comprehensive search was conducted across PubMed, Embase, ClinicalTrials.gov, and Web of Science. Randomized controlled trials, cohort studies, and retrospective studies comparing TOETVA and OT were included. Statistical analysis was performed using RevMan version 5.3. Standardized mean differences and odds ratios with 95% confidence intervals were calculated. A P -value of <0.05 was considered statistically significant. Results: A total of 22 studies involving 4397 patients were included. TOETVA was associated with a significantly longer operative time and higher drainage volume. However, no significant differences were observed in blood loss, number of retrieved central lymph nodes, metastatic lymph node yield, recurrent laryngeal nerve palsy, seroma formation, or wound infection. Conclusion: TOETVA represents a safe and feasible alternative to OT, offering comparable surgical and oncological outcomes with the added benefit of superior cosmetic results.