A decade experiences of transoral endoscopic thyroidectomy vestibular approach (TOETVA) compared to open thyroidectomy: A comparative analysis of outcomes and complications

Transoral endoscopic thyroidectomy via the vestibular approach (TOETVA) is an increasingly adopted scarless technique for benign thyroid nodules, offering distinct cosmetic advantages. This study compared TOETVA with conventional open thyroidectomy (OT) regarding safety, operative performance, and postoperative outcomes. A retrospective cohort study was conducted at Mahasarakham Hospital, Thailand (January 2015–January 2025). A total of 286 patients were evaluated: 142 underwent TOETVA and 144 underwent OT. Demographic data, operative parameters, postoperative pain scores, and complications were analyzed. Continuous variables were assessed using independent t-tests, and categorical variables using Pearson's chi-square or Fisher's exact tests. Statistical significance was set at P < 0.05. TOETVA was associated with significantly longer operative duration (102.96 ± 16.51 vs. 76.72 ± 11.23 min; P < 0.001) but slightly reduced intraoperative blood loss (25.43 ± 11.28 vs. 28.02 ± 9.34 ml; P = 0.035). Postoperative pain scores over 72 h were markedly lower in the TOETVA group (1.13 ± 0.41) compared with OT (2.94 ± 0.32; P < 0.001). Rates of transient recurrent laryngeal nerve palsy, transient hypocalcemia, and subcutaneous emphysema were comparable, and no permanent complications occurred in either cohort. TOETVA is a safe, effective, and cosmetically superior alternative for benign thyroid disease. Despite a longer operative duration, it confers substantially lower postoperative pain and maintains complication rates equivalent to OT. These findings support TOETVA as a reliable, truly scarless option with favorable outcomes even early in the learning curve.