Minimally invasive thyroid surgery: a narrative review

Background and Objective: Minimally invasive thyroid surgery has emerged as an alternative to conventional open thyroidectomy, aiming to reduce surgical trauma, improve cosmetic outcomes, and enhance postoperative recovery. Among these techniques, the transoral endoscopic thyroidectomy vestibular approach (TOETVA) has gained popularity due to its scarless nature and potential to improve patient satisfaction. However, despite growing adoption, there are concerns regarding its technical complexity, limited working space, and the potential for intraoperative complications. This narrative review aims to summarize the current literature regarding minimally invasive thyroid surgery, with a particular focus on TOETVA, emphasizing its safety, feasibility, and role in improving cosmetic outcomes while highlighting the need for proper patient selection and further evidence on oncological safety. Methods: An extensive literature review was performed to identify relevant articles on minimally invasive thyroid surgery and TOETVA. Databases including PubMed, ScienceDirect, and Springer Link were searched from inception until 2025 using specific keywords and including articles written in English, which were screened based on relevance and content quality. Key Content and Findings: Our review demonstrated that minimally invasive thyroid surgery, particularly TOETVA, offers favorable cosmetic outcomes and patient satisfaction with comparable safety profiles to conventional thyroidectomy. However, intraoperative complications such as bleeding and recurrent laryngeal nerve injury pose significant challenges due to the limited operative field. Furthermore, evidence regarding oncological safety remains limited to small case series, necessitating further research to establish long-term oncological outcomes. Conclusions: Minimally invasive thyroid surgery represents an alternative to conventional open thyroidectomy, offering superior cosmetic outcomes and high patient satisfaction. However, its widespread adoption should be approached with caution, emphasizing careful patient selection and ensuring adequate surgical expertise. Large-scale studies and long-term oncological outcome data are needed to further clarify the role of TOETVA in thyroid disease management.