The transoral endoscopic thyroidectomy vestibular approach (TOETVA) can be performed safely while avoiding any skin incision and with outcomes similar to those of open thyroidectomy (OT) in select patients, according to a study published in JAMA Surgery.
The investigators retrospectively reviewed the medical records for all TOETVA and OT operations performed from April 1, 2014 to August 31, 2016 from a single center in Thailand to compare operative time, blood loss, and complications related to thyroid surgery. A total of 422 patients successfully underwent TOETVA and 216 patients underwent OT. Baseline characteristics were similar in both groups except that patients in the TOETVA group had smaller mean tumor sizes compared with patients in the OT group (4.1 vs 4.7 cm, respectively; P =.08). The researchers used propensity score matching to reduce confounding factors attributable to patient selection. Compared with the matched OT group, the TOETVA group had a significantly longer operative time (79.4 vs 100.8 minutes, respectively; P =1.61 x 10-10). However, patients in the TOETVA group reported less postoperative pain according to mean visual analog scale scores compared with patients in the OT group (1.1 vs 2.8, respectively; P =2.52 x 10-38). Estimated blood loss and complication rates were similar in both groups.
This is the largest study conducted to date in patients who underwent TOETVA, and the only one to compare outcomes of TOETVA with those of OT. However, limitations of this study include that it was conducted in a single Asian institute with an unbalanced population in both groups and mainly in patients with benign lesions.
“Multicenter, multicountry studies, as well as prospective studies with long-term follow-up, are needed to confirm the safety and effectiveness of TOETVA, especially in patients with thyroid cancer,” concluded the investigators.
Anuwong A, Ketwong K, Jitpratoom P, Sasanakietkul T, Duh QY. Safety and outcomes of the transoral endoscopic thyroidectomy vestibular approach [published online September 6, 2017]. JAMA Surg. doi:10.1001/jamasurg.2017.3366