Tailoring the Message: A Survey of Patients' Information Needs and Preferences Before Transoral Endoscopic Thyroidectomy via the Vestibular Approach.

Abstract

Transoral endoscopic thyroidectomy via the vestibular approach (TOETVA) provides a scarless alternative to open thyroidectomy but entails specific risks, particularly mental nerve injury. How patients weigh these risks against cervical scarring and wound morbidity from open surgery remains unclear. In this prospective cross-sectional study at a high-volume endocrine surgery centre, 68 consecutive TOETVA patients completed pre- and postoperative surveys on informational priorities, risk recall, and satisfaction. To contextualize TOETVA-specific morbidity and the informational trade-offs faced by patients, we prospectively identified a contemporary open thyroidectomy cohort and applied 1:1 nearest-neighbor matching by age, sex, indication, and extent of resection, thereby supporting comparative inferences beyond simple descriptive contrasts. All patients received structured, multimodal counselling with centre-specific numerical risks, and an additional questionnaire assessed how risk information influenced procedure choice and willingness to reconsider preferences under alternative risk scenarios. TOETVA patients rated procedural details, TOETVA-specific risks-particularly mental nerve injury-and general thyroidectomy complications as highly important (≥ 4.7/5), with recall and satisfaction exceeding 90%. In the TOETVA cohort, transient recurrent laryngeal nerve palsy occurred in 7.4% and transient hypocalcaemia in 6.1%, with no permanent events; mental nerve paraesthesia affected 30.9%, persisting at 6 months in 4.4%. Matched open thyroidectomy patients showed comparable transient RLN palsy (5.9%) and hypocalcaemia (6.1%), but had 1.5% permanent RLN palsy, 1.5% permanent hypocalcaemia, no mental nerve injury, and 7.4% cervical wound complications. Overall, 94% of patients considered precise numerical risk estimates essential, and 88% reported that comparative risk information strongly influenced technique choice, with many indicating they would reconsider preferences if rates of persistent mental nerve symptoms or neck-scar morbidity changed. Patients prioritise quantified, centre-specific risk information and use it to balance the cosmetic benefits of TOETVA against mental nerve morbidity and the wound risks of open surgery, supporting routine integration of audited complication rates into shared decision-making.