Comparative outcomes of robotic and endoscopic transoral thyroidectomy in a 2,144-patient multicenter cohort.

Abstract

Transoral thyroidectomy is an established remote-access alternative to open thyroidectomy, performed mainly as the transoral endoscopic thyroidectomy vestibular approach or transoral robotic thyroidectomy. Their comparative safety and oncologic performance remain under investigation. This retrospective multicenter study included 2,144 patients who underwent transoral thyroidectomy at 4 high-volume centers between January 2017 and May 2024 (546 transoral endoscopic thyroidectomy vestibular approach, 1,598 transoral robotic thyroidectomy). Patient, operative, complication, and oncologic outcomes were compared. Total thyroidectomy was performed in 205 patients (9.6%), unilateral lobectomy or isthmectomy was performed in 1,774 (82.8%) patients, and subtotal/completion thyroidectomy was performed in the remaining patients. The mean operative time was longer for transoral robotic thyroidectomy than for transoral endoscopic thyroidectomy vestibular approach (167.5 ± 42.5 vs 121.3 ± 37.2 minutes; P < .001), whereas the postoperative hospital stay was shorter (2.5 ± 0.8 vs 3.5 ± 1.7 days; P < .001). Transient hypoparathyroidism occurred in 12 of 546 patients (2.2%) in the transoral endoscopic thyroidectomy vestibular approach group and 2 of 1,598 (0.1%) in the transoral robotic thyroidectomy group (P = .002). Transient recurrent laryngeal nerve palsy occurred in 24 transoral endoscopic thyroidectomy vestibular approach patients (4.4%) and 5 transoral robotic thyroidectomy patients (0.3%; P < .001). Mental nerve injury was more frequent after transoral endoscopic thyroidectomy vestibular approach (1.1% vs 0.2%; P = .005). No conversions or perioperative deaths occurred. At a mean 40-month follow-up, locoregional recurrence was observed in 9 patients (0.4%) with no disease-specific mortality. Both transoral endoscopic thyroidectomy vestibular approach and transoral robotic thyroidectomy are safe, feasible, and oncologically sound in appropriately selected patients. Transoral robotic thyroidectomy offers lower rates of nerve injury and hypoparathyroidism and may be preferred for more complex cases, whereas the transoral endoscopic thyroidectomy vestibular approach remains an effective scarless option for benign and low-risk malignancies.