Non-recurrent laryngeal nerve identified during endoscopic thyroidectomy using the breast approach

Conventional open surgery (OP) is effective and simple for treating papillary thyroid cancer (PTC), but the excessive separation of band strap muscles causes discomfort in the anterior cervical region and a long scar, which may impair the patient's life quality and beauty. Gasless endoscopic surgery via subclavicular approach (ESSA) may provide a better alternative. The prospective data of 90 PTC patients who underwent ESSA or OP (45:45) in hemithyroidectomy and central neck dissection (CND) in our center from March 2022 to August 2023 were analyzed. Safety indicator incidence of complications, efficiency indicator No. lymph nodes (LNs) of CND, postoperative recurrence of central neck LNs indicated by Ultrasound (US) at 6 months, postoperative functions of the anterior cervical region and cosmetic satisfaction were recorded as the primary endpoints. The ESSA group had no significant differences with the OP group in baseline data, complications, No. LNs (9.04 ± 4.58 vs. 9.87 ± 4.89, p = 0.413) and metastatic LNs (1.60 ± 2.79 vs.1.69 ± 2.50, p = 0.874) of CND. The two groups had no postoperative recurrence of central neck LNs indicated by ultrasound (US) at 6 months. The ESSA group exhibited better functionally sensitive and motional outcomes in the anterior cervical region compared to the OP group (P = 0.0217 and P = 0.008), and had higher cosmetic satisfaction than the OP group (P < 0.001). Compared with OP, ESSA is equally safe and effective, but more cosmetic and conducive to preserving functions of the anterior cervical region. ESSA can be considered an alternative approach to OP in hemithyroidectomy and CND.

Robotic and endoscopic thyroidectomy have increasingly been performed for patients with differentiated thyroid cancer (DTC). However, the advantages of robotic surgery over endoscopic surgery remain enigmatic, hence, the controversy about which is the optimal minimally-invasive surgery is hotly debated. This study compared the surgical outcomes and health-related quality of life (HRQOL) between robotic and endoscopic thyroidectomy in DTC patients. This study included 1,476 DTC patients, divided into endoscopic (n=698) and robotic groups (n=778). The patients were further subdivided into those undergoing total thyroidectomy (TT) and thyroid lobectomy (TL). Considering the differences in baseline characteristics among patients undergoing TL, propensity score matching (PSM) was performed. Intraoperative outcomes, postoperative outcomes, follow-up results, and HRQOL were compared between the two groups. The operation time was longer in the endoscopic group compared to the robotic group for both TT and TL (P < 0.05). The robotic group also had a higher number of dissected lymph nodes, lower incidence of parathyroid gland mis-resection, and smaller changes in parathyroid hormone levels (P < 0.05). For TT patients, the robotic group exhibited a lower incidence of transient and permanent hypoparathyroidism (P < 0.05). Over 32months of follow-up, there was a significant difference in postoperative serum thyroglobulin levels (1.70±3.50 vs 0.35±1.81, P < 0.001). One patient in the robotic group developed lung metastasis, while four experienced local or regional recurrence in the endoscopic group. Patients undergoing robotic TT reported significantly better thyroid cancer-specific QOL and less fear of disease progression compared to those undergoing endoscopic TT. Robotic thyroidectomy offers significant advantages for DTC patients over endoscopic thyroidectomy, particularly in TT procedures.

ObjectiveThis study aims to assess treatment preferences among newly diagnosed low-risk papillary thyroid microcarcinoma (PTMC) patients and analyse the trade-offs they make in treatment decisions.DesignCross-sectional study.MethodsConducted at the Fourth Affiliated Hospital of Harbin Medical University from June 2023 to April 2024, this study employed a discrete choice experiment. Participants were asked to choose among three treatment options with varying levels across seven attributes. A mixed logit model was used to analyse patient preferences, calculate the relative importance (RI) of attributes, and estimate marginal willingness to pay (mWTP). Subgroup analyses were also performed.ResultsThe final sample of 418 participants yielded 11,286 observations. The most influential attribute affecting treatment choice was the 10-year risk of disease recurrence or progression (RI = 58.4%), followed by the risk of short-term complications (RI = 8.9%), treatment type (RI = 8.5%), length of hospital stay (RI = 7.7%), need for lifelong thyroid medication (RI = 7.3%), and out-of-pocket treatment costs (RI = 6.9%). The risk of permanent voice change had minimal impact (RI = 2.4%). Regarding treatment type, participants significantly preferred thermal ablation over open surgery, while endoscopic thyroidectomy was less preferred, and active surveillance was the least favoured option. The mWTP analysis reinforced these priorities. Additionally, sociodemographic and psychological factors also influenced preferences.ConclusionThese findings highlight the need for healthcare providers to clearly communicate the long-term impacts of different treatment options to support informed decision-making. They also underscore the importance of improving patient-centred care, enhancing health education, and addressing the issue of overtreatment in PTMC.

Background Preclinical training is essential for thermal ablation (TA) of thyroid nodules; however, there is a lack of optimal simulators. We aimed to create a training model for TA using live pigs, followed by neck surgery. Methods We recruited trainees from across China to participate in a workshop that included TA practice and subsequent transoral endoscopic thyroidectomy. The operative performance of trainees and any complications were documented. Following the workshop, participants completed online questionnaires using a 1–5 Likert Scale to evaluate their subjective experiences. The costs associated with the training were meticulously calculated. Results Five pigs were utilized for the workshop. Eighteen trainees and six mentors from seventeen institutions participated in the study. Seventeen trainees (94.4%; 95% CI, 74.2–99.0) successfully visualized the needle tips within the thyroid gland, while one was unsuccessful. Two trainees (11.1%; 95% CI, 2.0–30.8) experienced trachea injury during the subsequent thyroidectomy assessment. No cases of recurrent laryngeal nerve (RLN) injury were reported, as evaluated by neuromonitoring. Participants rated their operational experience with a score of 3.33 ± 1.05 compared to human procedures. Excluding labor costs, the average expense for each trainee for TA training was 50.4 ± 4.0 euros. Conclusions This study presents a cost-effective porcine training model for TA followed by neck surgery. The model provided a realistic simulation of human procedures and enabled immediate assessment of structural injuries, demonstrating its potential for use in TA training prior to human procedures.

Outcomes in Surgical Management of Graves' Disease: Transcervical Versus Transoral Thyroidectomy.

This study aims to comprehensively evaluate surgical efficiency and quality of life (QoL) differences among Conventional open thyroidectomy (COT), gasless endoscopic thyroidectomy trans-axillary approach (GETTA), transoral endoscopic thyroidectomy vestibular approach (TOETVA), and endoscopic thyroidectomy via bilateral-areolar approach (ETBAA) in T1 papillary thyroid carcinoma (T1-PTC) patients. Prospective observational cohort study. Tertiary academic center. 463 female patients with T1-PTC were stratified into four cohorts: GETTA (n = 122), TOETVA (n = 108), COT (n = 128), and ETBAA (n = 105). Perioperative time periods were divided into five parts for analysis. Level VI lymph node dissection was routinely performed, and the yield is reported. QoL was assessed using Voice Impairment Score (VIS), Swallowing Impairment Score (SIS), Scar Cosmesis Assessment and Rating (SCAR-Q), European Organization for Research and Treatment of Cancer QoL Questionnaire-Core 30 (EORTC QLQ-C30), and Symptom Checklist-90 (SCL-90). Longitudinal QoL trends were evaluated during postoperative recovery. Significant intergroup disparities were observed in surgical efficiency (P < 0.001); COT demonstrated superior time efficiency. All cohorts experienced transient postoperative QoL declines, with endoscopic groups showing accelerated recovery trajectories in physical, psychological, and cosmetic domains (P < 0.001). Four techniques are safe and effective. COT remains the most time-efficient approach, while TOETVA excels in cosmesis. GETTA and ETBAA offer intermediate advantages, combining reasonable efficiency with enhanced recovery profiles. Clinical decision-making should prioritize patient-specific factors, including cosmetic preferences and recovery priorities.

ObjectiveTo evaluate the clinical and oncological outcomes of transoral endoscopic thyroidectomy via the vestibular approach (TOETVA) in the management of pediatric patients with benign and malignant thyroid lesions in Vietnam.MethodsA cross-sectional study was performed on pediatric patients (≤18 years old) who underwent TOETVA for thyroid cancer and benign thyroid nodules between August 2019 to September 2024.ResultsOf the 28 patients included in the study, 23 were female (82.1%), and 5 were male (17.9%) with a mean age of 15.86±2.45 years. Mean tumor size on ultrasound was 19.47±13.63 mm. TOETVA was completed successfully in all cases. Postoperative histopathological findings revealed benign lesions in 13 patients, differentiated thyroid carcinoma in 14 patients and non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) in one patient; central neck dissection (CND) was performed in 15 patients; nine of them had occult lymph node metastasis. Postoperative complications included transient hypoparathyroidism (3.6%) and vocal cord palsy (7.1%), all of which resolved. No permanent complications or recurrences were observed over a median follow-up of 26.5 months.ConclusionsTOETVA appears feasible for the treatment of thyroid nodules in children. However, larger prospective studies are needed to confirm these findings.

Minimally invasive thyroid surgery offers cosmetic benefits over traditional approaches, but mental nerve injury risk affecting the chin and lower lip persists. Transoral endoscopic thyroidectomy within a defined safety zone is a scarless alternative that may cause transient sensory changes. In this prospective observational study, 77 patients with benign thyroid conditions were enrolled; after exclusions, 37 underwent transoral endoscopic thyroidectomy and 40 underwent conventional transcutaneous thyroidectomy. Baseline chin and lower lip sensation was quantified preoperatively and postoperatively at 1week, 1month, and 2months using a monofilament evaluator, measuring the area of sensory deficit at 1mm intervals. The conventional group served as a control, as this approach is not associated with mental nerve injury. Baseline sensation was normal in both groups. The mean patient age was 32.5 ± 8.9years (53% female). Operative times were significantly longer in the transoral group. All 37 transoral patients experienced transient sensory disturbances immediately postoperatively. The area of sensory deficit decreased at 1 and 2months compared with 1week (p = 0.028), and 5 of 37 patients achieved complete recovery by 2months, while the remaining patients demonstrated progressive reduction in affected area. No sensory changes occurred in the conventional group at any time point. Transoral endoscopic thyroidectomy within a defined safety zone induces early transient sensory disturbances that improves or resolves by 2months postoperatively. These findings support its use as a safe, cosmetically superior alternative to conventional thyroidectomy, with minimal long-term compromise to mental nerve integrity.

Improved outcomes with chest-breast endoscopic thyroidectomy in early-stage thyroid carcinoma

This cross-sectional study analyzed 218 patients diagnosed with cT1N0M0 papillary thyroid carcinoma (PTC) who underwent transoral endoscopic thyroidectomy vestibular approach (TOETVA) at Hanoi Medical University Hospital between January 2020 and December 2023. Patients were classified into two groups based on postoperative pathology: those with occult cervical lymph node metastasis (oCLNM+) and those without (oCLNM−). The mean patient age was 35.3 years, and the majority were female (96.8%). Tumors had a mean size of 6.9mm, were primarily located in a single lobe (87.2%), and were multifocal in 13.8% of cases. Occult lymph node metastasis was identified in 41.3% of patients. Statistical analysis revealed that tumor size greater than 5.5mm and multifocality were significant predictors of oCLNM, with odds ratios of 2.4 (p = 0.028) and higher likelihood of nodal involvement. The median number of harvested lymph nodes was 4 (range: 0 – 22), and the median number of metastatic nodes was 0 (range: 0 – 17). These findings suggest that, even in patients with a clinically negative neck (cN0), there remains a considerable risk of occult lymph node metastases, especially in cases with multifocal tumors and primary tumor size exceeding 5.5mm.

Thyroid nodules are relatively common, with a high incidence rate among adults, particularly women. With the widespread application of ultrasound imaging technology, the detection rate of thyroid nodules has significantly increased. However, traditional open surgery can lead to significant scar formation and potential thyroid dysfunction. Therefore, minimally invasive techniques that preserve thyroid function and aesthetic appearance are increasingly important. A 51-year-old Han Chinese female patient had nodules in both thyroid glands (right side C-TIRADS 4A, left side C-TIRADS 3). The patient was placed in a supine position with the neck extended ("human" position). Following ultrasound guidance, a localization needle was precisely marked at the nodule in the left lower pole, with the needle tip positioned at the deep margin of the lesion. The needle tail was secured to the skin with sterile tape. Trocar incisions were made at the margins of both areolas and the right upper outer quadrant. Carbon dioxide was insufflated to 6mmHg to create the surgical space. The right thyroid lobe and isthmus were completely resected; subsequently, the surgeon shifted to the left thyroid lobe, identified the preplaced localization needle via endoscopy, and traced it to the nodule at the left lower pole. A circular dissection was performed around the needle tip with a 0.5-cm margin of normal tissue, precisely resecting the nodule. The localization needle enabled real-time, targeted resection under intraoperative guidance. Combining ultrasound-guided localization needles with endoscopic thyroidectomy via the trans-breast approach offers a minimally invasive surgical option that preserves thyroid function and aesthetics while enabling precise resection of thyroid nodules, minimizing damage to normal tissue, and improving patient outcomes. This surgical method holds great potential in the field of thyroid surgery, achieving a balance between radical resection and functional preservation. Highlights 1. Precision-guided minimally invasive surgery: this study introduces an innovative integration of ultrasound-guided needle localization with endoscopic thyroidectomy via the areola approach, achieving highly precise resection of thyroid nodules. The method significantly improves surgical accuracy, especially for small or nonpalpable nodules located deep within the thyroid gland. 2. Function-preserving surgical strategy: by restricting the resection margin to only 0.5cm beyond the lesion, the technique maximizes preservation of normal thyroid tissue. Consequently, the patient maintained relatively stable postoperative thyroid function, requiring only minimal hormone replacement therapy. 3. Excellent cosmetic and clinical outcomes: the areola-based access route provided a scar-free aesthetic result, while the patient recovered smoothly without complications such as hoarseness or hypocalcemia. The procedure was completed in a reasonable duration with minimal blood loss, underscoring both the safety and efficiency of the approach. 4. Pathological and functional validation: postoperative pathology confirmed complete resection of a papillary thyroid carcinoma in the right lobe and a noninvasive follicular thyroid neoplasm in the left lobe. No residual disease was detected, and subsequent thyroid function tests validated the success of the tissue-preserving strategy. This case highlights a promising advancement in thyroid surgery by merging technological precision with functional and cosmetic priorities. It underscores the potential for broader clinical adoption of approaches that balance oncologic safety with quality-of-life outcomes.

The increasing incidence of thyroid tumors, combined with patients’ growing emphasis on cosmetic outcomes, has fueled advancements in endoscopic thyroidectomy techniques. This study aims to evaluate the safety, feasibility, and aesthetic outcomes of trans-submental endoscopic thyroidectomy (TSET), a novel approach designed to overcome the limitations of the oral vestibular route. Clinical data from 95 patients who underwent TSET at our institution between May 2022 and December 2024 were retrospectively analyzed. Inclusion criteria were benign thyroid nodules ≤ 4 cm or papillary thyroid carcinoma (PTC) ≤ 3 cm without lateral neck or distant metastasis. Surgical outcomes, complications, and patient satisfaction were systematically assessed. Of the 96 patients initially enrolled, one required conversion to open thyroidectomy due to intraoperative bleeding. The remaining 95 patients successfully completed TSET, including 48 unilateral partial thyroidectomies, 6 bilateral partial thyroidectomies, 38 lobectomies with unilateral central neck dissection (UCND), and 3 total thyroidectomies with UCND. The mean operative time was 158.3 ± 40.1 min. No permanent complications, such as recurrent laryngeal nerve (RLN) injury or hypoparathyroidism, were observed. Transient RLN palsy occurred in 2 patients and resolved with conservative management. Aesthetic outcomes were highly satisfactory, with hidden submental scars and no postoperative infections reported. During the follow-up period (mean: 14.0 ± 7.7 months), no tumor recurrence was observed. TSET is a safe and feasible surgical approach with good cosmetic results and shows promising development prospects.

Transoral thyroidectomy, including transoral endoscopic thyroidectomy vestibular approach (TOETVA) and transoral robotic thyroidectomy (TORT), offers cosmetic advantages over conventional open thyroidectomy (OT). However, few studies have directly compared these three approaches in a single analysis. We evaluated the oncological adequacy and perioperative outcomes of OT, TOETVA, and TORT for papillary thyroid carcinoma using propensity score matching (PSM). We retrospectively reviewed 819 consecutive patients who underwent OT (n = 559), TOETVA (n = 128), or TORT (n = 132) between 2016 and 2023. PSM was performed using 10 baseline clinicopathological variables to create three balanced cohorts (n = 124 each). The outcomes included central lymph node (LN) yield, complications, operative time, postoperative pain, hospital stay, and thyroglobulin and radioactive iodine (RAI) parameters. After matching, OT and TORT achieved similar central LN yields (7.1 ± 5.4 vs. 6.9 ± 2.9), both significantly higher than TOETVA (4.8 ± 2.8; p < 0.001). Hospital stay was shortest in the OT group (2.8 ± 1.7 days), intermediate in the TORT group (3.3 ± 0.7), and longest in the TOETVA group (4.0 ± 1.9; p < 0.001). Operation-day pain was lowest in the OT group (2.6 ± 0.5), intermediate in the TORT group (3.2 ± 0.9), and highest in the TOETVA group (3.8 ± 0.9; p < 0.001). Transient vocal cord palsy occurred least frequently in the TORT group (1.6%), followed by the TOETVA (7.3%) and OT (8.1%) groups (p = 0.056). The rates of permanent palsy and hypocalcemia were similar between the groups. The operative time was significantly longer in the TORT group than in the OT or TOETVA groups. Thyroglobulin levels and RAI parameters did not differ significantly between the groups. Both transoral approaches were safe and feasible. TORT achieved oncologic adequacy comparable to that of OT while providing scarless benefits despite prolonged operative time. TOETVA was feasible but was associated with a low LN yield. The choice of the surgical approach should be individualized according to oncological adequacy, recovery, and cosmetic preferences.

Inadvertent excision of parathyroid glands (PTGs) during thyroidectomy remains a common and significant surgical complication, potentially leading to hypoparathyroidism. While near-infrared autofluorescence (NIRAF) imaging enhances intraoperative PTG identification, its specificity and real-world diagnostic accuracy remain uncertain. To evaluate the diagnostic accuracy of NIRAF imaging in identifying inadvertently excised PTGs in thyroidectomy specimens and to assess the added value of intraoperative tissue parathyroid hormone (PTH) washout testing. This was a prospective diagnostic accuracy study conducted at a university hospital between 28 February 2024, and 28 February 2025. Consecutive adult patients undergoing conventional or endoscopic thyroidectomy were included. NIRAF imaging was performed on all excised thyroid lobes prior to pathological examination. Autofluorescent (AF)-positive areas were assessed using intraoperative tissue PTH washout testing, with histopathology serving as the reference standard. The primary outcome was the diagnostic performance (sensitivity, specificity, positive predictive value [PPV], and negative predictive value [NPV]) of NIRAF imaging for identifying parathyroid tissue. Secondary outcomes included inadvertent parathyroid excision rate and diagnostic accuracy of the tissue PTH washout test. Among 672 patients (mean age, 46.8years; 82.7% female), 1,144 thyroid lobes were examined, yielding 224 AF-positive areas. Of these, 197 had PTH ≥100pg/mL and were confirmed as PTGs; 27 had PTH <100pg/mL, of which 2 were confirmed as PTGs on histopathology. The sensitivity and specificity of NIRAF imaging were 100.0% (95% CI, 98.1%-100.0%) and 97.9% (95% CI, 96.7%-98.7%), respectively; PPV was 88.8% and NPV was 100.0%. The inadvertent parathyroid excision rate was 8.7% (199/2,288). The tissue PTH washout test showed 99.1% overall diagnostic accuracy (95% CI, 97.3%-99.8%), with sensitivity 99.0% (95% CI, 96.2%-99.9%), specificity 100.0% (95% CI, 86.3%-100.0%), PPV 100.0% (95% CI, 98.1%-100.0%), and NPV 92.6% (95% CI, 75.7%-98.9%). NIRAF imaging is highly sensitive for detecting inadvertently excised parathyroid glands, but false-positive signals from non-parathyroid tissues limit its specificity. Combining NIRAF with intraoperative tissue PTH measurement can improve diagnostic accuracy and guide timely autotransplantation. Further studies are needed to refine tissue PTH thresholds and validate broader clinical applicability.

BackgroundTransoral Endoscopic Thyroidectomy via Vestibular Approach (TOETVA) offers a scar-free alternative for thyroid surgery. Traditionally, drains are used to prevent hematoma, seroma, and infection, yet the need for routine drain placement in TOETVA remains uncertain.MethodsWe conducted a retrospective cohort study of TOETVA patients from August 2021 to September 2024 at a single tertiary center. Patients were divided into drain and non-drain groups. All patients underwent unilateral TOETVA, with or without central lymph node dissection. Key outcomes included operative time, postoperative pain, hospital stay, and complications. Propensity score matching (PSM) was applied to minimize selection bias. Statistical significance was set at p < 0.05.ResultsA total of 408 TOETVA patients were included, with 214 in the drain group and 194 in the non-drain group. After PSM, 174 matched pairs were analyzed. Operative time, pain scores, hematoma, seroma, and infection rates were comparable between groups. However, the non-drain group had a significantly shorter hospital stay (3.38 ± 0.94 vs. 4.37 ± 1.02 days, p < 0.001). No significant differences in hospitalization costs were observed.ConclusionRoutine drain placement may not be necessary in TOETVA patients, as omission of drains did not increase complication rates and was associated with shorter hospitalization in our cohort. Prospective multicenter studies are required to validate the optimal criteria for selective drain use.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12893-025-03310-z.

Endoscopic thyroidectomy (ET) avoids larger neck incisions. It offers superior cosmetic outcomes and improves patient satisfaction. However, the effect of ET on quality of life (QoL) remains incompletely investigated. This study was therefore designed to compare QoL and key surgical outcomes between ET and conventional open thyroidectomy (OT) in patients diagnosed with papillary thyroid carcinoma. This retrospective analysis enrolled 667 patients with papillary thyroid carcinoma who underwent thyroidectomy. To mitigate potential confounding factors, propensity score matching was applied, resulting in a final cohort of 44 ET patients and 66 OT patients for comparative analysis. The SF-36 and thyroid surgery-specific questionnaires were used to assess QoL, overall satisfaction, surgical and cosmetic outcomes at 15, 30, and 60 days postoperatively. Patients in the ET group generally exhibited higher SF-36 QoL scores than those in the OT group across several parameters. Thyroid surgery-specific questionnaires indicated lower swallowing discomfort in the ET group (P < .05). Significant differences were observed in operating time (P < .001), cosmetic outcomes (P < .001), hospital costs (P < .001), and overall satisfaction (P < .001). The ET group included a higher proportion of higher educated individuals (P < .05). No significant intergroup differences were observed in terms of postoperative drainage, visual analogue scale pain scores, length of hospital stay, or complication rates. ET offers comparable safety to OT, along with superior QoL and cosmetic outcomes, making it a viable alternative for both patients and surgeons.

BackgroundThe impact of pectoralis major fascia (PMF) preservation during endoscopic thyroidectomy (ET) via axillary approach on postoperative recovery remains poorly understood. This study aimed to compare the quality of life (QoL) and shoulder function between patients with and without PMF preservation intraoperatively.MethodsA total of 77 patients were enrolled, including 39 cases with the PMF preservation (Group A) and 38 cases without (Group B). Postoperatively QoL and shoulder joint function were assessed at 1month, 3 months, and 6 months using Thyroid Cancer-Specific Quality of Life (THYCA-QoL) questionnaire and American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) questionnaire, respectively.ResultsThe median follow-up time was 7.55 ± 1.36 months across all cases. Intraoperatively, Group A exhibited significantly lower total drainage volume than Group B (p <0.001). During postoperative follow-up, while THYCA-QoL scores were comparable at 1 and 6 months, Group A demonstrated superior neuromuscular (p = 0.03), sympathetic (p = 0.01), and sensory (p = 0.01) recovery at 6 months. ASES scores revealed no differences at 1 month, however, by 3 months, Group A achieved higher total scores (p = 0.02). At 6 months, Group A outperformed Group B in total ASES score (p < 0.001), pain (p = 0.04), and function (p < 0.001).ConclusionPreserving the PMF during ET via an axillary approach can improve QoL, reduce bleeding, enhance long-term sensory and shoulder functional recovery, suggesting that the protection of PMF might have a positive impact on the postoperative patient recovery.

Abstract Transoral endoscopic thyroidectomy via vestibular approach (TOETVA) is a novel, minimally invasive, and cosmetically ideal procedure, with less postoperative pain and rapid recovery. The approach is performed through a natural orifice using three ports in the buccal-oral area with subsequent dissection to the sternal notch and the edges of the sternocleidomastoid muscles. The first case of TOETVA is presented at the General Hospital of Puebla “Dr. Eduardo Vázquez N.”, a 38-year-old female with left Anestesia en México 2025; Volumen 37 (3) : 300-304 septiembre-diciembre 301 thyroid nodule TIRADS IV; the anesthetic implications of the surgical technique are described; Anesthetic management begins with preoperative evaluation, requiring a euthyroid state before surgery. The technique of choice is balanced general or total intravenous anesthesia; it is considered essential to ensure adequate anesthetic depth and an optimal level of muscle relaxation. Transanesthetic care does not differ from other minimally invasive thyroid surgical techniques. Palabras claves: Transoral thyroidectomy, anesthetic management, carbon dioxide.

BackgroundConventional open thyroidectomy (COT) results in visible neck scarring. Transaxillary endoscopic thyroidectomy (TET) comprises gasless (suspension-assisted) and gas-inflated approaches, both of which offer superior scar concealment. This study aimed to compare the efficacy and safety of these two endoscopic techniques for treating papillary thyroid carcinoma (PTC).MethodsA total of 471 patients were stratified into three groups: gasless transaxillary endoscopic thyroidectomy (GTET), gas-inflated transaxillary endoscopic thyroidectomy (GITET), and COT. Comparative analyses included perioperative outcomes, complication rates, cosmetic satisfaction and others. The cumulative sum (CUSUM) curve was applied to evaluate the learning curves of GTET and GITET.ResultsPatients in the TET groups were younger and included a higher proportion of females compared to COT. The COT group demonstrated advantages in operation time, postoperative drainage volume, and the number of retrieved central lymph nodes over TET groups. No significant differences were observed among the three groups in postoperative complication rates or sensory abnormalities. However, the COT group had higher swallowing-discomfort incidence. In terms of cosmetic outcomes, GITET surpassed GTET, with lower postoperative pain scores. The learning curves for both GTET and GITET were biphasic, achieving mastery after 42 and 67 cases respectively. No significant difference was found in the efficacy of central lymph node dissection between the two endoscopic approaches.ConclusionBoth GTET and GITET were reliable and safe surgical approaches, with reduced postoperative swallowing discomfort compared to COT. While GITET offered superior cosmetic outcomes and lower postoperative pain scores than GTET, achieving technical proficiency required more cases.