Transoral Approach Research Articles

Transoral Approach to Parotid Tumors: A Review of the Literature

Different surgical techniques have been proposed for parapharyngeal space tumors, including transcervical, transparotid, trans-mandibular, infratemporal, and transoral. The choice of the correct approach depends on the size, localization and nature of the tumor. The transoral approach can be used for benign prestyloid masses, such as tumors of the deep lobe of the parotid gland. It guarantees a short hospitalization without skin scars. The narrowed access represents the main limitation of this technique. This review will summarize and analyze the current knowledge about the transoral approach to parotid lesions. Thirty-seven studies were included in a qualitative and quantitative synthesis. The novelty of this review is the quantitative analyses of the clinical data reported in the included studies.

Diagnosis and treatment of Schwannoma of the parapharyngeal space on the example of a 14-year-old male patient

The parapharyngeal space is located on the side of the pharynx wall. It is an inverted pyramid-shaped anatomical area filled with adipose and connective tissue. Schwannoma (neurinoma) is a benign tumour that originates from the Schwann cells that form the myelin sheaths of nerves. This neoplasm in the parapharyngeal space usually arises from the vagus nerve and the sympathetic trunk. Parapharyngeal space tumours are often a complicated diagnostic and therapeutic problem. A 14-year-old patient was admitted to the hospital because of a feeling of discomfort in the throat due to a nodular lesion on the right side. The lesion was removed through transoral approach. The patient remains under laryngological and oncological care. In follow-up examinations 6 months and 1 year after surgery, no features of recurrence were revealed. Due to their rare occurrence, non-specific symptoms, and anatomical topography, the diagnostic and therapeutic process of parapharyngeal space tumours is very difficult.

Standardized Intraoperative Neuromonitoring Procedure is Feasible in Transoral Endoscopic Thyroidectomy.

Intraoperative neuromonitoring in thyroid surgeries has become popular, but the standardized manner of intraoperative neuromonitoring during transoral endoscopic thyroidectomy vestibular approach (TOETVA) is not well established. This study evaluated the feasibility of using a standardized intraoperative neuromonitoring method for TOETVA. Medical records of consecutive patients who underwent TOETVA with intraoperative neuromonitoring were retrospectively reviewed. Patients were positioned before intubation to prevent tube migration, then intubated using video laryngoscopy. The electromyography amplitudes of the vagal nerves and the recurrent laryngeal nerves were checked before (V1, R1) and after (V2, R2) thyroid resection. V1 and V2 signals were evaluated using a long ball tip stimulator with a stimulus current of 3mA. R1 and R2 signals were obtained using the stimulus current of 1 to 3mA. Forty-two patients (3 males and 39 females) were included. Lobectomy was performed in 40 patients (95.2%) and total thyroidectomy in 2 (4.8%). Pathologic diagnoses were 30 papillary thyroid carcinomas, 2 follicular thyroid carcinomas, and 9 benign diseases. Conversion to open surgery occurred in 1 patient due to bleeding. Thus, 43 nerves at risk in 41 patients were analyzed. V1 and R1 signals were detected from all nerves. The mean V1 and R1 amplitudes were 738.7±391.4μV and 804.4±347.5μV, respectively, and 38 (88.3%) and 39 (90.7%) nerves had R1 and V1 amplitudes of more than 500μV. There were 2 cases (4.6%) of transient recurrent laryngeal nerve injury. R2 and V2 signals were detected in the 41 remaining nerves. The mean R2 and V2 amplitudes were 917.2±505.2μV and 715.7±356.2μV, respectively, and 36 (87.8%) and 32 (78.0%) nerves had respective R2 and V2 amplitudes of more than 500μV. Intraoperative neuromonitoring could be performed in a standardized manner in TOETVA, and the quality of intraoperative neuromonitoring was excellent. Further studies are needed to verify the feasibility of the current approach.

2022 Canadian Surgery Forum Sept. 15–17, 202201. Operative classification of ventral abdominal hernias: new and practical classification02. Watchful waiting for large primary splenic cysts03. Transversus abdominis plane (TAP) blocks with and without dexamethasone in colorectal surgery04. What factors determine publication of resident research day projects?05. Characterization of near-infrared imaging and indocyanine green use amongst general surgeons06. Variation in opioid prescribing

# 01. Operative classification of ventral abdominal hernias: new and practical classification {#article-title-2} Ventral hernias of the abdomen are defined as a noninguinal, nonhiatal defect in the fascia of the abdominal wall. Unfortunately, there is not currently a universal classification system

Removal of dental implants displaced into the maxillary sinus: a retrospective single-center study

BackgroundThe use of dental implants in the prosthetic rehabilitation of the posterior atrophic maxilla might be a challenge procedure because of low bone quantity and quality. This study aimed to report cases of implant displacement or migration into the maxillary sinus treated from 2008 to 2021.Materials and methodsAll patients with unintentional insertion and/or displacement of dental implants into the maxillary sinus cavity that underwent surgical removal were included. Variables assessed included the patients’ characteristics, past medical history, clinical and radiological findings at presentation, surgical approach (transoral, transnasal, combined), and outcome.ResultsA total of forty patients (23 male, 17 female) underwent surgical removal of dental implant displaced in the maxillary sinus. The mean age was 52,3 + 11,3 years. Seven patients presented with oro-antral fistula (OAF). In 15 cases, an ostium obstruction was diagnosed. Twenty-five patients underwent transoral surgery under local anesthesia. Eleven patients were treated solely via transnasal endoscopic approach, and four patients who had an associated OAF underwent surgery through a combined transnasal and transoral approach. All patients healed uneventfully without complications.ConclusionThese results and recent literature validate that transoral and transnasal approach, or a combination of these procedures, can be used safely to treat complications following displacement/migration of dental implants in the maxillary sinus. Early surgical removal minimizes sinus inflammation and prevents more invasive procedures. Each procedure presents specific indications that must be carefully evaluated prior to treatment choice to optimize intervention outcomes.

Expanding the therapeutic options for Zenker’s diverticulum: from open diverticulectomy to transoral septoplasty

Significant technical changes and a shift toward a transoral approach have occurred in the management of Zenker’s diverticulum over the past three decades. Transoral stapling is already an established and commonly performed procedure. Zenker peroral endoscopic myotomy (Z-POEM) and Zenker peroral endoscopy septotomy (Z-POES) are innovative techniques that are rapidly spreading and replacing more traditional therapeutic options. This review provides an overview of the current status of minimally invasive transoral management to assess whether a tailored approach is feasible and safe and may improve quality of life and reduce recurrence rates.

Endoscopic transoral approach to the lateral poststyloid space.

The lateral poststyloid space (LPSS) located at the posterolateral aspect of the styloid process. This study aims to explore the anatomical relationships in LPSS via a transoral corridor, providing reference for addressing lesions extending to this region. An endoscopic transoral approach for exposure of the LPSS was performed on 6 cadaveric specimens (12 sides). Related landmarks were explored, and transoral extirpation of tumors extended into LPSS was employed in 12 patients. The deep lobe of the parotid gland, extratemporal facial nerve, and the accompanying artery in the LPSS were sufficiently exposed via the transoral corridor in all 12 cadaveric sides. The transoral corridor provided adequate exposure for tumors extending to the LPSS, and en bloc resection was achieved in these 12 patients. No facial nerve or vascular injury occurred, and no recurrence observed in this cohort with an average follow-up of 26 months. An endoscopic transoral approach provides a direct access to the LPSS. Appreciation of the anatomical relationships within the LPSS is valuable for employing a transoral extirpation of tumors extending to this specific region.

Treatment of irreducible atlantoaxial dislocation by bony deformity osteotomy, remodeling, releasing, and plate fixating through transoral approach.

Investigate a novel method for treating irreducible atlantoaxial dislocation (IAAD) or with basilar invagination (BI) by bony deformityosteotomy, remodeling, releasing, and plate fixating through transoral approach. From March 2015 to December 2019, 213 consecutive patients diagnosed as IAAD/BI were treated with transoral bony deformity remodeling and releasing combined with plate fixation. The main clinical symptoms include neck pain, headache, numbness of the limbs, weakness, unstable walking, inflexible hand-held objects, and sphincter dysfunction. The bony factors that impact reduction were divided into as follows: type A1 (sloping of upper facet joint in C2), type A2 (osteophyte in lateral mass joints between C1 and C2), type A3 (ball-and-socket deformity of lateral mass joint), type A4 (vertical interlocking between lateral mass joints of C1-C2), type A5 (regional bone fusion in lateral mass joints), type B1 (bony factor hindering reduction between the atlas-dens gap), type B2 (uncinate odontoid deformity), and type B3 (hypertrophic odontoid deformity). All of them were treated with bony deformity osteotomy,remodeling, and releasing techs. The operation time was 144 [Formula: see text] 25min with blood loss of 102 [Formula: see text] 35ml. The average pre-operative ADI improved from 7.5 [Formula: see text] 3.2mm pre-surgery to 2.5 [Formula: see text] 1.5mm post-surgery (p < 0.05). The average VDI improved from 12.3 [Formula: see text] 4.8mm pre-surgery to 3.3 [Formula: see text] 2.1mm post-surgery (p < 0.05). The average pre-operative CMA improved from 115 [Formula: see text] 25° pre-surgery to 158 [Formula: see text] 21° post-surgery (p < 0.05); the pre-operative CAA changed from 101 [Formula: see text] 28° pre-surgery to 141 [Formula: see text] 10° post-surgery. After the operation, the clinic symptoms improved, and the JOA score improved from 9.3 [Formula: see text] 2.8 pre-operatively to 13.8 [Formula: see text] 2.5 in the sixth months of follow-up. In addition to soft tissue factors, bony obstruction was another important factor impeding atlantoaxial reduction. Transoral bony deformity osteotomy, remodeling, releasingcombined withplate fixating was effective in treating IAAD/BI with bony obstruction factors.

Endoscopic lateral neck dissection via the breast and transoral approaches for papillary thyroid carcinoma: A preliminary report

Complete lymph node dissection is essential for the management of papillary thyroid carcinoma (PTC) with lymph node metastasis (LNM). This work aimed to describe the feasibility of endoscopic lateral neck dissection via the breast and transoral approach (ELNDBTOA) in PTC patients and the necessity of the addition of the transoral approach. We included 13 patients with PTC and suspected lateral LNM who underwent ELNDBTOA at the Zhongshan Hospital, Xiamen University. Total thyroidectomy, ipsilateral central lymph node dissection, and selective neck dissection (levels IIA, IIB, III, and IV) were performed endoscopically via the breast approach. Residual lymph nodes were further dissected via the transoral approach. The mean operation time was 362.1 ± 73.5 min. In the lateral neck compartments, the mean number of retrieved lymph nodes was 36.6 ± 23.8, and the mean number of positive lymph nodes was 6.8 ± 4.7. In further dissection via the transoral approach, lymph nodes in the lateral neck compartment were obtained in nine patients (9/13, 69.2%), and three patients (3/13, 23.1%) had confirmed lateral neck metastases. Transient hypocalcemia occurred in two patients (2/13, 15.4%), and three patients (3/13, 23.1%) developed transient skin numbness in the mandibular area. No other major complications were observed. There was no evidence of local recurrence or distant metastasis during the follow-up period (range, 24-87 months). All patients were satisfied with the good cosmetic outcome. ELNDBTOA is an option with proven feasibility for select PTC patients with LNM, and the addition of the transoral approach is necessary to ensure complete dissection.

An Endoscopic Cap Electrode for Posterior Cricoarythenoid Muscle Stimulation in a Porcine Model.

Laryngeal pacing (LP) is a highly anticipated therapeutic option for patients suffering from bilateral vocal fold paralysis with synkinesis. Identification of candidate patients requires confirmation of a stimulable posterior cricoidarythenoid muscle (PCA) by neuromuscular electrical stimulation (NMES). A silicone endoscopic cap electrode (ECE50) was designed to be operated as an endoscopic extension tip for selective PCA stimulation and confirmation of a glottic opening movement in a setting comparable to a gastroscopy procedure. A porcine animal model (n=6) was applied to develop and test endoscopic cap prototypes in general anesthesia and sedation at a biomedical research center. Two ENT endoscopy experts evaluated and refined the cap design and performance in regard to procedure safety, endoscope handling, accessibility of the PCA by the transoral approach and selective muscle stimulation. Vocal fold opening movements could be evoked by the investigators in 9 of 12 PCA muscles to stimulate with similar electric parameters. The endoscopic approach using the ECE50 proved to be atraumatic and sufficiently controlled under sedation to locate the required hotspot for NMES of the PCA. The functionality of the novel endoscopic cap concept has been proven in a porcine model. It can be expected to be transferable to human application and to be of diagnostic importance in the screening and identification of LP candidate patients in future. NA Laryngoscope, 133:2279-2284, 2023.

Research on pharyngeal bacterial flora in transoral atlantoaxial operation and the postoperative follow-up study

ObjectivesTo study the changes of bacterial flora after a series of preoperative oral disinfection and the postoperative recovery of nerve function of patients with craniovertebral junction disorders who were treated with transoral approach operations.MethodsThis research analyzed 20 cases collected from October 2009 to May 2010. All these patients were with CVJ disorders, including 8 males and 12 females, aged 2 to 66 (38.1 on average), and they were all treated with transoral approach operations. The mucosa samples of the posterior pharyngeal wall were sent for bacteria culture. These samples were collected by sterile cotton swabs at four crucial points, including 3 days before operation/before gargling, 3 days after continuous gargling/after anesthesia intubation on the day of operation, after intraoperative cleaning and washing of the mouth, and after intraoperative iodophor immersion. The microflora was stained by means of smear and further counted after an investigation by microscope. The neural function of patients was evaluated by the ASIA classification and the JOA scores. All patients but two with posterior stabilization performed respectively underwent transoral atlantoaxial reduction plate (TARP) fixation consecutively in the same sitting. A regular reexamination of cervical vertebra with lateral and open mouth X-ray, CT and MRI was conducted after operation to evaluate the reduction of atlantoaxial dislocation, internal fixation position, bone graft fusion, inflammatory lesions and tumor recurrence.ResultsThis bacteriological research showed that the mucosa of the posterior pharyngeal wall of all the patients was in a sterile state after a series of oral preoperative preparations and intraoperative iodophor disinfection, which was considered as type I incision. The bacterial culture results of the mucosa samples of the posterior pharyngeal wall collected at different time points showed significant differences (χ2 = 42.762, P = 0.000). All the patients had improvement in ASIA, and their neural functions were improved to different levels after operation. There was a significant difference in JOA scores before and after operation (t = 8.677, P = 0.000). Postoperative imaging examination showed that the atlantoaxial screw position was good and firm, and the CVJ disorders were treated appropriately.ConclusionIt is safe and effective to cut the posterior pharyngeal muscle layer and implant internal fixation by means of transoral approach.

Microelectrodes and radiofrequency for transoral horizontal supraglottic laryngectomy in T3 tumors.

The aim of this manuscript is to show the surgical technique for horizontal supraglottic laryngectomy in T3 carcinomas by a transoral approach using microelectrodes and radiofrequency. From 2009 to 2020, 11 selected cases of T3 laryngeal supraglottic carcinomas invading the pre-epiglottic space, with preserved vocal cords mobility underwent surgery. The technique is described step by step. Average time duration of the larynx surgery was 95 min. Nine percent of the patients presented a profuse hemorrhage 7 days postoperative; in 73% of patients the nasogastric feeding tube was withdrew 10 days after surgery. We emphasize a remarkable short surgical time and high hemostatic effectiveness. The ME tips allow to perform cuts at angles and contribute with a sense of touch. The low cost of the equipment and its easy handling and maintenance is a remarkable advantage over other technologies for transoral surgery.

Comment on: Evolution of transoral endoscopic thyroidectomy vestibular approach according to the IDEAL framework.

Comment on: Evolution of transoral endoscopic thyroidectomy vestibular approach according to the IDEAL framework.

Feasibility of transoral robotic selective neck dissection with or without a postauricular incision for papillary thyroid carcinoma: A pilot study.

BackgroundThe study aimed to evaluate the feasibility of transoral robotic selective neck dissection (SND) with or without a postauricular incision for papillary thyroid carcinoma (PTC).MethodsWe studied 14 patients with PTC who underwent robotic SND via the transoral or combined transoral and postauricular approaches.ResultsThe transoral approach was performed on 10 patients for dissection of levels III and IV. An additional postauricular incision was made on 4 patients for dissection of level II in addition to levels III, IV, and V. The operation was completed successfully in 13 patients, except 1 patient with the procedure conversion due to uncontrolled bleeding from the internal jugular vein. The mean numbers of removed lymph nodes in the lateral compartment were 23.1 ± 9.4 and 38.3 ± 8.5 in the transoral and combined groups. Transient recurrent laryngeal nerve palsy occurred in 1 patient, transient hypoparathyroidism in 3 patients, and chyle leakage in 1 patient. There were no hematomas, mental nerve injuries, surgical space infections, or CO2 embolisms.ConclusionTransoral robotic SND is feasible with or without a postauricular incision.

Transoral endoscopic thyroidectomy vestibular approach (TOETVA): first twelve case series in Erbil, Iraq.

Endoscopic thyroid surgery has gained popularity with the advances in laparoscopic and endoscopic instruments and techniques. Of all endoscopic approaches for thyroidectomy, the transoral endoscopic thyroidectomy vestibular approach (TOETVA) is the most promising procedure as it avoids neck scars and has less tissue dissection than other endoscopic techniques. This study aimed to present our first impression and initial experience with TOETVA in Erbil city. Twelve patients underwent surgery between November 2020 and April 2021, including eleven females and one male. Eleven total thyroidectomies and one lobectomy were performed. We found no significant postoperative complications. TOETVA is a safe and effective procedure, but it is challenging, needs good skills, and is a promising technique.

Endoscopic Transcervical Approach for Single-stage Anterior Decompression and Stabilization for Atlantoaxial Dislocation

Background: Anterior and posterior approaches are used for the management of atlantoaxial dislocation (AAD). Anterior decompression is required in some patients in whom the C1–2 dislocation is not properly reduced by the posterior approach. It can be done using transnasal, transoral, or transcervical approaches. The endoscopic transcervical approach can be used for single-stage decompression and stabilization that includes an odontoidectomy and anterior fusion. Objective: To determine the surgical outcomes of endoscopic transcervical approach for single-stage decompression and fixation for atlantoaxial dislocation. Material and Methods: This was a prospective observational study done at a tertiary center specialized for endoscopic neurosurgery during the period from 2015 to 2021. All surgeries were performed under endoscopic control. Data were collected for the extent of decompression, amount of blood loss, operative time, need for conversion to microscopy, and complications. Results: The age ranged from 5 to 68 years, and follow-up from 12 to 84 months (average = 46 months). Preoperatively, 54 patients were in the Ranawat Grade 3b, 43 in the Ranawat Grade 3a, and 5 in Grade 2. A total of 42 patients needed odontoidectomy with median C2 corpectomy. Conversion to a microscopic approach was not required in any case. Of 102 patients, 90 improved to Ranawat Grade 1, 7 patients to Grade 2, and 5 patients to Grade 3a. The blood loss was between 25 and 100 ml (average = 68 ml). Two patients suffered from screw pull-out. One patient had re-dislocation and was managed with redo surgery. There was no mortality. Conclusion: Endoscopic transcervical single-stage decompression and stabilization is a safe and effective technique for AAD.

Management of unfavorable displaced mandibular angle fracture with combined rigid and semi-rigid fixation using trans-oral and trans-buccal approaches. One year prospective clinical and radiographic study

Management of unfavorable displaced mandibular angle fracture with combined rigid and semi-rigid fixation using trans-oral and trans-buccal approaches. One year prospective clinical and radiographic study

S2829 ERCP via EUS Guided Duodenojejunostomy for a Biliary Stricture After Roux-en-Y Hepaticojejunostomy

Introduction: Patients with a Roux-en-Y hepaticojejunostomy (RYHJ) present a unique challenge when endoscopic retrograde cholangiography (ERC) is required. Standard approaches range from a surgical approach involving laparoscopic assistance to device assisted enteroscopy, with transoral approaches generally being variably successful, due to anatomy, length of intestinal limbs after surgery, and limitations in available accessories for use in device assisted enteroscopy. Here, we report the endoscopic use of a LAMS to create a duodenojejunostomy (DJ), thereby enabling ERC in a patient with RYHJ. Case Description/Methods: A 46-year-old woman status post cholecystectomy complicated by common bile duct injury necessitating RHYJ and prior anastamotic strictures, presented with recurrent self-limited cholangitis. She presented to clinic with intermittent episodes right upper quadrant pain, and fever which were treated conservatively with antibiotics. MRCP demonstrated stricture of the hepatic duct near the anastomosis [1]. Device assisted endoscopy was performed, but the anastomosis was unable to be reached. After discussing endoscopic, IR, and surigcal options we proceeded with EUS guided interventions given the anticipated need for recurrent interventions for a biliary stricture. EUS demonstrated mild intrahepatic dilation with limited access points for hepaticogastrostomy. The bile duct and hepaticojejunostomy were visualized from the bulb with small bowel adjacent to the anastomosis [2]. The jejunum was accessed using a 19 G FNA needle, and bile was aspirated to confirm intraluminal location. The jejunum was filled with 200 mL of sterile water and contrast [3]. A 15 mm x 10 mm AXIOS was then deployed in good position, creating a DJ, which was confirmed fluoroscopically and endoscopically [4]. Contrast was then injected through the stent to exclude a leak. 4 weeks later, ERCP was performed via the DJ [5]. Cholangioscopy was performed which showed some edematous bile duct mucosa without findings concerning for malignancy [6]. Biopsies and brushings were performed and three plastic stents were placed. The patient tolerated the procedure well, the tissue was benign and the patient has had resolution of her cholangitis symptoms. Discussion: In conclusion, we report a novel use of LAMS enabling ERC in patient’s status post RHYJ which allows easy access for repeat interventions and avoids the difficulties and limitations of device assisted enteroscopy ERCP.Figure 1.: Image 1. MRCP showing hepatic duct stricture near the anastomosis Image 2. EUS with bile duct adjacent to fluid filled jejunum Image 3. EUS with FNA needle accessing hepaticojejunostomy Image 4. EUS with LAMS deployed from duodenum to jejunum Image 5. Matured duodenojejunostomy Image 6. Cholangioscopy demonstrating edematous mucosa.

A Retrospective Analysis on the Effects and Complications of Endoscope-Assisted Transoral Approach and Lateral Cervical Approach in the Resection of Parapharyngeal Space Tumors.

Objective To observe and compare the effects and complications of endoscope-assisted transoral approach and lateral cervical approach in the resection of parapharyngeal space (PSS) tumors. Methods From January 2013 to September 2021, 69 patients with parapharyngeal space tumors in the Affiliated Hospital of Jiangnan University were divided into the control group (n = 37) and the observation group (n = 32) according to the mode of operation. The tumors in the parapharyngeal space were resected by the lateral cervical approach in the control group, and the tumors in the parapharyngeal space were removed by endoscopy-assisted transoral approach in the observation group. The general clinical data and operation conditions of the two groups, including operative blood loss, operation time, drainage volume and drainage time, hospital stay, perioperative pain degree, and tumor resection rate were collected and analyzed statistically. The patients were followed up for 6 months, and the complications of the two groups were recorded. Results Compared with the control group, the operation time in the observation group was significantly shorter, and the amount of intraoperative bleeding in the observation group was significantly less than that in the control group, and the difference was statistically significant (P < 0.05). The postoperative drainage was less and the hospital stay in the observation group was shorter than that in the control group, and the difference was statistically significant (P < 0.05). There was no significant difference in tumor resection rate between the two groups. The visual analog scale (VAS) score on the 1st and 3rd day after operation in the observation group was lower than that in the control group. After treatment, some patients in the two groups had complications such as nerve injury, dysphagia, difficulty in mouth opening, massive hemorrhage, and parotid fistula. The total incidence of complications in the observation group was lower than that in the control group, and the difference was statistically significant (P < 0.05). Conclusions The effect of the endoscope-assisted transoral approach is similar to that of the lateral cervical approach in the resection of tumors in parapharyngeal space, but the endoscope-assisted transoral approach has shorter operation time, less intraoperative bleeding, and less postoperative drainage. The indwelling time and hospital stay of the drainage device were shorter than those of the patients with transcervical approach, and the perioperative stress response of patients with endoscope-assisted transoral approach is mild, which is beneficial to the physical and mental recovery of the patients.

Comparative surgical outcomes of transoral endoscopic and robotic thyroidectomy for thyroid carcinoma: a propensity score-matched analysis.

Surgical outcomes of patients with thyroid carcinoma who underwent transoral endoscopic thyroidectomy vestibular approach (TOETVA) versus transoral robotic thyroidectomy (TORT) were compared. Patients who underwent TOETVA or TORT between July 2016 and February 2022 were retrospectively analyzed. TOETVA and TORT groups were propensity score-matched (1:1) based on age, sex, body mass index, surgical extent, tumor size, and presence of thyroiditis. A total of 185 patients underwent transoral thyroidectomy (142 TOETVA and 43 TORT). Final diagnoses consisted of 135 papillary and seven follicular thyroid carcinomas in the TOETVA group and 43 papillary thyroid carcinomas in the TORT group (p = 0.138). Mean operative time was shorter for the TOETVA group than the TORT group (106.3 vs. 158.9min, p < 0.001), whereas mean hospital stay was longer for the TOETVA group than the TORT group (2.2 vs. 1.9days, p = 0.031). After 1:1 propensity score matching, each group included 43 patients. Mean operative time was shorter in the TOETVA group than the TORT group (106.2 vs. 158.9min, p < 0.001), whereas mean hospital stay was longer in the TOETVA group (2.3 vs. 1.9days, p = 0.031). There was no significant difference in vocal cord palsy incidences between the groups (one transient, one permanent in the TOETVA group vs. none in the TORT group, p = 0.359). The learning curve was 71 cases for TOETVA and 25 cases for TORT. TOETVA had shorter mean operative time, and TORT had shorter learning curve and shorter mean hospital stay. Surgeons should be familiar with the advantages and disadvantages of each procedure.