A Systematic Review and Meta-Analysis: Surgical Outcomes Comparing Transoral Robotic and Open Approaches to Thyroidectomy

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Although conventional open thyroidectomy (OT) is effective in disease control, the inevitable neck scar has a potential negative effect on the patients’ mental health. In an attempt to minimize cosmetic deformity, transoral robotic thyroidectomy (TORT) has emerged as a scarless and minimally invasive technique. However, its safety and completeness need to be assessed. Methods: PubMed, Embase, the Cochrane Library, and Web of Science were systematically queried for clinical trials comparing transoral robotic thyroidectomy and open thyroidectomy for thyroid disease. The primary endpoints were the central lymph node yield, the rates of complications such as recurrent laryngeal nerve injury, hypoparathyroidism, hematoma, seroma, and skin flap perforation, whereas the secondary endpoints included the operation time, length of hospitalization, and postoperative pain. The results were synthesized using a random effects model. Results: A total of five studies were included in this meta-analysis. Compared to OT, TORT was associated with increased operative time (MD = -79.19, 95% CI [-128.55, -29.83], P < 0.05; MD = -107.6, 95% CI [-167.63, -47.58], P < 0.05), increased length of stay (MD = -0.35, 95% CI [-0.52, -0.18], P < 0.05), and increased early postoperative pain scores. The central lymph node yield, transient or permanent recurrent laryngeal nerve injury, and hypoparathyroidism were comparable. The incidence of skin flap perforation was noted only in the TORT group. Conclusions: TORT has the advantage of providing superior cosmetic results without compromising the completeness of oncological clearance or increasing the risk of significant nerve and parathyroid gland damage. However, the cost of this approach is increased operative time, pain, length of stay, and the possibility of skin flap perforation. Further studies are required to assess the long-term oncological outcome. Robotic-assisted surgery Transoral robotic thyroidectomy TORT Meta-analysis Figures Figure 1 Figure 2 Figure 3 1. Introduction Thyroid carcinoma increases the risk of mortality and has been managed mainly through surgical intervention [ 1 ] . Open thyroidectomy (OT) has proven itself as an effective and stable surgery for cancer treatment, though the cervical scar following surgery may impact patients’ physical appearance, psychological status, and quality of life, especially among young women [ 2 – 4 ] . In response to increasing patient demand for improved postoperative cosmetic results, several endoscopic and robotic thyroidectomy approaches using natural orifices. To meet the increasing demand of patients for better postoperative cosmetic outcomes, various endoscopic and robotic thyroidectomy procedures using natural orifices and remote access have been proposed. Among these procedures, transoral robotic thyroidectomy (TORT) has been receiving more and more attention from clinicians and researchers due to its advantages, including the lack of neck scar, midline approach for dissection of the bilateral lobes of the thyroid gland, and the use of robotic devices for more accurate dissection [ 4 – 7 ] . Furthermore, there are emerging data that indicate that postoperative neck aesthetic satisfaction and quality of life for patients are better with transoral robotic thyroidectomy compared to conventional open thyroidectomy [ 8 ] . Considering the fact that TORT is a new technology, many studies have evaluated its short- and intermediate-term results. In low-risk papillary thyroid cancer patients, oncologic outcomes of TORT have been found to be comparable to those of conventional OT in terms of recurrence rates, disease-free survival, and adequacy of lymph node retrieval. [ 9 – 11 ] . However, the perioperative outcomes of TORT and OT have been found to be significantly different. In fact, a significantly longer operative time, a steep learning curve, and a higher rate of procedure-related complications, including carbon dioxide embolism, oral incision-related infection, and cervical skin injury, have been observed with TORT [ 11 , 12 ] . Recent years have seen an increase in studies comparing TORT with OT. However, most are retrospective and underpowered due to small sample sizes, limiting the reliability of their conclusions. Furthermore, systematic evaluations of this body of evidence through meta-analysis remain scarce. Accordingly, no objective appraisal of the merits and drawbacks of TORT versus OT for thyroid carcinoma currently exists. The present study sought to fill this gap by providing more robust evidence on perioperative outcomes, complications, and treatment completeness associated with both surgical approaches. 2. Methods This systematic review and meta-analysis was done following the Cochrane Handbook and the PRISMA guidelines. [ 13 , 14 ] . The PROSPERO registration database is: CRD42026128669 on January 16, 2026, before commencing the database search on January 18, 2026, thus fulfilling the criteria for prospective registration. This study was conducted according to the protocol with minimal modification. 2.1 Search strategy To identify relevant studies, we searched PubMed, the Cochrane Library, Embase, and Web of Science systematically from the date of each database's inception to January 31, 2026. The search strategy included the following key words: "Thyroidectomy", "Robotic-Assisted Surgery"AND "Open Surgery". To limit language bias, only English language studies were considered for inclusion. Furthermore, the bibliographies of all included studies were manually searched to ensure that any additional relevant studies were not missed. Any discrepancies that may have arisen in the selection of studies are resolved by the consensus meeting. The selection of studies is shown in Fig. 1 following the PRISMA flow chart. 2.2 Study selection criteria Selection of studies for inclusion was done using the following eligibility criteria: (1) clinical studies comparing TORT and CT directly, (2) study designs that had a comparative aspect, and (3) Eligible studies had to provide data on a range of key outcomes, including operative time (for both lobectomy and total thyroidectomy), length of stay, lymph node count, pain levels, and the incidence of complications such as flap perforation, seroma, hematoma, transient/permanent hypoparathyroidism, and transient/permanent recurrent laryngeal nerve injury. Studies were excluded if they were reviews, editorials, non-English, preclinical, duplicate records, individual case reports, or lacked full text and retrievable data. Study selection was done independently by two authors through duplicate removal, screening of titles and abstracts, and full-text evaluation. 2.3 Bias and Quality Check The quality of the included non-randomized studies was assessed for the methodological quality using the ROBINS-I tool [ 15 ] .Similar to the Cochrane and GRADE systems, the ROBINS-I approach also considers seven domains for the evaluation of potential biases. To assess the risk of bias, we applied the ROBINS-I tool to all included studies. The studies are rated as having a low, moderate, serious, critical, or unclear risk of bias [ 16 ] . Because fewer than ten studies were included, publication bias was not assessed with a funnel plot. 2.4 Data Extraction and Outcomes Three reviewers used a standardized data extraction form to extract relevant data from each of the included studies independently. The extracted data included origin, study design, sample size, and surgical methods used in the TORT and OT groups; patients’ baseline data, such as gender, age, body mass index, tumor size, pathological type, and stages of diseases; and outcome measures, which were defined as primary and secondary in the included studies. Disagreements were resolved by re-reading the included studies. Recurrent laryngeal nerve injury and hypoparathyroidism were considered transient when they resolved within 6 months of surgery and permanent when they persisted beyond 6 months. Since the criteria for hypocalcemia and hypoparathyroidism varied among studies, the data were extracted using the criteria used by the studies. 2.5 Statistical Analysis This meta-analysis was performed using RevMan software (version 5.4), provided by the Cochrane Collaboration. Given the potential for heterogeneity across the included clinical trials, a random-effects model was employed for all statistical analyses. A p-value of less than 0.05 was considered statistically significant. For outcome measures, pooled data were calculated and reported using odds ratios (OR) with 95% confidence intervals for dichotomous variables and weighted mean differences (WMD) with 95% confidence intervals for continuous variables. Due to the limited number of trials included in the analysis, a meta-regression was not feasible, as it would have lacked precision and accuracy. Therefore, no further statistical adjustments were undertaken to address potential baseline confounding. 3. Results 3.1 Study selection The search of the database resulted in a total of 275 articles, of which 117 were excluded after the screening of the title and abstract, while five more were excluded after the screening of the full text, leaving only five studies included [ 8 , 10 – 12 , 17 ] , as presented in Fig. 1 . The total number of patients in all studies was 1,241, with 567 (45.6%) undergoing TORT and 674 (54.4%) receiving OT. The baseline characteristics of patients, such as sex, age, BMI, tumor size, and stages of disease, were well balanced in all groups. However, there were variations in CND and pathological composition, such as the ratio of benign lesions to PTC, as shown in Supplementary Figure. The variations in CND were mainly due to different CND rates, which were largely influenced by different practice patterns and guidelines during different time periods. The variations in pathological composition were mainly due to different proportions of benign lesions, which is not as directly related to evaluating the efficacy of PTC as is surgical efficacy. However, as shown in Supplementary Figure, there was sufficient intergroup comparability of patients' baseline characteristics among PTC patients in both groups, as shown in the original studies, indicating that heterogeneity is not likely to affect the results of our current meta-analysis. Besides, as shown in Tables 1 and 2 , two studies [ 8 , 12 ] also evaluated patients' satisfaction and found higher satisfaction in patients receiving TORT, as shown in Table 3 , which shows an overview of perioperative outcome measures. Table 1 Characteristics of included studies author year Region study type No. of patients OT TORT Lee 2026 Korea Propensity Score-Matched 124 124 Lee 2023 Korea Propensity Score-Matched 100 100 Song 2021 Korea Propensity Score-Matched 57 57 Tae 2019 Korea Retrospective 207 100 You 2020 Korea Propensity Score-Matched 186 186 Abbreviations: OT, open thyroidectomy; TORT, transoral robotic thyroidectomy. Table 2 Baseline characteristics of the studies included in this review Lee 2026 Lee 2023 Song 2021 Tae 2019 You 2020 OT TORT OT TORT OT TORT OT TORT OT TORT Number of patients,n 124 124 100 100 57 57 207 100 186 186 Mean age(year) 43.0 ± 8.9 43.2 ± 8.1 45.7 ± 14.6 45.7 ± 11.5 51.2 ± 11.5 51.7 ± 9.5 54.5 ± 14.5 45.5 ± 18.8 43.1 ± 10.7 42.2 ± 10.1 BMI(Kg/m 2 ) 23.8 ± 3.0 23.7 ± 3.4 25.1 ± 4.7 24.3 ± 3.3 NA NA 25.0 ± 3.9 24.6 ± 3.7 24.1 ± 3.5 23.5 ± 3.8 Sex (female), n 98 109 72 68 42 41 150 75 150 154 Tumor size, cm 0.6 ± 0.3 0.6 ± 0.4 0.9 ± 0.6 0.9 ± 0.7 NA NA 1.49 ± 0.8 1.02 ± 0.8 0.67 ± 0.55 0.7 ± 0.5 Extent of thyroidectomy, n Isthmusectomy 0 0 4 5 0 0 3 3 0 0 Lobectomy 115 111 71 71 42 42 125 74 174 174 Total thyroidectomy 9 13 25 24 15 15 79 23 12 12 Central neck dissection, n 119 103 60 57 49 18 88 20 NA NA TNM Stage, n I NA NA 94 97 53 54 153 86 NA NA II NA NA 6 3 4 3 16 3 NA NA III NA NA 0 0 0 0 0 0 NA NA Pathology, n Benign tumor 0 0 0 0 0 0 38 11 12 7 PTC 124 124 100 100 57 57 164 87 153 167 FTC 0 0 0 0 0 0 5 1 3 2 Abbreviation: OT, open thyroidectomy; TORT, transoral robotic thyroidectomy ; BMI, body mass index; PTC, papillary thyroid carcinoma; FTC, follicular thyroid carcinoma;NA, Not available. Table 3 Surgical outcomes of the studies included in this review Lee 2026 Lee 2023 Song 2021 Tae 2019 You 2020 p OT TORT OT TORT OT TORT OT TORT OT TORT Number of patients, n 124 124 100 100 57 57 207 100 186 186 Operative time, min Lobectomy 56.7 ± 14.2 170.7 ± 28.8 101.93 ± 33.98 186.91 ± 53.6 NA NA 115.5 ± 32.6 153.9 ± 40.5 NA NA < 0.05 Total thyroidectomy 101.1 ± 19 260.2 ± 32.6 131.2 ± 43.48 225.21 ± 47.01 NA NA 140.4 ± 34.3 209.8 ± 50 NA NA < 0.05 LOS, day 2.8 ± 1.7 3.3 ± 0.7 NA NA NA NA NA NA 2.6 ± 0.86 2.9 ± 0.87 < 0.05 Number of retrieved lymph nodes, n 7.1 ± 5.4 6.9 ± 2.9 5.46 ± 3.86 4.6 ± 4.77 NA NA 6.6 ± 5.5 6.3 ± 6 8.62 ± 9.53 4.96 ± 4.44 0.1 Postoperative pain 2.6 ± 0.5 3.2 ± 0.9 NA NA NA NA NA NA 2.64 ± 1.19 3.12 ± 0.76 < 0.05 RLN injury, n Permanent 3 0 1 1 0 0 2 0 0 0 0.29 Transient 10 2 4 0 2 1 7 5 0 1 0.33 Skin fiap perforation, n 0 2 0 1 NA NA 0 1 NA NA 0.1 Seroma, n 0 0 4 12 7 5 18 13 1 0 0.32 Hematoma, n NA NA 3 0 1 1 6 1 NA NA 0.18 Hypoparathyroidism, n Permanent 0 0 2 2 0 0 1 1 3 2 0.94 Transient 2 5 8 10 9 8 25 7 0 0 0.79 Abbreviation: Abbreviations: OT, open thyroidectomy; TORT, transoral robotic thyroidectomy ; RLN, recurrent laryngeal nerve;NA, Not available. 3.2 Assessment of quality Using the ROBINS-I tool—which examines confounding, participant selection, intervention classification, deviations from intended interventions, missing data, outcome measurement, and selective reporting—we evaluated the methodological quality of the included studies. The results showed that there was no critical risk of bias in the studies included. Domain 1 of the ROBINS-I tool covers bias due to confounding. In this analysis, the studies were regarded as being at moderate risk of bias due to confounding as they used propensity score matching, while the previous study was regarded as being at serious risk of bias as it did not use the matching method. In the second domain of the ROBINS-I tool, which deals with bias in participant selection, the studies were regarded as being at moderate risk of bias as they were observational studies. In Domain 4 of the ROBINS-I tool, the studies' bias due to departure from the intended intervention is evaluated. In the studies reviewed, a moderate level of bias was established in this domain of the tool since the studies reviewed were of an observational nature. In Domain 6 and 7 of the tool, where the studies' bias in the measurement of the outcome and selective reporting is evaluated, it was established that the studies reviewed had a low level of bias. In addition, none of the studies reviewed had insufficient information in any of the domains of the tool. Overall, the studies included in the review showed good methodological quality. While the level of evidence was not high for the studies included in the review, the use of statistical adjustment methods, as used in the current meta-analysis, helped to increase the reliability of the findings. 3.3 Outcome analysis 3.3.1 Operative time In the case of the two procedures, namely lobectomy and total thyroidectomy, it was evident that the time required to carry out the procedures was significantly higher when the transoral robotic thyroidectomy approach was used as opposed to the open thyroidectomy approach, as demonstrated by the results obtained from the pooled analysis of the lobectomy procedure, whereby a significant difference was noted between the two procedures, as demonstrated by the results obtained, whereby it was noted that there was a significant difference between the two procedures, with a calculated MD of -79.19, 95% CI -128.55 to -29.83, p < 0.05, I² = 99%, as demonstrated in Fig. 2 A and 2 B. 3.2.2 LOS Patients who underwent open thyroidectomy had a significantly shorter length of hospital stay compared to those who received transoral robotic thyroidectomy (WMD = -0.35 days, 95% CI [-0.52 to -0.18], p < 0.05; I² = 12%), as demonstrated in Fig. 2 C. 3.2.3 Number of retrieved lymph nodes The pooled analysis showed that the two groups had similar lymph node retrieval, and there was no significant difference (OR = 1.2, 95% CI [-0.24 to 2.64], p = 0.10, I² = 80%) as shown in Fig. 2 D. 3.2.4 Postoperative pain The OT group had significantly lower mean postoperative pain scores compared with the TORT group (OR = -0.55, 95% [CI -0.68 to -0.41], p < 0.05; I² = 0%), as shown in Fig. 2 E. 3.2.5 Recurrent laryngeal nerve injury The pooled results indicated that the rates of both permanent and transient RLN injury in the two groups were comparable, with no significant differences in permanent injury (OR = 2.49, 95% CI [0.46 to 13.51], p = 0.29, I² = 0%) or transient injury (OR = 1.81, 95% CI [0.54 to 6.01], p = 0.33, I² = 43%), as indicated in Fig. 3 A and 3 B. 3.2.6 Skin flap perforation The skin flap perforation only happened in the TORT group; however, no significant difference between the groups was observed using the pooled analysis (OR = 0.22, 95% CI [0.04, 1.34], p = 0.10, I² = 0%), as shown in Fig. 3 C. 3.2.7 Seroma、Hematoma Pooled data revealed similar rates of seroma and hematoma for both groups. There were no statistically significant differences for seroma (OR 0.69, 95% CI [0.34–1.42], p = 0.32, I² = 28%) or for hematoma (OR 2.72, 95% CI [0.62–11.87], p = 0.18, I² = 0%), as shown in Fig. 3 D and 3 E. 3.2.8 Hypoparathyroidism The pooled analysis showed that the rates of permanent and transient hypoparathyroidism were similar in both groups, with no significant differences (OR = 1.05, 95% CI [0.31 to 3.48], p = 0.94, I² = 0%; OR = 1.08, 95% CI [0.62 to 1.87], p = 0.79, I² = 8%), as shown in Fig. 3 F and 3 G. 4. Discussion Even though previous studies have shown the viability of TORT in specific patient groups [ 18 , 19 ] , the benefits of TORT over conventional OT, especially with regards to oncological safety, recovery, and outcome, are not clear. This study aims to be the first meta-analysis comparing TORT and OT, which goes beyond the results of the comparative studies to a more comprehensive evaluation of the two methods. Operative duration has also been taken into consideration as an important factor for the efficiency of surgery as well as the proficiency of the surgical team. Reduction of the operative time has been considered to be important for minimizing the anesthetic exposure as well as making the most efficient use of resources. During the present meta-analysis, it was observed that there was a longer operative time with TORT compared to OT. This has been considered to be due to the additional time required for docking the robotic system, changing the instruments, as well as creating the subplatysmal space through the transoral approach [ 20 – 23 ] . Among the transoral approaches, robotic procedures have also been observed to be more time-consuming compared to purely endoscopic procedures [ 22 , 23 ] . Though the long operative time has been considered to be a disadvantage of the TORT procedure, it has also been observed that this disadvantage is directly related to the learning curve of the procedure [ 24 ] . As the learning curve of the procedure increases, the efficiency of the procedure has been observed to be greatly increased. This has also been considered to be related to the three-dimensional magnified vision of the surgical field that has been considered to be helpful for meticulous dissection of the structures [ 24 ] . As far as the short-term postoperative period is concerned, it is easy to understand the advantages of the OT approach, as it was demonstrated during the analysis that the short hospital stay following the OT approach is associated with reduced levels of postoperative pain compared to the TORT approach, as it was demonstrated in previous studies [ 25 , 26 ] . This is easily explained if the degree of tissue trauma is considered, as in the OT approach the incision of the tissue is limited in the neck area, whereas in the TORT approach the dissection of the subcutaneous tissue from the facial area to the neck is required in order to avoid the presence of a scar after the operation. This increases the level of early postoperative pain after the TORT approach. In conclusion, it is not necessarily true that the absence of a scar after thyroidectomy is associated with the minimally invasive nature of the specific approach. Patients who are undergoing the TORT approach need to be informed about the compromises of this approach. With regard to oncological completeness of surgery and common postoperative complications, there are several issues of interest. The central compartment being the most common location for lymph node metastasis in PTC, lymph node dissection in the central compartment is critical in order to reduce locoregional recurrence. Therefore, the new method should have the same efficacy as the open method in terms of surgical completeness. Our analysis revealed no significant difference in the number of central lymph nodes retrieved between patients undergoing transoral robotic thyroidectomy and those receiving open thyroidectomy. This further emphasizes the fact that the main goal of thyroidectomy surgery is cure, not retrieval of lymph nodes. The robotic platform used in TORT provides three-dimensional magnified visualization and precise instrument articulation, which may help in more accurate discrimination of lymphatic tissue from surrounding adipose tissue, vascular structures, and parathyroid glands in a confined field of dissection, thereby providing precise dissection of these structures [ 27 ] . With respect to common postoperative complications, no significant differences were found between both techniques with respect to postoperative hematoma and seroma formation, as deduced from the analysis of both techniques. The magnified visualization of robotic surgery may provide accurate intraoperative hemostasis of small vessels, which might be difficult with other techniques [ 28 , 29 ] . Although seroma formation following TORT may be related to increased risk of disruption of lymphatic vessels following extensive flap dissection for TORT, which increases the risk of seroma, and failure of routine placement of drains, seroma formation following TORT is easily managed with simple aspiration and does not pose any adverse effects [ 30 , 31 ] . With regard to the critical anatomical structures involved, the RLN travels down on the back of the thyroid gland in the tracheo-esophageal groove and remains prone to traction, thermal, or even iatrogenic division during surgery. Injury to the RLN can lead to hoarseness, aspiration, or even airway obstruction in the most severe cases. Therefore, preserving the RLN is one of the critical technical objectives in thyroid surgery. Our meta-analysis showed that the percentage of RLN injury in TORT and OT does not significantly differ from each other. The similar rate of RLN preservation in the TORT group is likely due to the consistent use of intraoperative neuromonitoring (IONM), which facilitates accurate nerve localization—even from indirect visual angles—and helps minimize nerve injury. [ 32 ] Another major complication that arises after thyroid surgery is postoperative hypoparathyroidism, which is attributed to damage or compromise of the blood supply to the parathyroid glands during thyroid surgery. Parathyroid glands are particularly vulnerable due to their small size and anatomical proximity to the posterior thyroid capsule, making their blood supply susceptible to compromise during surgical procedures. In the current meta-analysis, no significant difference in the occurrence of hypoparathyroidism between the TORT and OT groups was observed, indicating that TORT does not increase the risk and provides the same level of long-term safety when performed by experienced surgeons [ 33 ] . However, as has been suggested in other studies, the success of thyroidectomy, whether performed by the transoral robotic thyroidectomy technique or the traditional open thyroidectomy technique, is based primarily on the careful capsular dissection of the thyroid gland along the posterior capsule of the thyroid gland, as well as the careful identification and preservation of the parathyroid glands, rather than the technique used for thyroidectomy [ 34 ] . Skin flap perforation was found to be the complication that was uniquely associated with the procedure of TORT in this study. This complication is more likely to happen in the early learning phases of this new technique and is believed to be related to the technical difficulty in performing a subcutaneous dissection with a small endoscopic view, especially in patients with relatively thin skin in the neck [ 35 ] . The study highlights the importance of the surgeon's skill in the procedure of TORT and shows that the rate of this complication can be significantly reduced by the implementation of a standard approach and gaining experience in the procedure. Two studies [ 8 , 12 ] have demonstrated a significant advantage of the procedure of TORT over OT in terms of cosmetic satisfaction and improvement of the appearance of the neck. The most important point for the acceptance of this procedure has to do with the level of satisfaction regarding cosmetics and quality of life with regard to the appearance of the neck. Overall patient satisfaction is a complex evaluation of the individual. The overall patient satisfaction is a multifactorial assessment, where many factors are considered other than the aspect of cosmetic satisfaction. However, there are some limitations that need to be considered in this study. First, the study only included retrospective observational studies, the vast majority of which used propensity score matching. Nevertheless, the level of evidence is lower than what can be obtained from randomized controlled trials. Secondly, the technical specifics of the operation, such as the routine use of an auxiliary axillary port and intraoperative neural monitoring, may have caused heterogeneity and, as a result, influenced the outcomes, including the time and complications. Thirdly, the studies that were analyzed were carried out on Asian populations, and although they reflect the level of development and application of the technique, they may not be applicable to other populations in the world, as the patients and the surgeons may be different. Finally, the short follow-up time, as clearly represented in the studies, cannot be considered for the evaluation of the long-term results, such as the occurrence of distant metastases, of papillary carcinoma. 5.Conclusion The meta-analysis showed similar performance of the two techniques in terms of oncological and safety-related parameters. However, transoral robotic thyroidectomy was resulted in significantly prolonged operative duration, increased early postoperative pain, and extended LOS when compared with open thyroidectomy. There was also a risk of skin flap perforation in the case of the robotic procedure. Although the overall complication profile was similar in both techniques, the risk of skin flap perforation in the robotic procedure needs to be considered. These conclusions have to be validated by further studies. 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Int J Clin Exp Med 7(1):101–107 Ha TK, Kim DW, Park HK et al (2018) Comparison of Postoperative Neck Pain and Discomfort, Swallowing Difficulty, and Voice Change After Conventional Open, Endoscopic, and Robotic Thyroidectomy: A Single-Center Cohort Study. Front Endocrinol (Lausanne) 9:416 Agrawal A, Ayantunde AA, Cheung KL (2006) Concepts of seroma formation and prevention in breast cancer surgery. ANZ J Surg 76(12):1088–1095 Kandil E, Attia AS, Hadedeya D et al (2020) Robotic Thyroidectomy: Past, Future, and Current Perspectives. Otolaryngol Clin North Am 53(6):1031–1039 Kim WW, Jung JH, Lee J et al (2016) Comparison of the Quality of Life for Thyroid Cancer Survivors Who Had Open Versus Robotic Thyroidectomy. J Laparoendosc Adv Surg Tech A 26(8):618–624 Kandil E, Hammad AY, Walvekar RR et al (2016) Robotic Thyroidectomy Versus Nonrobotic Approaches: A Meta-Analysis Examining Surgical Outcomes. Surg Innov 23(3):317–325 Ramouz A, Rasihashemi SZ, Daghigh F et al (2017) Predisposing factors for seroma formation in patients undergoing thyroidectomy: Cross-sectional study. Ann Med Surg (Lond) 23:8–12 Ebner F, Friedl TWP, de Gregorio A et al (2018) Seroma in breast surgery: all the surgeons fault? Arch Gynecol Obstet 298(5):951–959 Dionigi G, Kim HY, Wu CW et al (2017) Neuromonitoring in endoscopic and robotic thyroidectomy. Updates Surg 69(2):171–179 Lang BH, Wong CK, Tsang JS et al (2015) A systematic review and meta-analysis evaluating completeness and outcomes of robotic thyroidectomy. Laryngoscope 125(2):509–518 Giordano D, Valcavi R, Thompson GB et al (2012) Complications of central neck dissection in patients with papillary thyroid carcinoma: results of a study on 1087 patients and review of the literature. Thyroid 22(9):911–917 Tae K, Lee DW, Song CM et al (2019) Early experience of transoral thyroidectomy: Comparison of robotic and endoscopic procedures. Head Neck 41(3):730–738 Additional Declarations No competing interests reported. Supplementary Files Assessmentofrisk.docx SupplementaryFigure.docx Cite Share Download PDF Status: Published Journal Publication published 02 Apr, 2026 Read the published version in Journal of Robotic Surgery → Version 1 posted Editorial decision: Revision requested 15 Mar, 2026 Reviews received at journal 15 Mar, 2026 Reviews received at journal 11 Mar, 2026 Reviewers agreed at journal 08 Mar, 2026 Reviewers agreed at journal 04 Mar, 2026 Reviewers agreed at journal 04 Mar, 2026 Reviewers invited by journal 02 Mar, 2026 Editor assigned by journal 24 Feb, 2026 Submission checks completed at journal 23 Feb, 2026 First submitted to journal 23 Feb, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8946733","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":600862852,"identity":"af4e19b8-283c-4f93-9631-b6c28274ba64","order_by":0,"name":"Xiang Gao","email":"","orcid":"","institution":"North Sichuan Medical College, Affiliated Hospital of North Sichuan Medical College","correspondingAuthor":false,"prefix":"","firstName":"Xiang","middleName":"","lastName":"Gao","suffix":""},{"id":600862853,"identity":"6dfe817f-f876-4a51-a1f4-6c053814c3ea","order_by":1,"name":"Yuan Ren","email":"","orcid":"","institution":"North Sichuan Medical College, Affiliated Hospital of North Sichuan Medical College","correspondingAuthor":false,"prefix":"","firstName":"Yuan","middleName":"","lastName":"Ren","suffix":""},{"id":600862854,"identity":"34fec751-a0fe-4980-86f9-5c7c93285d5e","order_by":2,"name":"Xia Xu","email":"","orcid":"","institution":"North Sichuan Medical College, Affiliated Hospital of North Sichuan Medical College","correspondingAuthor":false,"prefix":"","firstName":"Xia","middleName":"","lastName":"Xu","suffix":""},{"id":600862855,"identity":"cdfef975-c332-4171-b3da-6ec570803e3e","order_by":3,"name":"YuanFeng Zhao","email":"","orcid":"","institution":"North Sichuan Medical College, Affiliated Hospital of North Sichuan Medical College","correspondingAuthor":false,"prefix":"","firstName":"YuanFeng","middleName":"","lastName":"Zhao","suffix":""},{"id":600862856,"identity":"695a6e14-1da9-429b-affb-c509fbfe27f3","order_by":4,"name":"Jiang Sun","email":"","orcid":"","institution":"North Sichuan Medical College, Affiliated Hospital of North Sichuan Medical College","correspondingAuthor":false,"prefix":"","firstName":"Jiang","middleName":"","lastName":"Sun","suffix":""},{"id":600862857,"identity":"6c34ac9e-a37a-4351-9a0b-7a416dcabeb7","order_by":5,"name":"YuMeng Luo","email":"","orcid":"","institution":"North Sichuan Medical College, Affiliated Hospital of North Sichuan Medical College","correspondingAuthor":false,"prefix":"","firstName":"YuMeng","middleName":"","lastName":"Luo","suffix":""},{"id":600862858,"identity":"8c5f067f-7d63-42b5-a6ab-70b4c700f203","order_by":6,"name":"Jing Hou","email":"","orcid":"","institution":"North Sichuan Medical College, Affiliated Hospital of North Sichuan Medical College","correspondingAuthor":false,"prefix":"","firstName":"Jing","middleName":"","lastName":"Hou","suffix":""},{"id":600862859,"identity":"a069bfa3-4d0f-44aa-87bf-61f65e43fa7f","order_by":7,"name":"Shuai Lin","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA+UlEQVRIiWNgGAWjYDCCAyDCQIKHgZn58APJPzZyDMxEaSmwkGFgZ0szsGxIMyZSy4cKGwZ+HgOJyoZDiQ2EdPDdPnzw0w2wwxgMDG7uOJA+v5334AeGGptoXFokz6UlS+dAtCQ8nHnmTu6Gw3zJEgzH0nJxWWdwhscApuWAsQTbs9wNzEAXMjYcxqOF//NviBbGBuk/bIfT5Zt5jH/g18LDBrWFmUFCsu1wAsNhHjO8tkieYTOzhmhhYzOQOJNmuAGoxSIBj1/4zjA/vp3zp86egf/85wcSFTby8v1njG98qLHBqQUO7A8g8xIIKR8Fo2AUjIJRgBcAADZcU6bsdK40AAAAAElFTkSuQmCC","orcid":"","institution":"North Sichuan Medical College, Affiliated Hospital of North Sichuan Medical College","correspondingAuthor":true,"prefix":"","firstName":"Shuai","middleName":"","lastName":"Lin","suffix":""}],"badges":[],"createdAt":"2026-02-23 11:53:34","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8946733/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8946733/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1007/s11701-026-03382-w","type":"published","date":"2026-04-02T15:57:51+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":104178976,"identity":"b5912c2a-ff4f-402c-a4bf-26a144e49109","added_by":"auto","created_at":"2026-03-08 17:00:14","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":33165,"visible":true,"origin":"","legend":"\u003cp\u003ePRISMA flow diagram for the systematic review\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-8946733/v1/a3df3b32a24b92b0602aec5d.png"},{"id":104178972,"identity":"8cec0c59-916c-4d16-a6d7-cf0169426de5","added_by":"auto","created_at":"2026-03-08 17:00:14","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":336016,"visible":true,"origin":"","legend":"\u003cp\u003eForest plot of meta-analysis of the following variables: (A)The operation time of lobectomy, (B) The operation time of total thyroidectomy, (C)LOS, (D) Number of retrieved lymph nodes, (E) Postoperative pain.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-8946733/v1/de06b27a07847f14d01d9053.png"},{"id":104404008,"identity":"677cf19d-e3a7-4e77-9eec-233a8d041608","added_by":"auto","created_at":"2026-03-11 12:19:35","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":632449,"visible":true,"origin":"","legend":"\u003cp\u003eForest plot of meta-analysis of the following variables: (A) Permanent RLN injury, (B) Transient RLN injury, (C) Skin fiap perforation, (D) Seroma, (E) Hematoma, (F) Permanent hypoparathyroidism,(G) Transient hypoparathyroidism.\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-8946733/v1/f4614ed429b1bf4e12e8c0be.png"},{"id":106343310,"identity":"fab86e32-6292-4373-bc68-42c58c345195","added_by":"auto","created_at":"2026-04-07 16:01:32","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1776829,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8946733/v1/dabfc0b7-a67f-4e44-bc5b-bb0fefda35e8.pdf"},{"id":104178973,"identity":"52b258fb-3ced-4442-a90a-be79369bb7d4","added_by":"auto","created_at":"2026-03-08 17:00:14","extension":"docx","order_by":3,"title":"","display":"","copyAsset":false,"role":"supplement","size":12400,"visible":true,"origin":"","legend":"","description":"","filename":"Assessmentofrisk.docx","url":"https://assets-eu.researchsquare.com/files/rs-8946733/v1/5f2d34d5afffb5cae0698cf2.docx"},{"id":104178975,"identity":"d2cd8396-e0df-4b43-aba8-cbe1b5dd21ee","added_by":"auto","created_at":"2026-03-08 17:00:14","extension":"docx","order_by":4,"title":"","display":"","copyAsset":false,"role":"supplement","size":131873,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryFigure.docx","url":"https://assets-eu.researchsquare.com/files/rs-8946733/v1/a704049fe8f9392e7f9c4428.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"A Systematic Review and Meta-Analysis: Surgical Outcomes Comparing Transoral Robotic and Open Approaches to Thyroidectomy","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eThyroid carcinoma increases the risk of mortality and has been managed mainly through surgical intervention \u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]\u003c/sup\u003e. Open thyroidectomy (OT) has proven itself as an effective and stable surgery for cancer treatment, though the cervical scar following surgery may impact patients\u0026rsquo; physical appearance, psychological status, and quality of life, especially among young women \u003csup\u003e[\u003cspan additionalcitationids=\"CR3\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/sup\u003e. In response to increasing patient demand for improved postoperative cosmetic results, several endoscopic and robotic thyroidectomy approaches using natural orifices. To meet the increasing demand of patients for better postoperative cosmetic outcomes, various endoscopic and robotic thyroidectomy procedures using natural orifices and remote access have been proposed. Among these procedures, transoral robotic thyroidectomy (TORT) has been receiving more and more attention from clinicians and researchers due to its advantages, including the lack of neck scar, midline approach for dissection of the bilateral lobes of the thyroid gland, and the use of robotic devices for more accurate dissection\u003csup\u003e[\u003cspan additionalcitationids=\"CR5 CR6\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/sup\u003e. Furthermore, there are emerging data that indicate that postoperative neck aesthetic satisfaction and quality of life for patients are better with transoral robotic thyroidectomy compared to conventional open thyroidectomy\u003csup\u003e[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eConsidering the fact that TORT is a new technology, many studies have evaluated its short- and intermediate-term results. In low-risk papillary thyroid cancer patients, oncologic outcomes of TORT have been found to be comparable to those of conventional OT in terms of recurrence rates, disease-free survival, and adequacy of lymph node retrieval.\u003csup\u003e[\u003cspan additionalcitationids=\"CR10\" citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003c/sup\u003e. However, the perioperative outcomes of TORT and OT have been found to be significantly different. In fact, a significantly longer operative time, a steep learning curve, and a higher rate of procedure-related complications, including carbon dioxide embolism, oral incision-related infection, and cervical skin injury, have been observed with TORT\u003csup\u003e[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eRecent years have seen an increase in studies comparing TORT with OT. However, most are retrospective and underpowered due to small sample sizes, limiting the reliability of their conclusions. Furthermore, systematic evaluations of this body of evidence through meta-analysis remain scarce. Accordingly, no objective appraisal of the merits and drawbacks of TORT versus OT for thyroid carcinoma currently exists. The present study sought to fill this gap by providing more robust evidence on perioperative outcomes, complications, and treatment completeness associated with both surgical approaches.\u003c/p\u003e"},{"header":"2. Methods","content":"\u003cp\u003e This systematic review and meta-analysis was done following the Cochrane Handbook and the PRISMA guidelines. \u003csup\u003e[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]\u003c/sup\u003e. The PROSPERO registration database is: CRD42026128669 on January 16, 2026, before commencing the database search on January 18, 2026, thus fulfilling the criteria for prospective registration. This study was conducted according to the protocol with minimal modification.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1 Search strategy\u003c/h2\u003e \u003cp\u003eTo identify relevant studies, we searched PubMed, the Cochrane Library, Embase, and Web of Science systematically from the date of each database's inception to January 31, 2026. The search strategy included the following key words: \"Thyroidectomy\", \"Robotic-Assisted Surgery\"AND \"Open Surgery\". To limit language bias, only English language studies were considered for inclusion. Furthermore, the bibliographies of all included studies were manually searched to ensure that any additional relevant studies were not missed. Any discrepancies that may have arisen in the selection of studies are resolved by the consensus meeting. The selection of studies is shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e1\u003c/span\u003e following the PRISMA flow chart.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2 Study selection criteria\u003c/h2\u003e \u003cp\u003eSelection of studies for inclusion was done using the following eligibility criteria: (1) clinical studies comparing TORT and CT directly, (2) study designs that had a comparative aspect, and (3) Eligible studies had to provide data on a range of key outcomes, including operative time (for both lobectomy and total thyroidectomy), length of stay, lymph node count, pain levels, and the incidence of complications such as flap perforation, seroma, hematoma, transient/permanent hypoparathyroidism, and transient/permanent recurrent laryngeal nerve injury. Studies were excluded if they were reviews, editorials, non-English, preclinical, duplicate records, individual case reports, or lacked full text and retrievable data. Study selection was done independently by two authors through duplicate removal, screening of titles and abstracts, and full-text evaluation.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e2.3 Bias and Quality Check\u003c/h2\u003e \u003cp\u003eThe quality of the included non-randomized studies was assessed for the methodological quality using the ROBINS-I tool\u003csup\u003e[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]\u003c/sup\u003e.Similar to the Cochrane and GRADE systems, the ROBINS-I approach also considers seven domains for the evaluation of potential biases. To assess the risk of bias, we applied the ROBINS-I tool to all included studies. The studies are rated as having a low, moderate, serious, critical, or unclear risk of bias \u003csup\u003e[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]\u003c/sup\u003e. Because fewer than ten studies were included, publication bias was not assessed with a funnel plot.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003e2.4 Data Extraction and Outcomes\u003c/h2\u003e \u003cp\u003eThree reviewers used a standardized data extraction form to extract relevant data from each of the included studies independently. The extracted data included origin, study design, sample size, and surgical methods used in the TORT and OT groups; patients\u0026rsquo; baseline data, such as gender, age, body mass index, tumor size, pathological type, and stages of diseases; and outcome measures, which were defined as primary and secondary in the included studies. Disagreements were resolved by re-reading the included studies. Recurrent laryngeal nerve injury and hypoparathyroidism were considered transient when they resolved within 6 months of surgery and permanent when they persisted beyond 6 months. Since the criteria for hypocalcemia and hypoparathyroidism varied among studies, the data were extracted using the criteria used by the studies.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003e2.5 Statistical Analysis\u003c/h2\u003e \u003cp\u003e This meta-analysis was performed using RevMan software (version 5.4), provided by the Cochrane Collaboration. Given the potential for heterogeneity across the included clinical trials, a random-effects model was employed for all statistical analyses. A p-value of less than 0.05 was considered statistically significant. For outcome measures, pooled data were calculated and reported using odds ratios (OR) with 95% confidence intervals for dichotomous variables and weighted mean differences (WMD) with 95% confidence intervals for continuous variables. Due to the limited number of trials included in the analysis, a meta-regression was not feasible, as it would have lacked precision and accuracy. Therefore, no further statistical adjustments were undertaken to address potential baseline confounding.\u003c/p\u003e \u003c/div\u003e"},{"header":"3. Results","content":"\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003e3.1 Study selection\u003c/h2\u003e \u003cp\u003eThe search of the database resulted in a total of 275 articles, of which 117 were excluded after the screening of the title and abstract, while five more were excluded after the screening of the full text, leaving only five studies included \u003csup\u003e[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan additionalcitationids=\"CR11\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]\u003c/sup\u003e, as presented in Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e1\u003c/span\u003e. The total number of patients in all studies was 1,241, with 567 (45.6%) undergoing TORT and 674 (54.4%) receiving OT. The baseline characteristics of patients, such as sex, age, BMI, tumor size, and stages of disease, were well balanced in all groups. However, there were variations in CND and pathological composition, such as the ratio of benign lesions to PTC, as shown in Supplementary Figure. The variations in CND were mainly due to different CND rates, which were largely influenced by different practice patterns and guidelines during different time periods. The variations in pathological composition were mainly due to different proportions of benign lesions, which is not as directly related to evaluating the efficacy of PTC as is surgical efficacy. However, as shown in Supplementary Figure, there was sufficient intergroup comparability of patients' baseline characteristics among PTC patients in both groups, as shown in the original studies, indicating that heterogeneity is not likely to affect the results of our current meta-analysis. Besides, as shown in Tables\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e and \u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, two studies \u003csup\u003e[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]\u003c/sup\u003e also evaluated patients' satisfaction and found higher satisfaction in patients receiving TORT, as shown in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e, which shows an overview of perioperative outcome measures.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e Characteristics of included studies\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eauthor\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eyear\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eRegion\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003estudy type\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003eNo. of patients\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eOT\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eTORT\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLee\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2026\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eKorea\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePropensity Score-Matched\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e124\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e124\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLee\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2023\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eKorea\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePropensity Score-Matched\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSong\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2021\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eKorea\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePropensity Score-Matched\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e57\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTae\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2019\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eKorea\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRetrospective\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e207\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYou\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2020\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eKorea\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePropensity Score-Matched\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e186\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e186\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003eAbbreviations: OT, open thyroidectomy; TORT, transoral robotic thyroidectomy.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBaseline characteristics of the studies included in this review\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"11\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eLee 2026\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eLee 2023\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003eSong 2021\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003eTae 2019\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e \u003cp\u003eYou 2020\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOT\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTORT\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eOT\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eTORT\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eOT\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eTORT\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eOT\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003eTORT\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e \u003cp\u003eOT\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c11\"\u003e \u003cp\u003eTORT\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNumber of patients,n\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e124\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e124\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e207\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e186\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e186\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMean age(year)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e43.0\u0026thinsp;\u0026plusmn;\u0026thinsp;8.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e43.2\u0026thinsp;\u0026plusmn;\u0026thinsp;8.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e45.7\u0026thinsp;\u0026plusmn;\u0026thinsp;14.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e45.7\u0026thinsp;\u0026plusmn;\u0026thinsp;11.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e51.2\u0026thinsp;\u0026plusmn;\u0026thinsp;11.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e51.7\u0026thinsp;\u0026plusmn;\u0026thinsp;9.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e54.5\u0026thinsp;\u0026plusmn;\u0026thinsp;14.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e45.5\u0026thinsp;\u0026plusmn;\u0026thinsp;18.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e43.1\u0026thinsp;\u0026plusmn;\u0026thinsp;10.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e42.2\u0026thinsp;\u0026plusmn;\u0026thinsp;10.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI(Kg/m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23.8\u0026thinsp;\u0026plusmn;\u0026thinsp;3.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23.7\u0026thinsp;\u0026plusmn;\u0026thinsp;3.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e25.1\u0026thinsp;\u0026plusmn;\u0026thinsp;4.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e24.3\u0026thinsp;\u0026plusmn;\u0026thinsp;3.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e25.0\u0026thinsp;\u0026plusmn;\u0026thinsp;3.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e24.6\u0026thinsp;\u0026plusmn;\u0026thinsp;3.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e24.1\u0026thinsp;\u0026plusmn;\u0026thinsp;3.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e23.5\u0026thinsp;\u0026plusmn;\u0026thinsp;3.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex (female), n\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e109\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e150\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e150\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e154\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTumor size, cm\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.6\u0026thinsp;\u0026plusmn;\u0026thinsp;0.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.6\u0026thinsp;\u0026plusmn;\u0026thinsp;0.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.9\u0026thinsp;\u0026plusmn;\u0026thinsp;0.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.9\u0026thinsp;\u0026plusmn;\u0026thinsp;0.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.49\u0026thinsp;\u0026plusmn;\u0026thinsp;0.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1.02\u0026thinsp;\u0026plusmn;\u0026thinsp;0.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.67\u0026thinsp;\u0026plusmn;\u0026thinsp;0.55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.7\u0026thinsp;\u0026plusmn;\u0026thinsp;0.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eExtent of thyroidectomy, n\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIsthmusectomy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLobectomy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e115\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e111\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e125\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e174\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e174\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal thyroidectomy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCentral neck dissection, n\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e119\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e103\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTNM Stage, n\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e153\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eII\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIII\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePathology, n\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBenign tumor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePTC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e124\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e124\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e164\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e153\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e167\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFTC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"11\"\u003eAbbreviation: OT, open thyroidectomy; TORT, transoral robotic thyroidectomy ; BMI, body mass index; PTC, papillary thyroid carcinoma; FTC, follicular thyroid carcinoma;NA, Not available.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e Surgical outcomes of the studies included in this review\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"12\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c12\" colnum=\"12\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eLee 2026\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eLee 2023\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003eSong 2021\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003eTae 2019\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e \u003cp\u003eYou 2020\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c12\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOT\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTORT\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eOT\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eTORT\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eOT\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eTORT\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eOT\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003eTORT\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e \u003cp\u003eOT\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c11\"\u003e \u003cp\u003eTORT\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNumber of patients, n\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e124\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e124\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e207\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e186\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e186\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOperative time, min\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLobectomy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e56.7\u0026thinsp;\u0026plusmn;\u0026thinsp;14.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e170.7\u0026thinsp;\u0026plusmn;\u0026thinsp;28.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e101.93\u0026thinsp;\u0026plusmn;\u0026thinsp;33.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e186.91\u0026thinsp;\u0026plusmn;\u0026thinsp;53.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e115.5\u0026thinsp;\u0026plusmn;\u0026thinsp;32.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e153.9\u0026thinsp;\u0026plusmn;\u0026thinsp;40.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal thyroidectomy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e101.1\u0026thinsp;\u0026plusmn;\u0026thinsp;19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e260.2\u0026thinsp;\u0026plusmn;\u0026thinsp;32.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e131.2\u0026thinsp;\u0026plusmn;\u0026thinsp;43.48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e225.21\u0026thinsp;\u0026plusmn;\u0026thinsp;47.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e140.4\u0026thinsp;\u0026plusmn;\u0026thinsp;34.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e209.8\u0026thinsp;\u0026plusmn;\u0026thinsp;50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLOS, day\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.8\u0026thinsp;\u0026plusmn;\u0026thinsp;1.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.3\u0026thinsp;\u0026plusmn;\u0026thinsp;0.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e2.6\u0026thinsp;\u0026plusmn;\u0026thinsp;0.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e2.9\u0026thinsp;\u0026plusmn;\u0026thinsp;0.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNumber of retrieved lymph nodes, n\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7.1\u0026thinsp;\u0026plusmn;\u0026thinsp;5.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.9\u0026thinsp;\u0026plusmn;\u0026thinsp;2.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.46\u0026thinsp;\u0026plusmn;\u0026thinsp;3.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4.6\u0026thinsp;\u0026plusmn;\u0026thinsp;4.77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e6.6\u0026thinsp;\u0026plusmn;\u0026thinsp;5.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e6.3\u0026thinsp;\u0026plusmn;\u0026thinsp;6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e8.62\u0026thinsp;\u0026plusmn;\u0026thinsp;9.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e4.96\u0026thinsp;\u0026plusmn;\u0026thinsp;4.44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e0.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePostoperative pain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.6\u0026thinsp;\u0026plusmn;\u0026thinsp;0.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.2\u0026thinsp;\u0026plusmn;\u0026thinsp;0.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e2.64\u0026thinsp;\u0026plusmn;\u0026thinsp;1.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e3.12\u0026thinsp;\u0026plusmn;\u0026thinsp;0.76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRLN injury, n\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePermanent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e0.29\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTransient\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e0.33\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSkin fiap perforation, n\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e0.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSeroma, n\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e0.32\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHematoma, n\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e0.18\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHypoparathyroidism, n\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePermanent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e0.94\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTransient\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e0.79\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"10\" nameend=\"c10\" namest=\"c1\"\u003e \u003cp\u003eAbbreviation: Abbreviations: OT, open thyroidectomy; TORT, transoral robotic thyroidectomy ; RLN, recurrent laryngeal nerve;NA, Not available.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003e3.2 Assessment of quality\u003c/h2\u003e \u003cp\u003eUsing the ROBINS-I tool\u0026mdash;which examines confounding, participant selection, intervention classification, deviations from intended interventions, missing data, outcome measurement, and selective reporting\u0026mdash;we evaluated the methodological quality of the included studies. The results showed that there was no critical risk of bias in the studies included. Domain 1 of the ROBINS-I tool covers bias due to confounding. In this analysis, the studies were regarded as being at moderate risk of bias due to confounding as they used propensity score matching, while the previous study was regarded as being at serious risk of bias as it did not use the matching method. In the second domain of the ROBINS-I tool, which deals with bias in participant selection, the studies were regarded as being at moderate risk of bias as they were observational studies. In Domain 4 of the ROBINS-I tool, the studies' bias due to departure from the intended intervention is evaluated. In the studies reviewed, a moderate level of bias was established in this domain of the tool since the studies reviewed were of an observational nature. In Domain 6 and 7 of the tool, where the studies' bias in the measurement of the outcome and selective reporting is evaluated, it was established that the studies reviewed had a low level of bias. In addition, none of the studies reviewed had insufficient information in any of the domains of the tool. Overall, the studies included in the review showed good methodological quality. While the level of evidence was not high for the studies included in the review, the use of statistical adjustment methods, as used in the current meta-analysis, helped to increase the reliability of the findings.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003e3.3 Outcome analysis\u003c/h2\u003e \u003cdiv id=\"Sec12\" class=\"Section3\"\u003e \u003ch2\u003e3.3.1 Operative time\u003c/h2\u003e \u003cp\u003eIn the case of the two procedures, namely lobectomy and total thyroidectomy, it was evident that the time required to carry out the procedures was significantly higher when the transoral robotic thyroidectomy approach was used as opposed to the open thyroidectomy approach, as demonstrated by the results obtained from the pooled analysis of the lobectomy procedure, whereby a significant difference was noted between the two procedures, as demonstrated by the results obtained, whereby it was noted that there was a significant difference between the two procedures, with a calculated MD of -79.19, 95% CI -128.55 to -29.83, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05, I\u0026sup2; = 99%, as demonstrated in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e2\u003c/span\u003eA and \u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e2\u003c/span\u003eB.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section3\"\u003e \u003ch2\u003e3.2.2 LOS\u003c/h2\u003e \u003cp\u003ePatients who underwent open thyroidectomy had a significantly shorter length of hospital stay compared to those who received transoral robotic thyroidectomy (WMD = -0.35 days, 95% CI [-0.52 to -0.18], \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05; I\u0026sup2; = 12%), as demonstrated in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e2\u003c/span\u003eC.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section3\"\u003e \u003ch2\u003e3.2.3 Number of retrieved lymph nodes\u003c/h2\u003e \u003cp\u003eThe pooled analysis showed that the two groups had similar lymph node retrieval, and there was no significant difference (OR\u0026thinsp;=\u0026thinsp;1.2, 95% CI [-0.24 to 2.64], \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.10, I\u0026sup2; = 80%) as shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e2\u003c/span\u003eD.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section3\"\u003e \u003ch2\u003e3.2.4 Postoperative pain\u003c/h2\u003e \u003cp\u003eThe OT group had significantly lower mean postoperative pain scores compared with the TORT group (OR = -0.55, 95% [CI -0.68 to -0.41], \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05; I\u0026sup2; = 0%), as shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e2\u003c/span\u003eE.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section3\"\u003e \u003ch2\u003e3.2.5 Recurrent laryngeal nerve injury\u003c/h2\u003e \u003cp\u003eThe pooled results indicated that the rates of both permanent and transient RLN injury in the two groups were comparable, with no significant differences in permanent injury (OR\u0026thinsp;=\u0026thinsp;2.49, 95% CI [0.46 to 13.51], \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.29, I\u0026sup2; = 0%) or transient injury (OR\u0026thinsp;=\u0026thinsp;1.81, 95% CI [0.54 to 6.01], \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.33, I\u0026sup2; = 43%), as indicated in Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e3\u003c/span\u003eA and \u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e3\u003c/span\u003eB.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section3\"\u003e \u003ch2\u003e3.2.6 Skin flap perforation\u003c/h2\u003e \u003cp\u003eThe skin flap perforation only happened in the TORT group; however, no significant difference between the groups was observed using the pooled analysis (OR\u0026thinsp;=\u0026thinsp;0.22, 95% CI [0.04, 1.34], \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.10, I\u0026sup2; = 0%), as shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e3\u003c/span\u003eC.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section3\"\u003e \u003ch2\u003e3.2.7 Seroma、Hematoma\u003c/h2\u003e \u003cp\u003ePooled data revealed similar rates of seroma and hematoma for both groups. There were no statistically significant differences for seroma (OR 0.69, 95% CI [0.34\u0026ndash;1.42], \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.32, I\u0026sup2; = 28%) or for hematoma (OR 2.72, 95% CI [0.62\u0026ndash;11.87], \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.18, I\u0026sup2; = 0%), as shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e3\u003c/span\u003eD and \u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e3\u003c/span\u003eE.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section3\"\u003e \u003ch2\u003e3.2.8 Hypoparathyroidism\u003c/h2\u003e \u003cp\u003eThe pooled analysis showed that the rates of permanent and transient hypoparathyroidism were similar in both groups, with no significant differences (OR\u0026thinsp;=\u0026thinsp;1.05, 95% CI [0.31 to 3.48], p\u0026thinsp;=\u0026thinsp;0.94, I\u0026sup2; = 0%; OR\u0026thinsp;=\u0026thinsp;1.08, 95% CI [0.62 to 1.87], \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.79, I\u0026sup2; = 8%), as shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e3\u003c/span\u003eF and \u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e3\u003c/span\u003eG.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eEven though previous studies have shown the viability of TORT in specific patient groups \u003csup\u003e[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]\u003c/sup\u003e, the benefits of TORT over conventional OT, especially with regards to oncological safety, recovery, and outcome, are not clear. This study aims to be the first meta-analysis comparing TORT and OT, which goes beyond the results of the comparative studies to a more comprehensive evaluation of the two methods.\u003c/p\u003e \u003cp\u003eOperative duration has also been taken into consideration as an important factor for the efficiency of surgery as well as the proficiency of the surgical team. Reduction of the operative time has been considered to be important for minimizing the anesthetic exposure as well as making the most efficient use of resources. During the present meta-analysis, it was observed that there was a longer operative time with TORT compared to OT. This has been considered to be due to the additional time required for docking the robotic system, changing the instruments, as well as creating the subplatysmal space through the transoral approach\u003csup\u003e[\u003cspan additionalcitationids=\"CR21 CR22\" citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]\u003c/sup\u003e. Among the transoral approaches, robotic procedures have also been observed to be more time-consuming compared to purely endoscopic procedures\u003csup\u003e[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]\u003c/sup\u003e. Though the long operative time has been considered to be a disadvantage of the TORT procedure, it has also been observed that this disadvantage is directly related to the learning curve of the procedure\u003csup\u003e[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]\u003c/sup\u003e. As the learning curve of the procedure increases, the efficiency of the procedure has been observed to be greatly increased. This has also been considered to be related to the three-dimensional magnified vision of the surgical field that has been considered to be helpful for meticulous dissection of the structures\u003csup\u003e[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eAs far as the short-term postoperative period is concerned, it is easy to understand the advantages of the OT approach, as it was demonstrated during the analysis that the short hospital stay following the OT approach is associated with reduced levels of postoperative pain compared to the TORT approach, as it was demonstrated in previous studies\u003csup\u003e[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]\u003c/sup\u003e. This is easily explained if the degree of tissue trauma is considered, as in the OT approach the incision of the tissue is limited in the neck area, whereas in the TORT approach the dissection of the subcutaneous tissue from the facial area to the neck is required in order to avoid the presence of a scar after the operation. This increases the level of early postoperative pain after the TORT approach. In conclusion, it is not necessarily true that the absence of a scar after thyroidectomy is associated with the minimally invasive nature of the specific approach. Patients who are undergoing the TORT approach need to be informed about the compromises of this approach.\u003c/p\u003e \u003cp\u003eWith regard to oncological completeness of surgery and common postoperative complications, there are several issues of interest. The central compartment being the most common location for lymph node metastasis in PTC, lymph node dissection in the central compartment is critical in order to reduce locoregional recurrence. Therefore, the new method should have the same efficacy as the open method in terms of surgical completeness. Our analysis revealed no significant difference in the number of central lymph nodes retrieved between patients undergoing transoral robotic thyroidectomy and those receiving open thyroidectomy. This further emphasizes the fact that the main goal of thyroidectomy surgery is cure, not retrieval of lymph nodes. The robotic platform used in TORT provides three-dimensional magnified visualization and precise instrument articulation, which may help in more accurate discrimination of lymphatic tissue from surrounding adipose tissue, vascular structures, and parathyroid glands in a confined field of dissection, thereby providing precise dissection of these structures \u003csup\u003e[\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]\u003c/sup\u003e. With respect to common postoperative complications, no significant differences were found between both techniques with respect to postoperative hematoma and seroma formation, as deduced from the analysis of both techniques. The magnified visualization of robotic surgery may provide accurate intraoperative hemostasis of small vessels, which might be difficult with other techniques \u003csup\u003e[\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]\u003c/sup\u003e. Although seroma formation following TORT may be related to increased risk of disruption of lymphatic vessels following extensive flap dissection for TORT, which increases the risk of seroma, and failure of routine placement of drains, seroma formation following TORT is easily managed with simple aspiration and does not pose any adverse effects\u003csup\u003e[\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eWith regard to the critical anatomical structures involved, the RLN travels down on the back of the thyroid gland in the tracheo-esophageal groove and remains prone to traction, thermal, or even iatrogenic division during surgery. Injury to the RLN can lead to hoarseness, aspiration, or even airway obstruction in the most severe cases. Therefore, preserving the RLN is one of the critical technical objectives in thyroid surgery. Our meta-analysis showed that the percentage of RLN injury in TORT and OT does not significantly differ from each other. The similar rate of RLN preservation in the TORT group is likely due to the consistent use of intraoperative neuromonitoring (IONM), which facilitates accurate nerve localization\u0026mdash;even from indirect visual angles\u0026mdash;and helps minimize nerve injury. \u003csup\u003e[\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eAnother major complication that arises after thyroid surgery is postoperative hypoparathyroidism, which is attributed to damage or compromise of the blood supply to the parathyroid glands during thyroid surgery. Parathyroid glands are particularly vulnerable due to their small size and anatomical proximity to the posterior thyroid capsule, making their blood supply susceptible to compromise during surgical procedures. In the current meta-analysis, no significant difference in the occurrence of hypoparathyroidism between the TORT and OT groups was observed, indicating that TORT does not increase the risk and provides the same level of long-term safety when performed by experienced surgeons \u003csup\u003e[\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]\u003c/sup\u003e. However, as has been suggested in other studies, the success of thyroidectomy, whether performed by the transoral robotic thyroidectomy technique or the traditional open thyroidectomy technique, is based primarily on the careful capsular dissection of the thyroid gland along the posterior capsule of the thyroid gland, as well as the careful identification and preservation of the parathyroid glands, rather than the technique used for thyroidectomy \u003csup\u003e[\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eSkin flap perforation was found to be the complication that was uniquely associated with the procedure of TORT in this study. This complication is more likely to happen in the early learning phases of this new technique and is believed to be related to the technical difficulty in performing a subcutaneous dissection with a small endoscopic view, especially in patients with relatively thin skin in the neck\u003csup\u003e[\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]\u003c/sup\u003e. The study highlights the importance of the surgeon's skill in the procedure of TORT and shows that the rate of this complication can be significantly reduced by the implementation of a standard approach and gaining experience in the procedure. Two studies\u003csup\u003e[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]\u003c/sup\u003e have demonstrated a significant advantage of the procedure of TORT over OT in terms of cosmetic satisfaction and improvement of the appearance of the neck. The most important point for the acceptance of this procedure has to do with the level of satisfaction regarding cosmetics and quality of life with regard to the appearance of the neck. Overall patient satisfaction is a complex evaluation of the individual. The overall patient satisfaction is a multifactorial assessment, where many factors are considered other than the aspect of cosmetic satisfaction.\u003c/p\u003e \u003cp\u003eHowever, there are some limitations that need to be considered in this study. First, the study only included retrospective observational studies, the vast majority of which used propensity score matching. Nevertheless, the level of evidence is lower than what can be obtained from randomized controlled trials. Secondly, the technical specifics of the operation, such as the routine use of an auxiliary axillary port and intraoperative neural monitoring, may have caused heterogeneity and, as a result, influenced the outcomes, including the time and complications. Thirdly, the studies that were analyzed were carried out on Asian populations, and although they reflect the level of development and application of the technique, they may not be applicable to other populations in the world, as the patients and the surgeons may be different. Finally, the short follow-up time, as clearly represented in the studies, cannot be considered for the evaluation of the long-term results, such as the occurrence of distant metastases, of papillary carcinoma.\u003c/p\u003e"},{"header":"5.Conclusion","content":"\u003cp\u003eThe meta-analysis showed similar performance of the two techniques in terms of oncological and safety-related parameters. However, transoral robotic thyroidectomy was resulted in significantly prolonged operative duration, increased early postoperative pain, and extended LOS when compared with open thyroidectomy. There was also a risk of skin flap perforation in the case of the robotic procedure. Although the overall complication profile was similar in both techniques, the risk of skin flap perforation in the robotic procedure needs to be considered. These conclusions have to be validated by further studies.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eProtocol development: GX, RY, XX,HJ,LS; literature search and database creation: GX, RY and XX; formal analysis: GX, RY, XX, ZYF ; methodology: GX, SJ and LS;supervision: LS; writing manuscript: GX, XX, LYM, HJ,RY,LS; All authors have read and approved the final manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003ePizzato M, Li M, Vignat J et al (2022) The epidemiological landscape of thyroid cancer worldwide: GLOBOCAN estimates for incidence and mortality rates in 2020. Lancet Diabetes Endocrinol 10(4):264\u0026ndash;272\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWitzel K, von Rahden BH, Kaminski C et al (2008) Transoral access for endoscopic thyroid resection. Surg Endosc 22(8):1871\u0026ndash;1875\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChoi Y, Lee JH, Kim YH et al (2014) Impact of postthyroidectomy scar on the quality of life of thyroid cancer patients. Ann Dermatol 26(6):693\u0026ndash;699\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDionigi G, Bacuzzi A, Lavazza M et al (2016) Transoral endoscopic thyroidectomy via vestibular approach: operative steps and video. Gland Surg 5(6):625\u0026ndash;627\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAnuwong A, Sasanakietkul T, Jitpratoom P et al (2018) Transoral endoscopic thyroidectomy vestibular approach (TOETVA): indications, techniques and results. Surg Endosc 32(1):456\u0026ndash;465\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRichmon JD, Kim HY (2017) Transoral robotic thyroidectomy (TORT): procedures and outcomes. Gland Surg 6(3):285\u0026ndash;289\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTae K, Ji YB, Song CM et al (2019) Robotic and Endoscopic Thyroid Surgery: Evolution and Advances. Clin Exp Otorhinolaryngol 12(1):1\u0026ndash;11\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSong CM, Bang HS, Kim HG et al (2021) Health-related quality of life after transoral robotic thyroidectomy in papillary thyroid carcinoma. Surgery 170(1):99\u0026ndash;105\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKim HY, Chai YJ, Dionigi G et al (2018) Transoral robotic thyroidectomy: lessons learned from an initial consecutive series of 24 patients. Surg Endosc 32(2):688\u0026ndash;694\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLee SJ, Ryu SR, Ji YB et al (2023) Five-Year Oncologic Outcome and Surgical Completeness of Transoral Robotic Thyroidectomy for Papillary Thyroid Carcinoma: Comparison with Conventional Transcervical Thyroidectomy Using Propensity Score Matching. Ann Surg Oncol 30(4):2256\u0026ndash;2264\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYou JY, Kim HY, Park DW et al (2021) Transoral robotic thyroidectomy versus conventional open thyroidectomy: comparative analysis of surgical outcomes using propensity score matching. Surg Endosc 35(1):124\u0026ndash;129\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTae K, Ji YB, Song CM et al (2020) Safety and efficacy of transoral robotic and endoscopic thyroidectomy: The first 100 cases. Head Neck 42(2):321\u0026ndash;329\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePage MJ, McKenzie JE, Bossuyt PM et al (2021) The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 372:n71\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSterne JA, Hern\u0026aacute;n MA, Reeves BC et al (2016) ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ 355:i4919\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLau J, Ioannidis JP, Terrin N et al (2006) The case of the misleading funnel plot. BMJ 333(7568):597\u0026ndash;600\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eStang A (2010) Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol 25(9):603\u0026ndash;605\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLee JH, Gwak H (2025) Oncologic adequacy and outcomes of open, transoral endoscopic, and robotic thyroidectomy for papillary thyroid carcinoma: a propensity score-matched analysis. World J Surg Oncol 24(1):5\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNguyen VC, Song CM, Ji YB et al (2024) Comparison of surgical outcomes of transoral robotic and endoscopic thyroidectomy: A systematic review and network meta-analysis. Head Neck 46(3):688\u0026ndash;701\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhou S, Wang D, Liu X et al (2023) Transoral thyroidectomy vestibular approach vs. conventional open thyroidectomy: a systematic review and meta-analysis. Endocrine 81(1):36\u0026ndash;46\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSun GH, Peress L, Pynnonen MA (2014) Systematic review and meta-analysis of robotic vs conventional thyroidectomy approaches for thyroid disease. Otolaryngol Head Neck Surg 150(4):520\u0026ndash;532\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJackson NR, Yao L, Tufano RP et al (2014) Safety of robotic thyroidectomy approaches: meta-analysis and systematic review. Head Neck 36(1):137\u0026ndash;143\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRazavi CR, Khadem MGA, Fondong A et al (2018) Early outcomes in transoral vestibular thyroidectomy: Robotic versus endoscopic techniques. Head Neck 40(10):2246\u0026ndash;2253\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRussell JO, Razavi CR, Shaear M et al (2019) Transoral Vestibular Thyroidectomy: Current State of Affairs and Considerations for the Future. J Clin Endocrinol Metab 104(9):3779\u0026ndash;3784\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJiang Y, Gao B, Zhang X et al (2014) Prevention and treatment of recurrent laryngeal nerve injury in thyroid surgery. Int J Clin Exp Med 7(1):101\u0026ndash;107\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHa TK, Kim DW, Park HK et al (2018) Comparison of Postoperative Neck Pain and Discomfort, Swallowing Difficulty, and Voice Change After Conventional Open, Endoscopic, and Robotic Thyroidectomy: A Single-Center Cohort Study. Front Endocrinol (Lausanne) 9:416\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAgrawal A, Ayantunde AA, Cheung KL (2006) Concepts of seroma formation and prevention in breast cancer surgery. ANZ J Surg 76(12):1088\u0026ndash;1095\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKandil E, Attia AS, Hadedeya D et al (2020) Robotic Thyroidectomy: Past, Future, and Current Perspectives. Otolaryngol Clin North Am 53(6):1031\u0026ndash;1039\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKim WW, Jung JH, Lee J et al (2016) Comparison of the Quality of Life for Thyroid Cancer Survivors Who Had Open Versus Robotic Thyroidectomy. J Laparoendosc Adv Surg Tech A 26(8):618\u0026ndash;624\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKandil E, Hammad AY, Walvekar RR et al (2016) Robotic Thyroidectomy Versus Nonrobotic Approaches: A Meta-Analysis Examining Surgical Outcomes. Surg Innov 23(3):317\u0026ndash;325\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRamouz A, Rasihashemi SZ, Daghigh F et al (2017) Predisposing factors for seroma formation in patients undergoing thyroidectomy: Cross-sectional study. Ann Med Surg (Lond) 23:8\u0026ndash;12\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEbner F, Friedl TWP, de Gregorio A et al (2018) Seroma in breast surgery: all the surgeons fault? Arch Gynecol Obstet 298(5):951\u0026ndash;959\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDionigi G, Kim HY, Wu CW et al (2017) Neuromonitoring in endoscopic and robotic thyroidectomy. Updates Surg 69(2):171\u0026ndash;179\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLang BH, Wong CK, Tsang JS et al (2015) A systematic review and meta-analysis evaluating completeness and outcomes of robotic thyroidectomy. Laryngoscope 125(2):509\u0026ndash;518\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGiordano D, Valcavi R, Thompson GB et al (2012) Complications of central neck dissection in patients with papillary thyroid carcinoma: results of a study on 1087 patients and review of the literature. Thyroid 22(9):911\u0026ndash;917\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTae K, Lee DW, Song CM et al (2019) Early experience of transoral thyroidectomy: Comparison of robotic and endoscopic procedures. Head Neck 41(3):730\u0026ndash;738\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"journal-of-robotic-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"jors","sideBox":"Learn more about [Journal of Robotic Surgery](http://link.springer.com/journal/11701)","snPcode":"11701","submissionUrl":"https://submission.nature.com/new-submission/11701/3","title":"Journal of Robotic Surgery","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Robotic-assisted surgery, Transoral robotic thyroidectomy, TORT, Meta-analysis","lastPublishedDoi":"10.21203/rs.3.rs-8946733/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8946733/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eThe rate of thyroid cancer has continued to rise, especially among young women. Although conventional open thyroidectomy (OT) is effective in disease control, the inevitable neck scar has a potential negative effect on the patients’ mental health. In an attempt to minimize cosmetic deformity, transoral robotic thyroidectomy (TORT) has emerged as a scarless and minimally invasive technique. However, its safety and completeness need to be assessed.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003ePubMed, Embase, the Cochrane Library, and Web of Science were systematically queried for clinical trials comparing transoral robotic thyroidectomy and open thyroidectomy for thyroid disease. The primary endpoints were the central lymph node yield, the rates of complications such as recurrent laryngeal nerve injury, hypoparathyroidism, hematoma, seroma, and skin flap perforation, whereas the secondary endpoints included the operation time, length of hospitalization, and postoperative pain. The results were synthesized using a random effects model.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eA total of five studies were included in this meta-analysis. Compared to OT, TORT was associated with increased operative time (MD = -79.19, 95% CI [-128.55, -29.83], P \u0026lt; 0.05; MD = -107.6, 95% CI [-167.63, -47.58], P \u0026lt; 0.05), increased length of stay (MD = -0.35, 95% CI [-0.52, -0.18], P \u0026lt; 0.05), and increased early postoperative pain scores. The central lymph node yield, transient or permanent recurrent laryngeal nerve injury, and hypoparathyroidism were comparable. The incidence of skin flap perforation was noted only in the TORT group.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions: \u003c/strong\u003eTORT has the advantage of providing superior cosmetic results without compromising the completeness of oncological clearance or increasing the risk of significant nerve and parathyroid gland damage. However, the cost of this approach is increased operative time, pain, length of stay, and the possibility of skin flap perforation. Further studies are required to assess the long-term oncological outcome.\u003c/p\u003e","manuscriptTitle":"A Systematic Review and Meta-Analysis: Surgical Outcomes Comparing Transoral Robotic and Open Approaches to Thyroidectomy","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-03-08 17:00:09","doi":"10.21203/rs.3.rs-8946733/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-03-15T12:18:34+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-15T09:40:24+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-11T12:00:33+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"97754704135510488142889969911807776906","date":"2026-03-08T17:11:50+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"106428927082084382872992268757483173833","date":"2026-03-04T21:35:17+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"214821120980697619872868542021597287556","date":"2026-03-04T16:29:20+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-03-02T16:21:00+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-02-24T12:14:20+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-02-24T04:17:03+00:00","index":"","fulltext":""},{"type":"submitted","content":"Journal of Robotic Surgery","date":"2026-02-23T11:42:04+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"journal-of-robotic-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"jors","sideBox":"Learn more about [Journal of Robotic Surgery](http://link.springer.com/journal/11701)","snPcode":"11701","submissionUrl":"https://submission.nature.com/new-submission/11701/3","title":"Journal of Robotic Surgery","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"6d3e20b3-3968-48ee-8878-a6e5f1969c40","owner":[],"postedDate":"March 8th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-04-07T16:00:42+00:00","versionOfRecord":{"articleIdentity":"rs-8946733","link":"https://doi.org/10.1007/s11701-026-03382-w","journal":{"identity":"journal-of-robotic-surgery","isVorOnly":false,"title":"Journal of Robotic Surgery"},"publishedOn":"2026-04-02 15:57:51","publishedOnDateReadable":"April 2nd, 2026"},"versionCreatedAt":"2026-03-08 17:00:09","video":"","vorDoi":"10.1007/s11701-026-03382-w","vorDoiUrl":"https://doi.org/10.1007/s11701-026-03382-w","workflowStages":[]},"version":"v1","identity":"rs-8946733","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8946733","identity":"rs-8946733","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}