Afety and effectiveness of transoral vestibular approach laparoscopic thyroidectomy f or thyroid papillary carcinoma: a propensity score matching analysis

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Methods Clinical data of PTC patients who underwent thyroidectomy at a single center from March 2021 to March 2022 were retrospectively analyzed. Patients were divided into COT group and TOETVA group. Propensity score matching (1:1) was performed to balance baseline characteristics. Intraoperative and postoperative outcomes were compared between the two matched groups. Results A total of 97 patients (66 COT, 31 TOETVA) were included. After matching, 20 patients remained in each group, with comparable baseline data (P>0.05). No significant differences were observed in intraoperative blood loss, operative time, hospital stay, hospitalization cost, overall complication rate, or short-term recurrence rate (P>0.05). The TOETVA group had a significantly lower rate of parathyroid autotransplantation (5.0% vs. 55.0%, P<0.05) but a significantly lower number of harvested lymph nodes (5.2±4.3 vs. 11.6±7.9, P<0.05) compared to the COT group. Conclusions TOETVA demonstrates comparable safety and short-term efficacy to COT in selected PTC patients, with a potential advantage in preserving parathyroid glands. However, the lower number of harvested lymph nodes is a notable limitation. The long-term oncological safety requires further validation. Patient selection should be rigorous. Propensity score matching Thyroid papillary carcinoma Transoral approach Laparoscopic thyroidectomy Treatment outcome Introduction Thyroid cancer is the tenth most common malignant tumor in the world, with a global incidence rate of about 3% and a mortality rate of about 0.4%. The incidence rate of thyroid cancer in China is higher than the world average, but the mortality rate is lower than the world level [1-3]. Papillary Thyroid Carcinoma (PTC) is the most common pathologic type of thyroid cancer, accounting for about 90% [4]. Surgery is the mainstay of treatment for PTC, and conventional open thyroidectomy (COT) is highly effective, but leaves permanent scarring in the neck, which negatively affects the quality of life and psychological state of patients, especially those with keloid bodies and young women. With the deepening of the concept of minimally invasive surgery and the development of laparoscopic technology, various approaches to laparoscopic thyroid surgery have emerged, including the thoracic breast approach, axillary approach, retroauricular approach, and transoral vestibular approach [5-6]. Among them, Transoral Endoscopic Vestibular Approach Thyroidectomy (TOETVA) has become a research hotspot in thyroid surgery in recent years because of its complete scarlessness on the body surface, short surgical path, and clear anatomical level [7-9]. However, this procedure theoretically increases the risk of infection because the incision is located in the oral cavity (class II incision); at the same time, its thoroughness of central regional lymph node dissection and long-term oncological safety are controversial [10-11]. At present, high-quality clinical evidence on TOETVA for PTC is still limited both at home and abroad, and most studies suffer from small sample size, obvious selection bias, and short follow-up time. Therefore, it is necessary to systematically compare the safety and efficacy of TOETVA and COT in the treatment of PTC on the basis of controlling confounding factors, so as to provide a more reliable evidence-based basis for clinical decision-making. Methods Ethical Approval and Informed Consent This study was approved by the Medical Ethics Committee of Huaihua Central Hospital (Approval Number: HHSEYYEC-202604-K1). All patients signed a written informed consent form before surgery and agreed that their surgical and follow-up data would be used for the clinical study. Study Design The clinical data of patients with papillary thyroid carcinoma who underwent thyroidectomy at the Department of Hepatobiliary, Pancreatic and Thyroid Surgery, Huaihua City Central Hospital, from March 2021 to March 2022 were retrospectively analyzed. Inclusion and exclusion criteriaInclusion criteria Inclusion Criteria:(1) postoperative pathology confirmed the diagnosis of thyroid papillary carcinoma; (2) no distant metastasis in preoperative imaging (neck ultrasound and CT if necessary); (3) no serious heart, brain, lung or other organ diseases, and able to tolerate general anesthesia and surgery; (4) clear indications for surgery and voluntarily accept the corresponding operation. Exclusion Criteria:(1) Thyroid gland with lesions in both lobes requiring total resection; (2) Previous history of thyroid surgery or ablation; (3) Pregnant or lactating females; (4) Combined head and neck or oral deformity, unable to tolerate the position of the oral approach. Surg ery M ethod Endoscopy Team (Transoral Vestibular Approach): 24 hours before the operation and 24 hours after the operation oral third-generation cephalosporin to prevent infection. After general anesthesia intubation, the patient was placed in a mild hyperextension position of the neck. A transverse incision of about 2 cm in length was made anterior to the lower lip tie and away from the gingival root, and it was obliquely freed to the mandibular bone surface turn. A 10-mm Trocar was inserted into the sub-chin and anterior cervical regions with inflation fluid, and a CO₂ pneumoperitoneum was established with the pressure maintained at 6 mm Hg. A 5-mm Trocar was inserted into the mandibular bony surface by bluntly separating the operative tunnels approximately 2.5 cm on either side of the midline of the incision, lateral to the chin nerve, and toward the ipsilateral sternocleidomastoid joint, and incising the cervical white line, retracting the strap muscles and sternocleidomastoid muscle, and then removing the thyroid lesion and performing complete The thyroid lesion was resected and central lymph node dissection was performed. The field was repeatedly rinsed with distilled water, and a drain was placed in front of the neck. The oral cavity was sterilized with complex iodine, and the mucosa of the oral incision was closed with 5-0 absorbable suture. Traditional group (anterior cervical open approach): After general anesthesia intubation, the patient takes a mild hyperextension position of the neck. Take the low anterior cervical arc incision, about 6cm long, sequentially incise the skin, subcutaneous tissue and the vastus cervicis muscle, free the skin flap to the superficial surface of the subglottic muscle group, incise the cervical white line up to the intrinsic periosteum of the thyroid gland. After incision of the suspensory ligament and the lateral ligament, complete resection of the thyroid lesion and lymph node dissection were performed. Distilled water was repeatedly rinsed, and a drain was placed anteriorly in the neck.4-0 absorbable sutures were used to close the white line of the neck and the vastus cervicis muscle intermittently, and nickel-titanium memory alloy sutures were used to close the incision intradermally. Endpoint Event Definition number of lymph nodes cleared; indicators related to parathyroid injury (with intraoperative parathyroid transplantation rate as a surrogate indicator, with transplantation indicated as immediate autotransplantation after intraoperative detection of impaired parathyroid blood flow or unintentional resection). Secondary outcome indicators: operative time (minutes), intraoperative bleeding (milliliters), length of hospital stay (days), hospitalization costs (dollars), postoperative complications (including temporary or permanent recurrent laryngeal nerve injury, postoperative hematoma, infection, and symptoms of hypocalcemia, with severity documented by using the Clavien-Dindo grading scale), and short-term recurrences (neck recurrence confirmed by imaging or perforated cytology within 6 to 12 months after surgery). (neck recurrence confirmed by imaging or puncture cytology). Follow Up Postoperative follow-up was performed through a combination of outpatient follow-up (1, 3, 6, and 12 months after surgery) and telephone follow-up, which included thyroid function, calcium, parathyroid hormone, and neck ultrasound. The incision was closed intradermally with amniotic sutures. Statistical Analysis Statistical methods were used to analyze the data using SPSS 22.0 statistical software. In order to eliminate selection bias between groups, Propensity Score Matching (PSM) was used, with surgical method as the dependent variable and age, gender, and tumor diameter as the covariates, and 1:1 nearest neighbor matching method was used, and the caliper value was set to 0.004. After matching, the measurement data conforming to the normal distribution were expressed as (xˉ±sxˉ±s), and comparisons between groups were made using the independent samples t test; the count data were expressed as the number of cases (percentage), and comparisons between groups were made using the χ² test or Fisher exact test. p < p < p < s. The data were compared using the independent samples t test. Comparisons were made using independent samples t-test; count data were expressed as the number of cases (percentage), and comparisons between groups were made using the χ² test or Fisher's exact test. p < 0.05 was taken as statistically significant difference. Results Patient and Lesion Characteristics Comparison of general data before and after matching A total of 97 patients were included, including 66 patients in the conventional group and 31 patients in the lumpectomy group. Before matching, the differences between the two groups were statistically significant in gender composition (P=0.031) and tumor diameter (P=0.003), and the difference in age was not statistically significant (P=0.408). After propensity score matching (1:1), 20 pairs of patients were successfully matched. The differences between the two groups after matching in terms of gender, age, and tumor diameter were not statistically significant (P>0.05) and were comparable. See Table 1 and Table 2 . Table 1 Comparison of general information between the two groups of patients before matching Category Numbers(n) Gender (male/female, n) Age (x ± s, years) Tumour diameter (x ± s, cm) Traditional Group 66 9 / 57 44.8 ± 11.2 1.2 ± 1.1 Endoscopy Group 31 10 / 21 40.0 ± 9.9 0.7 ± 0.4 t/χ² χ² = 4.644 t = 2.004 t = 3.061 P 0.031 0.408 0.003 x ± s are mean±SD Table 2 Comparison of general information of the two groups of patients after matching Category Numbers(n) Gender (male/female, n) Age (x ± s, years) Tumour diameter (x ± s, cm) Traditional Group 20 4 / 16 45.1 ± 10.5 1.1 ± 0.8 Endoscopy Group 20 6 / 14 41.2 ± 9.3 0.7 ± 0.4 t/χ² χ² = 0.439 t = 1.226 t = 1.942 P 0.508 0.228 0.060 x ± s are mean±SD Comparison of intraoperative and postoperative conditions between the two groups after matching After matching, the differences in intraoperative bleeding, operation time, hospitalization time, and hospitalization cost between the two groups were not statistically significant (P>0.05). The parathyroid transplantation rate in the luminal group (5.0%) was significantly lower than that in the conventional group (55.0%), and the difference was statistically significant (P=0.002). The number of lymph nodes cleared in the lumboendoscopy group (5.2±4.3) was significantly less than that in the conventional group (11.6±7.9), and the difference was statistically significant (P=0.011). There were no serious complications of Clavien-Dindo grade III or higher in both groups after surgery, and there were no short-term recurrence or death cases. Among the postoperative complications, temporary laryngeal recurrent nerve palsy occurred in 1 case (5.0%) in the conventional group and temporary hypesthesia of the lower lip in 1 case (5.0%) in the luminal group, which both recovered within 3 months. The difference in the complication rate between the two groups was not statistically significant. See Table 3 and Table 4 . Table 3 Comparison of intraoperative conditions between the two groups after matching Category Numbers(n) Intraoperative blood loss (ml, x ± s) Duration of surgery (min, x ± s) Parathyroid gland transplantation [Cases (%)] Number of lymph nodes removed (n, x ± s) Endoscopy Group 20 11.5 ± 5.1 180.3 ± 44.4 1 (5.0%) 5.2 ± 4.3 Traditional Group 20 10.0 ± 4.5 184.7 ± 53.5 11 (55.0%) 11.6 ± 7.9 t/χ² t = 0.983 t = 0.286 χ² = 9.643 t = 3.056 P 0.332 0.776 0.002 0.004 x ± s are mean±SD Table 4 Comparison of postoperative conditions between the two groups after matching Category Numbers(n) Length of stay (days, x ± s) Hospitalisation costs (RMB, x±s ) Total complications [cases (%)] Short-term recurrence [cases (%)] Endoscopy Group 20 8.7 ± 2.7 16290.8 ± 1162.4 1 (5.0%) 0 (0.0%) Traditional Group 20 10.2 ± 4.2 17490.3 ± 4557.8 1 (5.0%) 0 (0.0%) t/χ² t = 1.335 t = 1.115 - - P 0.190 0.273 1.000* - x ± s are mean±SD Discussion The incidence of papillary thyroid carcinoma (PTC) continues to rise worldwide, and surgery is its mainstay of treatment [13]. Conventional open thyroidectomy (COT) is efficacious but leaves permanent scarring on the neck, which negatively affects the quality of life and psychological status of some patients, especially young women [14]. With the development of minimally invasive surgical concepts and laparoscopic techniques, transoral vestibular approach laparoscopic thyroidectomy (TOETVA) has become a research hotspot in thyroid surgery due to its realization of the advantages of complete scarlessness of the body surface, short pathway, and clear vision [15]. However, the oncologic safety and efficacy of this procedure in PTC still needs to be supported by high-quality clinical evidence. In this study, we compared the recent efficacy of transoral vestibular approach luminal thyroidectomy (TOETVA) with conventional open thyroidectomy (COT) for the treatment of papillary thyroid carcinoma (PTC) after balancing the baseline differences by propensity score matching method. The results showed that there were no significant differences between the two groups in terms of intraoperative bleeding, operative time, hospitalization time, and hospitalization costs, indicating that TOETVA was technically feasible and did not significantly increase surgical trauma or economic burden. This finding is highly consistent with the findings of Bian et al [16], who, after analyzing 466 thyroid cancer patients (318 final matches) by propensity score matching, found that TOETVA did not differ significantly from COT in terms of hospitalization costs, length of stay, complications, and pain scores, despite a longer operative time. However, the finding of no significant difference in operative time in this study is not consistent with most existing studies. For example, Zhang et al [17] stated that TOETVA had a longer operative time, higher costs and a reduced number of central lymph node dissections based on a propensity score-matched analysis of 177 cases, and Lee et al [18] also reported that the length of hospital stay was significantly longer in TOETVA than in the open group. These differences can be explained by: (i) the impact of the health insurance payment system - most tertiary hospitals in China have implemented DRG/DIP health insurance payment, where the same disease is billed at a fixed rate, which may reduce the cost difference between TOETVA and COT; (ii) the application of the ERAS concept - the prevalence of postoperative rapid rehabilitation processes; and (iii) the use of the ERAS concept - the prevalence of postoperative rapid rehabilitation processes. -The general implementation of rapid postoperative recovery process has shortened the hospitalization time to about 3 days, which may have compressed the difference in the number of hospitalization days between the two groups; ③ Learning curve of the operator - the present study team had already completed sufficient training in luminal operation before TOETVA, and had already crossed the steep stage of the learning curve, and the surgery time was therefore shortened; ④ Sample size and statistical efficacy - the sample size of this study was limited, which may have affected the efficacy of the statistical test for some of the indicators. The results of this study showed that the parathyroid transplantation rate was significantly lower in the TOETVA group than in the COT group (5.0% vs. 55.0%, P=0.002). This difference was mainly attributed to the magnified field of view provided by the luminal microscope system, which enabled the operator to more clearly identify the parathyroid glands and their blood supply sources, and thus to perform finer peritoneal dissection maneuvers, which significantly reduced the risk of misincision of the parathyroid glands or disruption of the blood supply. It has been shown that although endoscopic magnified imaging can help the identification of parathyroid tissue, there is still room for technological improvement at the level of fine dissection [19].Shaphaba et al. [20] reported that in endoscopic radical surgery for thyroid cancer with a transoral vestibular approach, the modified in situ parathyroid gland protection technique could effectively prevent postoperative hypoparathyroidism, suggesting that fine manipulation under the magnified field of view of the laparoscope has important value for the protection of parathyroid glands. This suggests that fine manipulation under the magnified field of view is of great value for parathyroid gland protection. In TOETVA, the magnified field of view is more helpful in preserving the parathyroid glands in situ, avoiding unnecessary accidental transplantation and thus reducing the incidence of postoperative permanent hypoparathyroidism. This advantage is clinically important in reducing the incidence of permanent postoperative hypoparathyroidism. However, this study also revealed a significant disadvantage of TOETVA: the number of lymph nodes cleared was significantly less than that of the COT group (5.2±4.3 vs. 11.6±7.9, P=0.004). This result is consistent with some domestic and international studies reported [17]. The reasons for this may include: (1) the relatively limited workspace of the transoral approach, especially the "visual dead space" of the upper sternal fossa and the lateral tracheo-esophageal sulcus; (2) the continuous CO₂ pneumoperitoneal pressure (6 mmHg) during the operation, which may lead to the collapse and displacement of small lymph nodes or adipose tissues, thus affecting the identification and grasping; (3) the need to protect the chin nerve and avoid over-expression of the chin nerve, and the need to avoid over-expression of the chin nerve, which is the most important factor to avoid the over-expression of the chin nerve. In order to protect the chin nerve and avoid excessive dissection, the operation range was somewhat limited. Although there were no short-term recurrence cases in either group in this study, incomplete lymph node dissection may increase the residual risk of occult lymph node metastasis in the central region, which in turn affects the long-term disease-free survival of patients. Therefore, the small number of lymph node dissection should never be regarded as an advantage, but rather as a major technical limitation and potential oncologic risk of this procedure. Based on these findings, this study concluded that TOETVA is not suitable for all patients with PTC. Strict selection of indications is a prerequisite to ensure its safety and efficacy. With reference to national and international consensus, ideal indications include unilateral PTC with tumor diameter ≤2 cm, no clear extra-thyroidal invasion (cT1-2 stage), clinical lymph node-negative (cN0) and no distant metastasis (cM0).For patients with tumor diameter >2 cm, multifocal, with clear extra-glandular invasion or clinically suspected central lymph node metastasis, open surgery or thoracic and breast access laparotomy may be more appropriate. may be more prudent. This study has the following limitations: first, the study design was a retrospective, single-center study with inherent selection bias and recall bias, and although propensity score matching was used, the effect of unmeasured confounding factors (e.g., tumor stage, lymph node metastasis status, and degree of standardization of surgical scope) could not be completely eliminated. Second, the sample size is still small (only 20 cases in each group after matching), and the statistical efficacy is limited, especially when comparing rare events (e.g., recurrence, serious complications), which may not be able to detect true differences. Third, the assessment of parathyroid injury utilized an intraoperative surrogate of "graft rate," which may have underestimated the incidence of transient hypoparathyroidism. Future prospective, multicenter, large-sample randomized controlled trials with extended follow-up periods are needed to clarify the long-term oncologic value of TOETVA in the treatment of PTC. Conclusion Luminal thyroidectomy via the oral vestibular approach has a similar safety profile and short-term efficacy to conventional open surgery in rigorously selected patients with papillary thyroid carcinoma and shows potential advantages in reducing intraoperative parathyroid injury. However, this procedure has the definite limitation of an insufficient number of central lymph node dissection, and its long-term oncologic safety needs further validation. It is recommended that this procedure be performed judiciously in large centers with extensive experience in lumpectomy with strict indications (e.g., unilateral, stage cT1-2N0M0). Declarations Ethics approval and consent to participate The study was conducted in accordance with the Declaration of Helsinki and was approved by the Ethics Committee of Huaihua Central Hospital (Huaihua Cancer Hospital) (no. HHSEYYEC-202604-K1) on April 29, 2026, with the need for written informed consent waived. Consent for publication Not applicable Availability of data and materials The datasets generated and/or analyzed during the current study are not publicly available due to patient privacy and ethical restrictions, but are available from the corresponding author upon reasonable request. Competing interests The authors declare that they have no competing interests. Funding None Authors' contributions Chuan Jiang: Conceptualization, Methodology, Design, Writing - Original Draft; Bo Cai,Linhui Gong: Formal analysis;Shiqing Gong: Resources, data acquisition; Chuan Jiang,Bo Cai,Linhui Gong: Software, Statistical analysis. Acknowledgements None References Zhang L, Jiang L, Xu R, et al. Epidemiological study of thyroid cancer at global, regional, and national levels from 1990 to 2021: an analysis derived from the Global Burden of Disease Study 2021. Front Endocrinol (Lausanne) . 2025;16:1644270. doi:10.3389/fendo.2025.1644270. Deng T, Liu Q, Zi H, et al. Global trends in thyroid cancer 1990-2021: an analysis based on the GBD 2021. Endocr Relat Cancer . 2025;32(3):e240297.doi:10.1530/ERC-24-0297. Sung H, Ferlay J, Siegel RL, et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin . 2021;71(3):209-249. doi:10.3322/caac.21660. Tang M, Li J, Sun M, et al. Global, regional, and national trends in thyroid cancer burden (1990-2021): Insights from the GBD 2021 study. Biomol Biomed . 2025;25(12):2680-2695. doi:10.17305/bb.2025.12503. Dong F, Yang A, Ouyang D. Retroauricular Single-Site Endoscopic Thyroidectomy-A Balanced Endoscopic Approach for Thyroid Excision. JAMA Surg . 2023;158(5):548-549. doi:10.1001/jamasurg.2022.7723. Lu Q, Zhu X, Wang P, et al. Comparisons of different approaches and incisions of thyroid surgery and selection strategy. Front Endocrinol (Lausanne) . 2023;14:1166820. doi:10.3389/fendo.2023.1166820. Moreno Llorente P, Francos Martínez JM, García Barrasa A, Pascua Solé M. Transoral endoscopic thyroidectomy vestibular approach (TOETVA). Cir Esp (Engl Ed) . 2022;100(4):234-239. doi:10.1016/j.cireng.2022.03.013. Wu J, Xiao Z, Liang W, et al. Outcomes of transoral endoscopic thyroidectomy vestibular approach versus endoscopic thyroidectomy via areola approach in the treatment of thyroid carcinoma: a meta-analysis. Front Oncol . 2025;15:1606389. doi:10.3389/fonc.2025.1606389 Kuo TC, Chen KY, Lai CW, et al. Transoral Endoscopic and Minimally Invasive Thyroidectomy. JAMA Surg . 2025;160(11):1203-1210. doi:10.1001/jamasurg.2025.3248. Karakas E, Klein G, Michlmayr L, et al. Transoral thyroid surgery vestibular approach: is there an increased risk of surgical site infections?. Updates Surg . 2022;74(1):303-308. doi:10.1007/s13304-021-01191-4. Turan MI, Ozturk Durmaz S, Celik M, et al. Current Practices in Antibiotic Prophylaxis for Transoral Endoscopic Thyroid and Parathyroid Surgery: A Comparative Study. Medicina (Kaunas) . 2025;61(5):939. doi:10.3390/medicina61050939. Li M, Li Q, Zou C, et al. Application and recent advances in conventional biomarkers for the prognosis of papillary thyroid carcinoma. Front Oncol . 2025;15:1598934. doi:10.3389/fonc.2025.1598934. Li M, Li Q, Zou C, et al. Application and recent advances in conventional biomarkers for the prognosis of papillary thyroid carcinoma. Front Oncol . 2025;15:1598934. doi:10.3389/fonc.2025.1598934. Hindawi MD, Ali AHG, Qafesha RM, et al. Transoral endoscopic thyroidectomy submental vestibular approach for early-stage papillary thyroid carcinoma: a systematic review and meta-analysis. Langenbecks Arch Surg . 2024;409(1):204. doi:10.1007/s00423-024-03377-x. Ngo DQ, Le DT, Ngo QX, et al. Modified Technique in Transoral Endoscopic Thyroidectomy Vestibular Approach (TOETVA). Ann Surg Oncol . 2025;32(7):4804. doi:10.1245/s10434-025-17429-z. Bian C, Lin Z, Yan M, et al. Comparative short- and long-term outcomes of TOETVA, ETGUA, and COT in thyroid cancer: a propensity score-matched study. Front Oncol . 2025;15:1606568. doi:10.3389/fonc.2025.1606568. Zhang X, Zhao WY, Li GL, et al. Comparison of Transoral Endoscopic Thyroidectomy via the Vestibular Approach and Conventional Open Thyroidectomy for Papillary Thyroid Carcinoma: A Propensity Score-Matched Analysis. Ann Surg Oncol . 2025;32(9):6765-6773. doi:10.1245/s10434-025-17655-5. Lee JH, Gwak H. Oncologic adequacy and outcomes of open, transoral endoscopic, and robotic thyroidectomy for papillary thyroid carcinoma: a propensity score-matched analysis. World J Surg Oncol . 2025;24(1):5. doi:10.1186/s12957-025-04110-8. Chen C, Gao D, Luo L, et al. Parathyroid preservation in total endoscopic thyroid surgeries via the mammary areolas approach: Real-world data from a single center. Asian J Surg . 2023;46(12):5421-5428. doi:10.1016/j.asjsur.2023.05.169. Shaphaba K, Thakar A, Sakthivel P, et al. Incremental value of magnification and indocyanine green for parathyroid preservation in thyroid surgery. Head Neck . 2023;45(7):1753-1760. doi:10.1002/hed.27387. Additional Declarations No competing interests reported. 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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-9565125","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":632046573,"identity":"f0de47be-7cb2-4cb0-8311-2f3f410a596b","order_by":0,"name":"Chuan Jiang","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA40lEQVRIiWNgGAWjYBACAwkGBgkYm7GhQkJOnkQtZyyMDRtI0tLYVpHIcICAFnPp9oc3Pu7Zlrjh/OJtkjPnSSQwNjA/fHQDjxbLOWeMLWc8u5244cazMsmN2yTy2BnYjI1z8DnsRg6bNM8BkJYzZjcfbpMoZmzgYZPGryX9mfQfuJY5EokNBwhqSTCTZgBpOd9jdnNjA1Facowtew7cNp55g63854xjEsaGzQT9kv7wxo8Dt2X7zh/ebNhTUycnz9788DE+LTDguOBGApTJTIRyELCX7z9ApNJRMApGwSgYcQAA6HlcTleMBosAAAAASUVORK5CYII=","orcid":"","institution":"Huaihua Central Hospital (Huaihua Cancer Hospital)","correspondingAuthor":true,"prefix":"","firstName":"Chuan","middleName":"","lastName":"Jiang","suffix":""},{"id":632046574,"identity":"5e2039c5-10ed-4eba-820e-8fce9f36784b","order_by":1,"name":"Bo Cai","email":"","orcid":"","institution":"Huaihua Central Hospital (Huaihua Cancer Hospital)","correspondingAuthor":false,"prefix":"","firstName":"Bo","middleName":"","lastName":"Cai","suffix":""},{"id":632046575,"identity":"080b4582-eded-4f87-8276-27bf90834ca7","order_by":2,"name":"Linhui Gong","email":"","orcid":"","institution":"Jishou University","correspondingAuthor":false,"prefix":"","firstName":"Linhui","middleName":"","lastName":"Gong","suffix":""},{"id":632046576,"identity":"05c2fa1d-29d9-4f1f-93a0-4c26ddb6389b","order_by":3,"name":"Shiqing Gong","email":"","orcid":"","institution":"Huaihua Central Hospital (Huaihua Cancer Hospital)","correspondingAuthor":false,"prefix":"","firstName":"Shiqing","middleName":"","lastName":"Gong","suffix":""}],"badges":[],"createdAt":"2026-04-29 11:24:24","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9565125/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9565125/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":108182809,"identity":"db603be9-4601-42de-abc8-b9dc15cbe53c","added_by":"auto","created_at":"2026-04-30 08:59:33","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":244515,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9565125/v1/1471d2af-e7dd-40cf-b1c9-0eff5a9bd0b5.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Afety and effectiveness of transoral vestibular approach laparoscopic thyroidectomy f or thyroid papillary carcinoma: a propensity score matching analysis","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThyroid cancer is the tenth most common malignant tumor in the world, with a global incidence rate of about 3% and a mortality rate of about 0.4%. The incidence rate of thyroid cancer in China is higher than the world average, but the mortality rate is lower than the world level [1-3]. Papillary Thyroid Carcinoma (PTC) is the most common pathologic type of thyroid cancer, accounting for about 90% [4]. Surgery is the mainstay of treatment for PTC, and conventional open thyroidectomy (COT) is highly effective, but leaves permanent scarring in the neck, which negatively affects the quality of life and psychological state of patients, especially those with keloid bodies and young women. With the deepening of the concept of minimally invasive surgery and the development of laparoscopic technology, various approaches to laparoscopic thyroid surgery have emerged, including the thoracic breast approach, axillary approach, retroauricular approach, and transoral vestibular approach [5-6]. Among them, Transoral Endoscopic Vestibular Approach Thyroidectomy (TOETVA) has become a research hotspot in thyroid surgery in recent years because of its complete scarlessness on the body surface, short surgical path, and clear anatomical level [7-9]. However, this procedure theoretically increases the risk of infection because the incision is located in the oral cavity (class II incision); at the same time, its thoroughness of central regional lymph node dissection and long-term oncological safety are controversial [10-11]. At present, high-quality clinical evidence on TOETVA for PTC is still limited both at home and abroad, and most studies suffer from small sample size, obvious selection bias, and short follow-up time. Therefore, it is necessary to systematically compare the safety and efficacy of TOETVA and COT in the treatment of PTC on the basis of controlling confounding factors, so as to provide a more reliable evidence-based basis for clinical decision-making.\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003eEthical Approval and Informed Consent\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the Medical Ethics Committee of Huaihua Central Hospital (Approval Number: HHSEYYEC-202604-K1). All patients signed a written informed consent form before surgery and agreed that their surgical and follow-up data would be used for the clinical study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy Design\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe clinical data of patients with papillary thyroid carcinoma who underwent thyroidectomy at the Department of Hepatobiliary, Pancreatic and Thyroid Surgery, Huaihua City Central Hospital, from March 2021 to March 2022 were retrospectively analyzed.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInclusion and exclusion criteriaInclusion criteria\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eInclusion Criteria:(1) postoperative pathology confirmed the diagnosis of thyroid papillary carcinoma; (2) no distant metastasis in preoperative imaging (neck ultrasound and CT if necessary); (3) no serious heart, brain, lung or other organ diseases, and able to tolerate general anesthesia and surgery; (4) clear indications for surgery and voluntarily accept the corresponding operation.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eExclusion Criteria:(1) Thyroid gland with lesions in both lobes requiring total resection; (2) Previous history of thyroid surgery or ablation; (3) Pregnant or lactating females; (4) Combined head and neck or oral deformity, unable to tolerate the position of the oral approach.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSurg\u003c/strong\u003e\u003cstrong\u003eery\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eM\u003c/strong\u003e\u003cstrong\u003eethod\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEndoscopy Team (Transoral Vestibular Approach): 24 hours before the operation and 24 hours after the operation oral third-generation cephalosporin to prevent infection. After general anesthesia intubation, the patient was placed in a mild hyperextension position of the neck. A transverse incision of about 2 cm in length was made anterior to the lower lip tie and away from the gingival root, and it was obliquely freed to the mandibular bone surface turn. A 10-mm Trocar was inserted into the sub-chin and anterior cervical regions with inflation fluid, and a CO₂ pneumoperitoneum was established with the pressure maintained at 6 mm Hg. A 5-mm Trocar was inserted into the mandibular bony surface by bluntly separating the operative tunnels approximately 2.5 cm on either side of the midline of the incision, lateral to the chin nerve, and toward the ipsilateral sternocleidomastoid joint, and incising the cervical white line, retracting the strap muscles and sternocleidomastoid muscle, and then removing the thyroid lesion and performing complete The thyroid lesion was resected and central lymph node dissection was performed. The field was repeatedly rinsed with distilled water, and a drain was placed in front of the neck. The oral cavity was sterilized with complex iodine, and the mucosa of the oral incision was closed with 5-0 absorbable suture.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTraditional group (anterior cervical open approach): After general anesthesia intubation, the patient takes a mild hyperextension position of the neck. Take the low anterior cervical arc incision, about 6cm long, sequentially incise the skin, subcutaneous tissue and the vastus cervicis muscle, free the skin flap to the superficial surface of the subglottic muscle group, incise the cervical white line up to the intrinsic periosteum of the thyroid gland. After incision of the suspensory ligament and the lateral ligament, complete resection of the thyroid lesion and lymph node dissection were performed. Distilled water was repeatedly rinsed, and a drain was placed anteriorly in the neck.4-0 absorbable sutures were used to close the white line of the neck and the vastus cervicis muscle intermittently, and nickel-titanium memory alloy sutures were used to close the incision intradermally.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEndpoint Event Definition\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003enumber of lymph nodes cleared; indicators related to parathyroid injury (with intraoperative parathyroid transplantation rate as a surrogate indicator, with transplantation indicated as immediate autotransplantation after intraoperative detection of impaired parathyroid blood flow or unintentional resection). Secondary outcome indicators: operative time (minutes), intraoperative bleeding (milliliters), length of hospital stay (days), hospitalization costs (dollars), postoperative complications (including temporary or permanent recurrent laryngeal nerve injury, postoperative hematoma, infection, and symptoms of hypocalcemia, with severity documented by using the Clavien-Dindo grading scale), and short-term recurrences (neck recurrence confirmed by imaging or perforated cytology within 6 to 12 months after surgery). (neck recurrence confirmed by imaging or puncture cytology).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFollow Up\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePostoperative follow-up was performed through a combination of outpatient follow-up (1, 3, 6, and 12 months after surgery) and telephone follow-up, which included thyroid function, calcium, parathyroid hormone, and neck ultrasound. The incision was closed intradermally with amniotic sutures.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical Analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eStatistical methods were used to analyze the data using SPSS 22.0 statistical software. In order to eliminate selection bias between groups, Propensity Score Matching (PSM) was used, with surgical method as the dependent variable and age, gender, and tumor diameter as the covariates, and 1:1 nearest neighbor matching method was used, and the caliper value was set to 0.004. After matching, the measurement data conforming to the normal distribution were expressed as (xˉ\u0026plusmn;sxˉ\u0026plusmn;s), and comparisons between groups were made using the independent samples t test; the count data were expressed as the number of cases (percentage), and comparisons between groups were made using the \u0026chi;\u0026sup2; test or Fisher exact test. p \u0026lt; p \u0026lt; p \u0026lt; s. The data were compared using the independent samples t test. Comparisons were made using independent samples t-test; count data were expressed as the number of cases (percentage), and comparisons between groups were made using the \u0026chi;\u0026sup2; test or Fisher\u0026apos;s exact test. p \u0026lt; 0.05 was taken as statistically significant difference.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003ePatient and Lesion Characteristics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eComparison of general data before and after matching A total of 97 patients were included, including 66 patients in the conventional group and 31 patients in the lumpectomy group. Before matching, the differences between the two groups were statistically significant in gender composition (P=0.031) and tumor diameter (P=0.003), and the difference in age was not statistically significant (P=0.408). After propensity score matching (1:1), 20 pairs of patients were successfully matched. The differences between the two groups after matching in terms of gender, age, and tumor diameter were not statistically significant (P\u0026gt;0.05) and were comparable. See \u003cstrong\u003eTable 1\u003c/strong\u003e and\u003cstrong\u003e\u0026nbsp;Table 2\u003c/strong\u003e.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1 Comparison of general information between the two groups of patients before matching\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eCategory\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eNumbers(n)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eGender (male/female, n)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eAge (x \u0026plusmn; s, years)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eTumour diameter (x \u0026plusmn; s, cm)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eTraditional Group\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e9 / 57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e44.8 \u0026plusmn; 11.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.2 \u0026plusmn; 1.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eEndoscopy Group\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e10 / 21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e40.0 \u0026plusmn; 9.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.7 \u0026plusmn; 0.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003et/\u0026chi;\u0026sup2;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026chi;\u0026sup2; = 4.644\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003et = 2.004\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003et = 3.061\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eP\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.031\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.408\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003ex \u0026plusmn; s are mean\u0026plusmn;SD\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2 Comparison of general information of the two groups of patients after matching\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 200px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCategory\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNumbers(n)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGender (male/female, n)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 118px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge (x \u0026plusmn; s, years)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTumour diameter (x \u0026plusmn; s, cm)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 200px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTraditional Group\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e4 / 16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 118px;\"\u003e\n \u003cp\u003e45.1 \u0026plusmn; 10.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003e1.1 \u0026plusmn; 0.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 200px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEndoscopy Group\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e6 / 14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 118px;\"\u003e\n \u003cp\u003e41.2 \u0026plusmn; 9.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003e0.7 \u0026plusmn; 0.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 200px;\"\u003e\n \u003cp\u003e\u003cstrong\u003et/\u0026chi;\u0026sup2;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e\u0026chi;\u0026sup2; = 0.439\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 118px;\"\u003e\n \u003cp\u003et = 1.226\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003et = 1.942\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 200px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e0.508\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 118px;\"\u003e\n \u003cp\u003e0.228\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003e0.060\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003ex \u0026plusmn; s are mean\u0026plusmn;SD\u003c/p\u003e\n\u003cp\u003eComparison of intraoperative and postoperative conditions between the two groups after matching After matching, the differences in intraoperative bleeding, operation time, hospitalization time, and hospitalization cost between the two groups were not statistically significant (P\u0026gt;0.05). The parathyroid transplantation rate in the luminal group (5.0%) was significantly lower than that in the conventional group (55.0%), and the difference was statistically significant (P=0.002). The number of lymph nodes cleared in the lumboendoscopy group (5.2\u0026plusmn;4.3) was significantly less than that in the conventional group (11.6\u0026plusmn;7.9), and the difference was statistically significant (P=0.011). There were no serious complications of Clavien-Dindo grade III or higher in both groups after surgery, and there were no short-term recurrence or death cases. Among the postoperative complications, temporary laryngeal recurrent nerve palsy occurred in 1 case (5.0%) in the conventional group and temporary hypesthesia of the lower lip in 1 case (5.0%) in the luminal group, which both recovered within 3 months. The difference in the complication rate between the two groups was not statistically significant. See \u003cstrong\u003eTable 3\u003c/strong\u003e and \u003cstrong\u003eTable 4\u003c/strong\u003e.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3 Comparison of intraoperative conditions between the two groups after matching\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCategory\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNumbers(n)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIntraoperative blood loss (ml, x \u0026plusmn; s)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDuration of surgery (min, x \u0026plusmn; s)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eParathyroid gland transplantation [Cases (%)]\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNumber of lymph nodes removed (n, x \u0026plusmn; s)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEndoscopy Group\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110px;\"\u003e\n \u003cp\u003e11.5 \u0026plusmn; 5.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003e180.3 \u0026plusmn; 44.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003e1 (5.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e5.2 \u0026plusmn; 4.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTraditional Group\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110px;\"\u003e\n \u003cp\u003e10.0 \u0026plusmn; 4.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003e184.7 \u0026plusmn; 53.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003e11 (55.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e11.6 \u0026plusmn; 7.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e\u003cstrong\u003et/\u0026chi;\u0026sup2;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110px;\"\u003e\n \u003cp\u003et = 0.983\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003et = 0.286\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003e\u0026chi;\u0026sup2; = 9.643\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003et = 3.056\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110px;\"\u003e\n \u003cp\u003e0.332\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003e0.776\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e0.004\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003ex \u0026plusmn; s are mean\u0026plusmn;SD\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4 Comparison of postoperative conditions between the two groups after matching\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eCategory\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eNumbers(n)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eLength of stay (days, x \u0026plusmn; s)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eHospitalisation costs (RMB, x\u0026plusmn;s )\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eTotal complications [cases (%)]\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eShort-term recurrence [cases (%)]\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eEndoscopy Group\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e8.7 \u0026plusmn; 2.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e16290.8 \u0026plusmn; 1162.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1 (5.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eTraditional Group\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e10.2 \u0026plusmn; 4.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e17490.3 \u0026plusmn; 4557.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1 (5.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003et/\u0026chi;\u0026sup2;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003et = 1.335\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003et = 1.115\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eP\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.190\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.273\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.000*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003ex \u0026plusmn; s are mean\u0026plusmn;SD\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe incidence of papillary thyroid carcinoma (PTC) continues to rise worldwide, and surgery is its mainstay of treatment [13]. Conventional open thyroidectomy (COT) is efficacious but leaves permanent scarring on the neck, which negatively affects the quality of life and psychological status of some patients, especially young women [14]. With the development of minimally invasive surgical concepts and laparoscopic techniques, transoral vestibular approach laparoscopic thyroidectomy (TOETVA) has become a research hotspot in thyroid surgery due to its realization of the advantages of complete scarlessness of the body surface, short pathway, and clear vision [15]. However, the oncologic safety and efficacy of this procedure in PTC still needs to be supported by high-quality clinical evidence. In this study, we compared the recent efficacy of transoral vestibular approach luminal thyroidectomy (TOETVA) with conventional open thyroidectomy (COT) for the treatment of papillary thyroid carcinoma (PTC) after balancing the baseline differences by propensity score matching method. The results showed that there were no significant differences between the two groups in terms of intraoperative bleeding, operative time, hospitalization time, and hospitalization costs, indicating that TOETVA was technically feasible and did not significantly increase surgical trauma or economic burden. This finding is highly consistent with the findings of Bian et al [16], who, after analyzing 466 thyroid cancer patients (318 final matches) by propensity score matching, found that TOETVA did not differ significantly from COT in terms of hospitalization costs, length of stay, complications, and pain scores, despite a longer operative time. However, the finding of no significant difference in operative time in this study is not consistent with most existing studies. For example, Zhang et al [17] stated that TOETVA had a longer operative time, higher costs and a reduced number of central lymph node dissections based on a propensity score-matched analysis of 177 cases, and Lee et al [18] also reported that the length of hospital stay was significantly longer in TOETVA than in the open group. These differences can be explained by: (i) the impact of the health insurance payment system - most tertiary hospitals in China have implemented DRG/DIP health insurance payment, where the same disease is billed at a fixed rate, which may reduce the cost difference between TOETVA and COT; (ii) the application of the ERAS concept - the prevalence of postoperative rapid rehabilitation processes; and (iii) the use of the ERAS concept - the prevalence of postoperative rapid rehabilitation processes. -The general implementation of rapid postoperative recovery process has shortened the hospitalization time to about 3 days, which may have compressed the difference in the number of hospitalization days between the two groups; ③ Learning curve of the operator - the present study team had already completed sufficient training in luminal operation before TOETVA, and had already crossed the steep stage of the learning curve, and the surgery time was therefore shortened; ④ Sample size and statistical efficacy - the sample size of this study was limited, which may have affected the efficacy of the statistical test for some of the indicators.\u003c/p\u003e\n\u003cp\u003eThe results of this study showed that the parathyroid transplantation rate was significantly lower in the TOETVA group than in the COT group (5.0% vs. 55.0%, P=0.002). This difference was mainly attributed to the magnified field of view provided by the luminal microscope system, which enabled the operator to more clearly identify the parathyroid glands and their blood supply sources, and thus to perform finer peritoneal dissection maneuvers, which significantly reduced the risk of misincision of the parathyroid glands or disruption of the blood supply. It has been shown that although endoscopic magnified imaging can help the identification of parathyroid tissue, there is still room for technological improvement at the level of fine dissection [19].Shaphaba et al. [20] reported that in endoscopic radical surgery for thyroid cancer with a transoral vestibular approach, the modified in situ parathyroid gland protection technique could effectively prevent postoperative hypoparathyroidism, suggesting that fine manipulation under the magnified field of view of the laparoscope has important value for the protection of parathyroid glands. This suggests that fine manipulation under the magnified field of view is of great value for parathyroid gland protection. In TOETVA, the magnified field of view is more helpful in preserving the parathyroid glands in situ, avoiding unnecessary accidental transplantation and thus reducing the incidence of postoperative permanent hypoparathyroidism. This advantage is clinically important in reducing the incidence of permanent postoperative hypoparathyroidism. However, this study also revealed a significant disadvantage of TOETVA: the number of lymph nodes cleared was significantly less than that of the COT group (5.2\u0026plusmn;4.3 vs. 11.6\u0026plusmn;7.9, P=0.004). This result is consistent with some domestic and international studies reported [17]. The reasons for this may include: (1) the relatively limited workspace of the transoral approach, especially the \u0026quot;visual dead space\u0026quot; of the upper sternal fossa and the lateral tracheo-esophageal sulcus; (2) the continuous CO₂ pneumoperitoneal pressure (6 mmHg) during the operation, which may lead to the collapse and displacement of small lymph nodes or adipose tissues, thus affecting the identification and grasping; (3) the need to protect the chin nerve and avoid over-expression of the chin nerve, and the need to avoid over-expression of the chin nerve, which is the most important factor to avoid the over-expression of the chin nerve. In order to protect the chin nerve and avoid excessive dissection, the operation range was somewhat limited. Although there were no short-term recurrence cases in either group in this study, incomplete lymph node dissection may increase the residual risk of occult lymph node metastasis in the central region, which in turn affects the long-term disease-free survival of patients. Therefore, the small number of lymph node dissection should never be regarded as an advantage, but rather as a major technical limitation and potential oncologic risk of this procedure.\u003c/p\u003e\n\u003cp\u003eBased on these findings, this study concluded that TOETVA is not suitable for all patients with PTC. Strict selection of indications is a prerequisite to ensure its safety and efficacy. With reference to national and international consensus, ideal indications include unilateral PTC with tumor diameter \u0026le;2 cm, no clear extra-thyroidal invasion (cT1-2 stage), clinical lymph node-negative (cN0) and no distant metastasis (cM0).For patients with tumor diameter \u0026gt;2 cm, multifocal, with clear extra-glandular invasion or clinically suspected central lymph node metastasis, open surgery or thoracic and breast access laparotomy may be more appropriate. may be more prudent. This study has the following limitations: first, the study design was a retrospective, single-center study with inherent selection bias and recall bias, and although propensity score matching was used, the effect of unmeasured confounding factors (e.g., tumor stage, lymph node metastasis status, and degree of standardization of surgical scope) could not be completely eliminated. Second, the sample size is still small (only 20 cases in each group after matching), and the statistical efficacy is limited, especially when comparing rare events (e.g., recurrence, serious complications), which may not be able to detect true differences. Third, the assessment of parathyroid injury utilized an intraoperative surrogate of \u0026quot;graft rate,\u0026quot; which may have underestimated the incidence of transient hypoparathyroidism. Future prospective, multicenter, large-sample randomized controlled trials with extended follow-up periods are needed to clarify the long-term oncologic value of TOETVA in the treatment of PTC.\u0026nbsp;\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eLuminal thyroidectomy via the oral vestibular approach has a similar safety profile and short-term efficacy to conventional open surgery in rigorously selected patients with papillary thyroid carcinoma and shows potential advantages in reducing intraoperative parathyroid injury. However, this procedure has the definite limitation of an insufficient number of central lymph node dissection, and its long-term oncologic safety needs further validation. It is recommended that this procedure be performed judiciously in large centers with extensive experience in lumpectomy with strict indications (e.g., unilateral, stage cT1-2N0M0).\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was conducted in accordance with the Declaration of Helsinki and was approved by the Ethics Committee of Huaihua Central Hospital (Huaihua Cancer Hospital) (no.\u0026nbsp;HHSEYYEC-202604-K1) on April 29, 2026, with the need for written informed consent waived.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated and/or analyzed during the current study are not publicly available due to patient privacy and ethical restrictions, but are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eChuan Jiang: Conceptualization, Methodology, Design, Writing - Original Draft;\u0026nbsp;Bo Cai,Linhui Gong: Formal analysis;Shiqing Gong: Resources, data acquisition;\u0026nbsp;Chuan Jiang,Bo Cai,Linhui Gong: Software, Statistical analysis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eZhang L, Jiang L, Xu R, et al. Epidemiological study of thyroid cancer at global, regional, and national levels from 1990 to 2021: an analysis derived from the Global Burden of Disease Study 2021. \u003cem\u003eFront Endocrinol (Lausanne)\u003c/em\u003e. 2025;16:1644270. doi:10.3389/fendo.2025.1644270.\u003c/li\u003e\n \u003cli\u003eDeng T, Liu Q, Zi H, et al. Global trends in thyroid cancer 1990-2021: an analysis based on the GBD 2021. \u003cem\u003eEndocr Relat Cancer\u003c/em\u003e. 2025;32(3):e240297.doi:10.1530/ERC-24-0297.\u003c/li\u003e\n \u003cli\u003eSung H, Ferlay J, Siegel RL, et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. \u003cem\u003eCA Cancer J Clin\u003c/em\u003e. 2021;71(3):209-249. doi:10.3322/caac.21660.\u003c/li\u003e\n \u003cli\u003eTang M, Li J, Sun M, et al. Global, regional, and national trends in thyroid cancer burden (1990-2021): Insights from the GBD 2021 study. \u003cem\u003eBiomol Biomed\u003c/em\u003e. 2025;25(12):2680-2695. doi:10.17305/bb.2025.12503.\u003c/li\u003e\n \u003cli\u003eDong F, Yang A, Ouyang D. Retroauricular Single-Site Endoscopic Thyroidectomy-A Balanced Endoscopic Approach for Thyroid Excision. \u003cem\u003eJAMA Surg\u003c/em\u003e. 2023;158(5):548-549. doi:10.1001/jamasurg.2022.7723.\u003c/li\u003e\n \u003cli\u003eLu Q, Zhu X, Wang P, et al. Comparisons of different approaches and incisions of thyroid surgery and selection strategy. \u003cem\u003eFront Endocrinol (Lausanne)\u003c/em\u003e. 2023;14:1166820. doi:10.3389/fendo.2023.1166820.\u003c/li\u003e\n \u003cli\u003eMoreno Llorente P, Francos Mart\u0026iacute;nez JM, Garc\u0026iacute;a Barrasa A, Pascua Sol\u0026eacute; M. Transoral endoscopic thyroidectomy vestibular approach (TOETVA). \u003cem\u003eCir Esp (Engl Ed)\u003c/em\u003e. 2022;100(4):234-239. doi:10.1016/j.cireng.2022.03.013.\u003c/li\u003e\n \u003cli\u003eWu J, Xiao Z, Liang W, et al. Outcomes of transoral endoscopic thyroidectomy vestibular approach versus endoscopic thyroidectomy via areola approach in the treatment of thyroid carcinoma: a meta-analysis. \u003cem\u003eFront Oncol\u003c/em\u003e. 2025;15:1606389. doi:10.3389/fonc.2025.1606389\u003c/li\u003e\n \u003cli\u003eKuo TC, Chen KY, Lai CW, et al. Transoral Endoscopic and Minimally Invasive Thyroidectomy. \u003cem\u003eJAMA Surg\u003c/em\u003e. 2025;160(11):1203-1210. doi:10.1001/jamasurg.2025.3248.\u003c/li\u003e\n \u003cli\u003eKarakas E, Klein G, Michlmayr L, et al. Transoral thyroid surgery vestibular approach: is there an increased risk of surgical site infections?. \u003cem\u003eUpdates Surg\u003c/em\u003e. 2022;74(1):303-308. doi:10.1007/s13304-021-01191-4.\u003c/li\u003e\n \u003cli\u003eTuran MI, Ozturk Durmaz S, Celik M, et al. Current Practices in Antibiotic Prophylaxis for Transoral Endoscopic Thyroid and Parathyroid Surgery: A Comparative Study. \u003cem\u003eMedicina (Kaunas)\u003c/em\u003e. 2025;61(5):939. doi:10.3390/medicina61050939.\u003c/li\u003e\n \u003cli\u003eLi M, Li Q, Zou C, et al. Application and recent advances in conventional biomarkers for the prognosis of papillary thyroid carcinoma.\u003cem\u003e\u0026nbsp;Front Oncol\u003c/em\u003e. 2025;15:1598934. doi:10.3389/fonc.2025.1598934.\u003c/li\u003e\n \u003cli\u003eLi M, Li Q, Zou C, et al. 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Comparative short- and long-term outcomes of TOETVA, ETGUA, and COT in thyroid cancer: a propensity score-matched study. \u003cem\u003eFront Oncol\u003c/em\u003e. 2025;15:1606568. doi:10.3389/fonc.2025.1606568.\u003c/li\u003e\n \u003cli\u003eZhang X, Zhao WY, Li GL, et al. Comparison of Transoral Endoscopic Thyroidectomy via the Vestibular Approach and Conventional Open Thyroidectomy for Papillary Thyroid Carcinoma: A Propensity Score-Matched Analysis. \u003cem\u003eAnn Surg Oncol\u003c/em\u003e. 2025;32(9):6765-6773. doi:10.1245/s10434-025-17655-5.\u003c/li\u003e\n \u003cli\u003eLee JH, Gwak H. Oncologic adequacy and outcomes of open, transoral endoscopic, and robotic thyroidectomy for papillary thyroid carcinoma: a propensity score-matched analysis. \u003cem\u003eWorld J Surg Oncol\u003c/em\u003e. 2025;24(1):5. doi:10.1186/s12957-025-04110-8.\u003c/li\u003e\n \u003cli\u003eChen C, Gao D, Luo L, et al. Parathyroid preservation in total endoscopic thyroid surgeries via the mammary areolas approach: Real-world data from a single center. \u003cem\u003eAsian J Surg\u003c/em\u003e. 2023;46(12):5421-5428. doi:10.1016/j.asjsur.2023.05.169.\u003c/li\u003e\n \u003cli\u003eShaphaba K, Thakar A, Sakthivel P, et al. Incremental value of magnification and indocyanine green for parathyroid preservation in thyroid surgery. \u003cem\u003eHead Neck\u003c/em\u003e. 2023;45(7):1753-1760. doi:10.1002/hed.27387.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Propensity score matching, Thyroid papillary carcinoma, Transoral approach, Laparoscopic thyroidectomy, Treatment outcome","lastPublishedDoi":"10.21203/rs.3.rs-9565125/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9565125/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjectives\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTo evaluate the safety and effectiveness of transoral vestibular approach laparoscopic thyroidectomy (TOETVA) for thyroid papillary carcinoma (PTC) by comparing it with conventional open thyroidectomy (COT).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eClinical data of PTC patients who underwent thyroidectomy at a single center from March 2021 to March 2022 were retrospectively analyzed. Patients were divided into COT group and TOETVA group. Propensity score matching (1:1) was performed to balance baseline characteristics. Intraoperative and postoperative outcomes were compared between the two matched groups.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA total of 97 patients (66 COT, 31 TOETVA) were included. After matching, 20 patients remained in each group, with comparable baseline data (P\u0026gt;0.05). No significant differences were observed in intraoperative blood loss, operative time, hospital stay, hospitalization cost, overall complication rate, or short-term recurrence rate (P\u0026gt;0.05). The TOETVA group had a significantly lower rate of parathyroid autotransplantation (5.0% vs. 55.0%, P\u0026lt;0.05) but a significantly lower number of harvested lymph nodes (5.2±4.3 vs. 11.6±7.9, P\u0026lt;0.05) compared to the COT group.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTOETVA demonstrates comparable safety and short-term efficacy to COT in selected PTC patients, with a potential advantage in preserving parathyroid glands. However, the lower number of harvested lymph nodes is a notable limitation. The long-term oncological safety requires further validation. Patient selection should be rigorous.\u003c/p\u003e","manuscriptTitle":"Afety and effectiveness of transoral vestibular approach laparoscopic thyroidectomy f or thyroid papillary carcinoma: a propensity score matching analysis","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-30 05:32:01","doi":"10.21203/rs.3.rs-9565125/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"ed7c192d-a99a-4ab6-9c83-79cf1164e1b7","owner":[],"postedDate":"April 30th, 2026","published":true,"recentEditorialEvents":[{"type":"editorInvited","content":"","date":"2026-05-07T12:48:55+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-05-06T13:22:40+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-05-06T13:22:29+00:00","index":"","fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-04-30T05:32:01+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-30 05:32:01","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9565125","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9565125","identity":"rs-9565125","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}