Transoral Vestibular Robotic Thyroidectomy vs Open Thyroidectomy for Thyroid Cancer: A Propensity Score-Matched Analysis

Transoral Vestibular Robotic Thyroidectomy vs Open Thyroidectomy for Thyroid Cancer: A Propensity Score-Matched Analysis | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Transoral Vestibular Robotic Thyroidectomy vs Open Thyroidectomy for Thyroid Cancer: A Propensity Score-Matched Analysis Fu Luo, Jing Xu, Gang Zhang, Yan Jiang, Lingji Guo, Fan Yu, Jie Yan, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7950983/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 19 Mar, 2026 Read the published version in Journal of Robotic Surgery → Version 1 posted 12 You are reading this latest preprint version Abstract Background Transoral vestibular robotic thyroidectomy (TOVRT) provides minimal scarring but requires comparative validation against open thyroidectomy (OT). Methods Patients undergoing thyroid surgery at our centre between January 2020 and October 2024 were included. Ultimately, through propensity score matching analysis, 322 adults (161 per group) with pathologically confirmed thyroid cancer. Analyse and compare the clinical outcomes of the two patient groups, as well as patient-reported outcomes (NRS pain, VHI-10 voice, SAQCO scar satisfaction at 1 week). Results Among 322 matched patients (age median [IQR], 41.0 [34.0–51.0] vs 43.0 [34.0–52.0]; [71.7%] female, 91[28.3%] male).The TOVRT group demonstrated significantly higher operative costs (median [IQR], TOVRT: 63,351.0 [60,644.5–64,948.8]¥ vs OT: 19,009.6 [17,127.7–21,774.4]¥; P < .001) and longer surgical duration (mean [SD], 242.0 [55.8]min vs 106.3 [38.4] min; mean difference, 136; 95% CI, 125–146; P < .001) than the OT group. However, the TOVRT group showed significantly shorter postoperative hospitalization time (mean [SD], 2.8 [1.4]days vs 3.4 [1.2] days; mean difference, 0.6 days; 95% CI, 0.31–0.88; P < .001), as well as a lower incidence of transient hypoparathyroidism (5 [3.1%] vs 29 [18.0%]; risk difference, -14.9%; 95% CI, -20.3 to -9.5; P < .001). Postoperative Numerical Rating Scale (NRS)( median [IQR], 3.0 [2.0–4.0] vs 7.0 [6.0–8.0]; median difference, -4.0; 95% CI, -5.0 to -4.0; P < .001) and Voice Handicap Index-10 (VHI-10) scores (median [IQR], 38.0 [12.0–59.0] vs 77.0 [59.0–89.0]; median difference, -39.0; 95% CI, -42.0 to -29.0; P < .001)were significantly lower in the TOVRT group, while scar satisfaction assessed by the Short Assessment of Quality of Cosmetic Outcome (SAQCO) (median [IQR], 20.0 [18.0–23.0] vs 14.0 [12.0–17.0]; difference, 6.0; 95% CI, 5.0 to 6.0; P < .001) was significantly superior. Conclusion TOVRT achieves comparable oncologic outcomes to OT with superior cosmesis, shorter hospitalization, and reduced transient hypoparathyroidism, but incurs significantly higher costs and longer operative times. Trial Registration: National clinical trials registry: NCT06958601, registered April 25th, 2025. Thyroid carcinoma Transoral vestibular robotic thyroidectomy Open thyroidectomy Patient-reported outcomes Figures Figure 1 Figure 2 Introduction Thyroid carcinoma incidence has risen progressively, especially among women [ 1 , 2 ] . While open thyroidectomy (OT) remains the surgical cornerstone [ 3 ] , demand for scar-concealing techniques has driven innovations including transaxillary, transoral, and retroauricular approaches [ 4 – 9 ] . Among these, transoral vestibular robotic thyroidectomy (TOVRT) achieves virtually scarless outcomes [ 10 , 11 ] , hrough the da Vinci® system’s articulated instruments and magnified 3D visualization, enabling precise dissection while mitigating endoscopic "chopstick effect" [ 12 – 14 ] . Despite these advantages, TOVRT adoption in China remains limited due to its steep learning curve and anatomical triangulation challenges [ 15 , 16 ] . This propensity score-matched cohort study therefore compares TOVRT versus OT for therapeutic efficacy, safety, and patient-reported cosmetic outcomes. Materials and Methods Ethical Approval and Registration : This retrospective cohort study was conducted in accordance with the Declaration of Helsinki and approved by the Clinical Research Ethics Committee of Daping Hospital, Army Medical University (Chongqing, China; Approval No. 2024 − 357). The protocol was registered at ClinicalTrials.gov (NCT06958601). Informed consent was waived due to the retrospective design. Patient selection and Research design This retrospective cohort study included patients who underwent thyroidectomy performed by senior surgeons(≥ 100 cases/year) at our institution between January 1, 2020, and October 31, 2024. Surgical approach (TOVRT vs OT) was determined by informed patient preference following multidisciplinary confirmation confirming eligibility for TOVRT [ 17 – 20 ] . Patients met all of the following: (1) Age 18–70 years; (2) Histopathologically confirmed papillary thyroid carcinoma (PTC); (3) Complete medical records. Patients were excluded if they met any of the following: (1) Benign pathology; (2) Incomplete records; (3) Preoperative evidence of lateral/distant metastasis; (4) Follow-up < 12 months. The patient selection flowchart is detailed in Fig. 1 . Preoperative Preparation Preoperative Preparation All patients undergo thyroid colour Doppler ultrasound, contrast-enhanced neck CT, and laryngoscopy for assessment prior to surgery. For patients undergoing robotic surgery, oral care is performed by a specialist dental surgeon the day before the procedure, with oral preparation using chlorhexidine mouthwash. Intravenous administration of cephalosporin antibiotics commences half an hour before surgery. Surgical Approach Open Surgery A 5–8 cm transverse incision was created along Langer's skin tension lines, centered 2–3 cm superior to the suprasternal notch. The incision penetrated sequentially through skin, subcutaneous tissue, and platysma muscle layer. The standardized resection included: Lobectomy of the affected thyroid lobe with capsular dissection; Isthmusectomy at the tracheal insertion level; Therapeutic central compartment lymph node dissection (Level VI) preserving both recurrent laryngeal nerves and parathyroid glands with autotransplantation as needed. Robotic surgery The principal workflow of transoral robotic thyroidectomy comprises: Surgical space creation; Robotic system docking; Flap dissection; Vessel ligation; Resection of the affected thyroid lobe, isthmus, and central compartment lymph nodes. The detailed procedural steps for the tri-port transoral vestibular approach have been previously reported [ 21 ] and are not reiterated here. Follow-up Drains were removed at 24–48 hours postoperatively for TOVRT patients. For OT patients, drains were removed when drainage volume was < 10 mL/24h for 2 consecutive days. Follow-up Schedule at 1 week postoperatively; 1 month postoperatively; 6 months postoperatively. At each visit, patients completed validated questionnaires via WeChat-mini-program (electronic data capture system): Numerical Rating Scale (NRS) [ 22 ] ; Voice Handicap Index-10 (VHI-10) [ 23 ] ; Short Assessment of Quality of Cosmetic Outcome (SAQCO) [ 24 ] . These instruments demonstrate established reliability and validity, with brief descriptions provided in digital table. Safety Definition Vocal function is assessed by an experienced clinician. Should vocal abnormalities be detected, laryngoscopy is performed. Hypoparathyroidism is defined as postoperative serum calcium < 2.0 mmol/L (8.0 mg/dL) or total parathyroid hormone level < 15 ng/L. Vocal cord paralysis or hypoparathyroidism persisting beyond 6–12 months without improvement is classified as permanent. Data Collection In accordance with research requirements, clinical characteristics during hospitalization were prospectively collected, including: Demographics (Sex, Age [years], Body Mass Index [kg/m²]); Preoperative Clinical Status (ASA physical status [I–V]); Tumor Profile (Location [unilateral/bilateral/isthmus], Maximum diameter [cm], Preoperative FNA cytology, BRAF V600E mutation status); Biochemical Markers (serum parathyroid hormone[(pg/mL], serum calcium[mg/dL], Comorbidities[Thyroiditis]); Surgical Parameters (Operative duration[skin-to-skin, minutes], Intraoperative blood loss [mL], Drain placement [yes/no], Total postoperative drainage volume[mL], pTNM stage[AJCC 8th ed.], Thyroid gland size [cm], Lymph nodes [ harvested/positive]); Hospitalization Metrics (Total hospital costs[¥; itemized billing], Length of stay[days; admission-to-discharge], Postoperative hospitalization [days; postop-to-discharge]); Postoperative Outcomes (Complications); and Patient-reported outcomes (NRS, VHI-10 and SAQCO). Propensity Score Matching To mitigate selection bias, 1:1 propensity score matching was performed using the nearest-neighbor algorithm without replacement (caliper width: 0.2 SD of logit PS). The propensity model included 12 preoperative covariates, incluing sex, age, BMI, ASA classification, thyroiditis (yes/no), Tumor location, preoperative FNA pathology, BRAF mutation status, tumor diameter, Preoperative PTH, serum calcium levels, and Operative approach. All standardized mean differences (SMD) were .05 per McNemar/paired t-test ). Statistical Analysis Categorical variables are presented as frequencies and percentages (n [%]). Intergroup comparisons were performed using the chi-square test or Fisher's exact test. Continuous variables were presented as median [interquartile range] or mean (standard deviation) based on distribution assessment. Intergroup comparisons employed the Mann-Whitney U test or t-test. Statistical significance was defined as P < 0.05. All analyses used the survival package in R. Results 1. Comparison of demographic and clinical characteristics before and after patient matching During the study period, our centre performed 4,371 thyroid surgeries. Ultimately, 417 patients(mean(SD) Age, 42.7 [10.7]years; 315 [75.5%] Female and 102 [24.5%] male) were included in this study: 217 in the transoral vestibular robotic thyroidectomy(TOVRT) group and 200 in the open thyroidectomy (OT) group. Prior to matching, the TOVRT group exhibited lower body mass index (BMI), younger age, lower ASA physical status classification, and fewer patients with concomitant thyroiditis (Table 1 ). These demographic findings suggest younger patients are more inclined to opt for TOVRT due to its superior cosmetic outcomes. The purpose of this study is unrelated to ethnicity, and therefore the issue of ethnicity is not discussed. Table 1 Comparison of clinical characteristics between the two groups before and after matching Variables Before PSM P value SMDs After PSM P value a SMDs b TOVRT (n = 217) OT (n = 200) TOVRT (n = 161) OT (n = 161) Sex, No.(%) Female 169 (77.9) 146 (73.0) 0.256 0.11 118 (73.3) 113 (70.2) 0.62 −0.06 Male 48 (22.1) 54 (27.0) 43 (26.7) 48 (29.8) BMI, mean (SD),kg/m 2 23.70 ( 2.3) 24.9 (3.7) < 0.001 0.04 24.15 ( 2.26) 24.32 (3.40) 0.79 0.06 Age, median (IQR), years 39.0 (33.0–49.0) 45.5 (35.0–54.0) 0.002 0.31 41.0 (34.0–51.0) 43.0 (34.0–52.0) 0.69 0.05 Tumor diameter, median (IQR), mm d 8.0 (6.0–11.0) 8.0 (6.0- 10.1) 0.95 0.13 8.0 (6.0–11.0) 8.0 (6.0-10.2) 0.912 −0.10 ASA, No.(%) c I 168 (77.4) 121 (60.5) < .001 0.37 114 (70.8) 109 (67.7) 0.63 0.07 II 49 (22.6) 79 (39.5) 47 (29.2) 52 (32.3) Tumor site, No.(%) Bilateral 27 (12.4) 19 (9.5) 0.52 0.15 21 (13.0) 16 (9.9) 0.75 −0.09 Isthmus 9 (4.1) 11 (5.5) 3 (1.9%) 5 (3.1) Left 86 (39.6) 90 (45.0) 72 (44.7) 73 (45.3) Right 95 (43.8) 80 (40.0) 65 (40.4) 67 (41.6) Surgical Procedure,No.(%) UL + UCND 149 (68.7) 135 (67.5) 0.96 0.03 111 (68.9) 111 (68.9) 0.62 0 TT + UCND 40 (18.4) 38 (19.0) 27 (16.8) 32 (19.9) TT + BCND 28 (12.9) 27 (13.5) 23 (14.3) 18 (11.2) Preoperative FNA cytology, No.(%) Atypical lesions 8 (3.7) 6 (3.0) 0.70 0.12 6 (3.7) 6 (3.7) > .99 0 Follicular epithelial cells 7 (3.2) 6 (3.0) 5 (3.1) 6 (3.7) Papillary Thyroid Carcinoma 196 (90.3) 178 (89.0) 144 (89.4) 143 (88.8) unchart 6 (2.8) 10 (5.0) 6 (3.7) 6 (3.7) Preoperative BRAF Mutation, No.(%) Negative 10 (4.6) 12 (6.0) 0.27 0.16 9 (5.6) 6 (3.7) 0.75 −0.09 Positive 160 (73.7) 133 (66.5) 112 (69.6) 113 (70.2) Uncharted 47 (21.7) 55 (27.5) 40 (24.8) 42 (26.1) Thyroiditis, No.(%) 44 (20.3) 67 (33.5) 0.003 0.30 40 (24.8) 46 (28.6) 0.53 0.08 Preoperative iPTH,median (IQR), ng/L 51.8 (39.0-61.9) 50.5 (39.9–66.1) 0.464 0.09 51.99 (41.05–62.56) 50.41 (40.22–64.47) 0.937 0.03 Preoperative Serum Calcium, mean (SD),mg/dL 2.4( 0.1) 2.4 ( 0.1) 0.481 0.03 2.36 (0.10) 2.36 (0.09) 0.912 −0.04 Abbreviations: PSM, Propensity score matching; TOVRT, transoral vestibular robotic thyroidectomy; OT, open thyroidectomy; BMI, body mass index; ASA, American Society of Anesthesiologists Physical Status Classification System; SMD, standardized mean difference; UL, Unilateral lobectomy; UCND, Unilateral central node dissection; TT, Total thyroidectomy; BCND, Bilateral central node dissection; FNA, Fine - needle aspiration; iPTH, Intact parathyroid hormone; SD, Standard Deviation; IQR, Interquartile Range. a A2-sided Pvalue < .05 was considered statitically significant. b SMD is to measure the Mean Difference between the two groups of data and eliminate the dimensional influence of the original data, making variables of different units or magnitude comparable. c ASA is a tool used by anaesthetists to assess a patient's overall health status and surgical risk prior to surgery. It comprises six grades, ranging from I to VI, with higher grades indicating greater surgical risk. d Tumour diameter refers to the measurement of the tumour's maximum diameter. 2. Comparison of surgical outcomes following propensity-matched analysis After 1:1 propensity score matching (161 pairs per group), TOVRT demonstrated distinct advantages and trade-offs compared to OT in Table 2 . Table 2 Comparison of clinical characteristics between the two groups after matching Variables TOVRT (n = 161) OT (n = 161) Mean or risk difference (95% CI) P value a T stage, No.(%) b 1a 115 (71.4) 121 (75.2) −3.7 (−13.4 to 6) 0.08 1b 41 (25.5) 40 (25.8) −0.6 (−8.9 to 10.1) 0.08 2 5 (3.1) 0 (0) 3.1 (3.1 to 7.1) 0.08 N stage, No.(%) b 0 84 (52.2) 76 (47.2) 5 (−6 to 15.8) 0.44 1a 77 (48.8) 85 (53.8) −5 (−15.8 to 6) 0.44 Drain Utilization, No.(%) Drain placed 99 (61.5) 161 (100) −38.5 (−46.2 to−31.3) < .001 No drain placed 62 (38.5) 0 (0) 38.5 (31.3 to 46.2 ) < .001 Gland width, mean (SD), cm 2.7 (0.4) 2.7 (0.4) 0.05 (-0.03 to 0.14) 0.20 Gland length, mean (SD), cm 4.3 (0.6) 4.3 (0.6) 0.03 (-0.09 to 0.16) 0.60 Gland thickness, mean (SD), cm 1.1 (0.2) 1.1 (0.3) -0.03 (-0.09 to 0.03) 0.30 Surgery Duration, mean (SD), minutes 242.0 (55.8) 106.3 ( 38.4) 136 (125 to 146) < .001 Blood Loss,median (IQR), mL c 20 (10 to 50) 20 (10 to 30) NA 0.02 Total Drainage, median (IQR), mL 0 (0 to 27) 60 (40 to 80) NA < .001 Total Hospital Stay,mean (SD), days 4.9 (1.8) 6.6 (2.2) -1.7 (-2.1 to -1.2) < .001 Postoperative Stay, mean (SD), days 2.8 (1.4) 3.4 (1.2) -0.6 (-0.88 to -0.31) < .001 Hospitalization Cost, median (IQR), (CNY, ¥) 63,351.0 (60,644.5 to 64,948.8) 19,009.6 (17,127.7 to 21,774.4) NA < .001 Number of Dissected Lymph Nodes, median (IQR) 7 (4 to 11) 8 (5 to 12) NA 0.06 Number of metastasis-positive lymph nodes, median (IQR) 0 (0 to 2) 1 (0 to 3) NA 0.06 Postoperative 1d PTH, mean(SD), pg/mL 39.9 (21.4) 32.3 (25.2) 7.6 (2.5 to 13.0) 0.004 Postoperative 1d Serum Calcium, mean(SD), mg/dL 2.1(0.1) 2.2 (0.1) -0.03 (-0.06 to 0) 0.03 Complications, No.(%) 11 (6.8) 32 (19.9) −13.0 (−19.3 to−6.8) .99 Permanent Hoarseness 0 (0) 0 (0) NA NA Transient Hypothyroidism 5 (3.1) 29 (18.0) −14.9 (−20.3 to−9.5) < .001 Permanent Hypothyroidism 0 (0) 1 (0.6) −0.6 (−1.8 to 0.6) 0.5 Infection 1 (0.6) 0(0) 0.6 (−0.6 to 1.8) 0.5 Numbness of the Mandible 2 (1.2) 0 (0) 1.2 (−0.4 to 2.8) 0.25 Conversion to Opening 1 (0.6) 0 (0) 0.6 (−0.6 to 1.8) 0.5 Flap perforation 0 0 NA NA Abbreviations: TOVRT, transoral vestibular robotic thyroidectomy; OT, open thyroidectomy; NA, not applicable; T, Tumor; N, Node; CNY, China Yuan; PTH, parathyroid hormone; SD, Standard Deviation; IQR, Interquartile Range; 95% Cl, Confidence Interval. a A 2-sided Pvalue < .05 was considered statistically significant. b The TNM staging system employs the 8th edition of the AJCC Cancer Staging Manual. c Blood loss represents an approximate estimate of intraoperative haemorrhage. TOVRT required longer operative time (mean [SD],242.0 [55.8]min vs 106.3 [38.4]min;mean difference, 136; 95%Cl, 125–146; P < .001) and incurred higher hospitalization costs (median [IQR], TOVRT: 63,351.0 [60,644.5–64,948.8]¥ vs OT: 19,009.6 [17,127.7–21,774.4]¥; P < .001). Dissected lymph nodes (median [IQR], TOVRT: 7.0 [4.0–11.0] vs OT: 8.0 [5.0–12.0]; P = 0.06) and metastasis-positive lymph nodes (median [IQR], TOVRT: 0 [0–2] vs OT: 1 [0–3]; P = 0.06) were comparable.It is evident that TOVRT achieves the same therapeutic efficacy as OT, but requires a longer surgical duration and incurs higher surgical costs. The TOVRT group exhibited shorter total hospital stays (mean [SD], 4.9 [1.8]days vs 6.6 [2.2]days; mean difference, -1.7; 95%Cl, -2.1 to -1.2; P < .001) and postoperative hospital stays (mean [SD], 2.8 [1.4]days vs 3.4 [1.2] days; mean difference, -0.6; 95%Cl, 0.31–0.88; P < .001) were both shorter than in the OT group. The exhibited postoperative drainage total volume was lower in TOVRT group (median [IQR], TOVRT: 0 [0–27] vs OT: 60 [40–80] mL; P < .001) and 38.5%(62/161) of patients required no drainage tube placement. TOVRT significantly accelerated recovery across multiple metrics. Serum parathyroid hormone concentrations on postoperative day 1 were higher in the TOVRT group than in the OT group (mean [SD], 39.9 [21.4]pg/mL vs 32.3 [25.2] pg/mL; mean difference, 7.6; 95%Cl, 2.5–13; P < .001), and a lower incidence of transient hypoparathyroidism in TOVRT group (5/161 [3.1%] vs 29/161 [18.0%]; risk difference, -14.9; 95Cl,−20.3 to−9.5; P < .001). Although serum calcium levels were lower on postoperative day 1 (mean [SD], 2.1 [0.1]mg/dL vs 2.2 [0.1] mg/dL; mean difference, -0.03; 95%Cl, -0.06-0; P = 0.03), the incidence of permanent hypoparathyroidism was comparable (0/161 [0%] vs 1/161 [0.6%]; risk difference, -0.6; 95Cl,−1.8 to 0.6; P = 0.5). These data indicate enhanced functional parathyroid preservation with TOVRT. There was no significant difference between the two groups in the incidence of transient postoperative hoarseness as a complication(2/161 [1.2%] vs 1/161 [0.6]; risk difference, 0.6; 95Cl,−1.2 to 2.4; P > .99). No patients in either group developed permanent hoarseness as a complication, and all instances of hoarseness were confirmed by laryngoscopy. Although TOVRT introduced a new spectrum of complications, including mumbness of the mandible(2/161 [1.2%] vs 0/161 [0%]; risk difference, 1.2; 95Cl,−0.4 to 2.8; P = 0.25, conversion to opening(1/161 [0.6%] vs 0/161 [0%]; risk difference, 0.6; 95Cl,−0.6 to 1.8; P = 0.5), and infection (1/161 [0.6%] vs 0/161 [0%]; risk difference, 0.6; 95Cl,−0.6 to 1.8; P = 0.5). However, the overall incidence of complications was lower in the TOVRT group than in the OT group༈11/161 [6.8%] vs 32 [19.9]; risk difference, -13.0; 95Cl,−19.3 to−6.8; P < .001). 3. Patient-Reported Outcomes Analysis Following propensity score matching (161 pairs), outcomes assessed one week postoperatively using the Numerical Rating Scale (NRS), Voice Handicap Index-10 (VHI-10), and Short Assessment of Quality of Cosmetic Outcome (SAQCO) scales demonstrated that TOVRT offers advantages in terms of minimal tissue trauma, accelerated recovery, and superior cosmetic outcomes in Table 3 .Patients undergoing TOVRT reported significantly lower pain scores than the OT group on NRS (median[IQR], 3.0 [2.0–4.0] vs 7.0 [6.0–8.0]; median difference, -4.0; 95% CI, -5.0 to -4.0; P < .001). The interquartile range analysis confirmed minimal overlap in pain experience between groups. VHI-10 consistently favored TOVRT across all domains, including functional score (median [IQR], 14.0[5.0–20.) vs 23.0[19.0–29.0]; median difference, -10.0; 95% CI, -12.0 to -7.0; P < .001), physical score( median[IQR] 16.0[ 7.0–20.0] vs 25.0[20.0–30.0]; median difference, -10.0; 95% CI, -12.0 to -8.0; P < .001), emotional score( median[IQR], 7.0 [ 0–18.0] vs 27.0 [20.0–30.0); median difference, -20.0; 95% CI, -20 to -14.0; P < .001). SAQCO outcomes showed marked advantages for the TOVRT approach, including cosmetic satisfaction (median[IQR], 8.0 [7.0–9.0] vs 6.0 [ 6.0–7.0]; median difference, 2.0; 95% CI, 1.0 to 2.0; P < .001), scar consciousness( median[IQR], 12.0[10.0, 15.0] vs 8.0[ 6.0–11.0]; median difference, 4.0; 95% CI, 4.0 to 5.0; P < .001).Regarding wound recovery, patients treated with TOVRT achieved near-complete resolution of surface lesions across the body, with oral wounds healing satisfactorily and requiring no further wound care. In contrast, patients in the OT group continued to require ongoing wound management (Fig. 2 ). Table 3 Patient-reported outcomes after matching Variables TOVRT (n = 161) OT (n = 161) Median difference (95% CI) a P value b NRS c , median[IQR] 3.0 (2.0 to 4.0) 7.0 (6.0 to 8.0) -4.0 (-5.0 to -4.0) < .001 VHI-10 d , median[IQR] 38.0 (12.0 to 59.0) 77.0 (59.0 to 89.0) -39.0 (-42.0 to -29.0) < .001 Functional score, median[IQR] 14.0 (5.0 to 20.0) 23.0 (19.0 to 29.0) -10.0 (-12.0 to -7.0) < .001 Physical score, median[IQR] 16.0 (7.0 to 20.0) 25.0 (20.0 to 30.0) -10.0 (-12.0 to -8.0) < .001 Emotional score 7.0 (0 to 18.0) 27.0 (20.0 to 30.0) -20.0 (-20.0 to -14.0) < .001 SAQCO e , median[IQR] 20.0 (18.0 to 23.0) 14.0 (12.0 to 17.0) 6.0 (5.0 to 6.0) < .001 cosmetic satisfaction, median[IQR] 8.0 (7.0 to 9.0) 6.0 (6.0 to 7.0) 2.0 (1.0 to 2.0) < .001 scar consciousness, median[IQR] 12.0 (10.0 to 15.0) 8.0 (6.0 to 11.0) 4.0 (4.0 to 5.0) < .001 Abbreviations: TOVRT, transoral vestibular robotic thyroidectomy; OT, open thyroidectomy; NRS, numerical rating scale;VHI−10, voice handicap index−10; SAQCO, short assessment of quality of cosmetic outcome. a Median difference (95% confidence interval) was assessed using the Mann-Whitney U test. b A 2-sided Pvalue < .05 was considered statistically significant. c The numerical rating scale was used to quantify the intensity of pain. d The VHI−10 questionnaire evaluates an individual’s perception of the handicap degree caused by a voice disorder in three subscales: function, physics, and emotion. e The aim was to collect patients' subjective evaluations of the effects of aesthetic treatments. The questionnaire covers a wide range of areas, including post-treatment satisfaction, improved appearance, changes in skin health and self-confidence. Discussion The increasing utilization of imaging modalities and fine-needle aspiration biopsy has facilitated earlier detection of subclinical thyroid lesions, contributing to a rising incidence of thyroid carcinoma [ 25 , 26 ] . Surgical resection remains the cornerstone of thyroid cancer management [ 27 , 28 ] . Open thyroidectomy requires a cervical collar incision, which invariably produces a visible scar [ 29 ] . Severe cases may develop hypertrophic scarring or hyperpigmentation, significantly compromising cosmesis [ 30 ] .Minimally invasive surgery (MIS) techniques enable surgical incision relocation to concealed anatomical sites while maintaining oncological efficacy comparable to open procedures [ 31 , 32 ] . For young female patients particularly, prominent scarring frequently induces postoperative psychological distress related to aesthetic outcomes [ 30 ] . Consequently, MIS has emerged as the preferred approach for patients prioritizing optimal cosmesis [ 10 , 33 ] . Nevertheless, the adoption of robotic thyroidectomy—despite its technical advantages in narrow anatomical spaces—remains constrained by significant economic barriers and regional healthcare disparities. Rigorous comparative studies are warranted to validate the long-term oncological safety, and functional outcomes of robotic versus conventional surgical approaches. In our study, propensity score matching of clinical characteristics and postoperative follow-up scale data from 417 patients resulted in 322 patients being included. Consistent with prior research, we confirmed the limitations of robotic surgery, namely higher costs and longer operative times [ 34 ] . Nevertheless, TOVRT significantly reduced postoperative hospital stays and accelerated recovery times. Notably, 62/161 [38.5%] of patients in the TOVRT group did not require surgical drain placement, further lowering postoperative care expenses. Regarding therapeutic efficacy, no statistically significant difference was found in the number of lymph nodes retrieved between robotic and open surgery (median[IQR], TOVRT: 7.0 [4.0–11.0] vs OT: 8.0 [5.0–12.0]; P = 0.06). Crucially, during the 5-year follow-up period, no cases of recurrence, metastasis, or death were observed in the robotic surgery group, indicating TOVRT is a safe and reliable approach. Concerning complications, robotic surgery demonstrated a significant advantage in preserving parathyroid function, resulting in a markedly lower incidence of postoperative hypoparathyroidism (TOVRT: 5 [3.11%] vs OT: 29 [18.01%]; risk difference,-14.9; 95%Cl,-20.3 to -9.5; p < 0.001). While some scholars [ 35 – 37 ] suggest the transoral approach may increase risks of mental nerve injury and surgical site infection, our study observed only 2 cases of transient mental nerve injury and 1 cases of postoperative infection. Through extensive experience, we identified effective mitigation strategies: positioning trocars away from adjacent mental nerve branches and minimizing intraoperative traction on the trocar reduces the risk of mental nerve injury; additionally, preoperative prophylactic antibiotic administration and strict postoperative adherence to prescribed antiseptic mouthwash protocols significantly reduce infection risk. During postoperative follow-up assessments using standardized scales, we observed a notable divergence from previous studies [ 16 , 38 ] : patients undergoing robotic surgery experienced significantly less postoperative pain compared to the open surgery group (NRS: median[IQR], TOVRT: 3.0 [2.0–4.0] vs OT: 7.0 [6.0–8.0], median difference,−4.0; 95%Cl,−5.0 to−4.0; P < 0.001). This reduction is primarily attributed to our center's exclusive use of a pure transoral three-port robotic approach without supplementary transaxillary ports, thereby minimizing additional tissue trauma. Robotic surgery also demonstrated superior voice outcomes (VHI: TOVRT: 38.0 [12.0–59.0] vs OT: 77.0 [59.0–89.0]; median difference,−39; 95%Cl,−42.0 to−29.0; P < 0.001). Furthermore, assessment via the SAQCO scale revealed that patients treated with the transoral robotic approach exhibited heightened scar consciousness(TOVRT: 12.0 [10.0–15.0] vs OT: 8.0[6.0–11.0]; median difference, 4.0; 95%Cl, 4.0 to 5.0; P < 0.001) and significantly higher scar satisfaction(TOVRT: 8.0 [7.0–9.0] vs OT: 6.0[6.0–7.0]; median difference, 2.0; 95%Cl, 1.0 to 2.0; P < 0.001) than the open surgery group, achieving a near absence of visible scarring on the body surface. This study has three main limitations. First, its design as a single-center, small-sample, retrospective investigation provides limited validation. Second, the use of subjective scales for postoperative recovery assessment introduces inherent bias. Third, the study did not perform a formal cost-effectiveness analysis. Future prospective studies are warranted to further validate the relationship between the efficacy of transoral robotic thyroidectomy and its cost-effectiveness ratio compared to open surgery. Conclusion Compared to traditional surgery, TOVRT shows no significant difference in therapeutic efficacy. Not only does TOVRT reduce the occurrence of some related complications, but it also significantly preserves patients' cosmetic appearance needs. In the future, it could become an alternative treatment to open surgery. Declarations Acknowledgments: This research was supported by the following projects: (1) Chongqing Natural Science Foundation: Mechanistic study of ZNF831 inhibiting breast cancer metastasis by transcriptionally downregulating CTNNB1, Project No. CSTB 2024NSCQ-KJFZMSX0103. (2) University Scientific and Technological Innovation Capacity Enhancement Programme: Investigation into the Tissue Levels of Persistent Organic Pollutants and Breast Cancer Risk, Project No. 2023XLC09. (3) Centre ‘Artificial Intelligence+’ Medical Research Programme: Accurate Diagnosis of Early-Stage Breast Cancer through AI Model-Assisted Clinical Practice, Project No. ZXAIYB014. Role of the Funder/Sponsor: The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. Data Sharing Statement: The datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request. Data can be provided after the Article is published. The corresponding authors have the right to decide whether to share the data or not based on the research objectives and plan provided. Funding: This research was supported by the following projects: (1) Chongqing Natural Science Foundation: Mechanistic study of ZNF831 inhibiting breast cancer metastasis by transcriptionally downregulating CTNNB1, Project No. CSTB 2024NSCQ-KJFZMSX0103. (2) University Scientific and Technological Innovation Capacity Enhancement Programme: Investigation into the Tissue Levels of Persistent Organic Pollutants and Breast Cancer Risk, Project No. 2023XLC09. (3) Centre ‘Artificial Intelligence+’ Medical Research Programme: Accurate Diagnosis of Early-Stage Breast Cancer through AI Model-Assisted Clinical Practice, Project No. ZXAIYB014. Conflicts of Interest : Any potential conflicts of interest "involving the work under consideration for publication". Author Contributions: Yan Xu responsible for the integrity and accuracy of the data, and had full access to the study. conceive and designe: Yan Xu, Fu Luo and Jing Xu. Draft and write: Fu Luo and Jing Xu Record the follow-up data and confirm data accuracy:Zhang, Ling-ji Guo and Yan Jiang. Data analysis and interpretion: Fu Luo, Jing Xu Jie Yan and Fan Yu Supervised data collection, reviewed and approved the final manuscript: Yan Xu Ethics approval: This retrospective cohort study was conducted in accordance with the Declaration of Helsinki and approved by the Clinical Research Ethics Committee of Daping Hospital, Army Medical University (Chongqing, China; Approval No. 2024-357). The protocol was registered at ClinicalTrials.gov (NCT06958601). Informed consent was waived due to the retrospective design. Consent to participate: informed consent was obtained from all individual participants included in the study. Consent to publish : Verbal informed consent was obtained prior to the interview. References Kitahara CM, Sosa JA (2020) Understanding the ever-changing incidence of thyroid cancer. Nat reviews Endocrinol 16(11):617–618. https://doi.org/10.1038/s41574-020-00414-9 Kitahara CM, Sosa JA (2016) The changing incidence of thyroid cancer. 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Surg Laparosc Endosc Percutan Tech 10(1):1–4 Tan CT, Cheah WK, Delbridge L (2008) Scarless (in the neck) endoscopic thyroidectomy (SET): an evidence-based review of published techniques. World J Surg 32(7):1349–1357. https://doi.org/10.1007/s00268-008-9555-3 Wang Y, Zhou S, Liu X et al (2021) Transoral endoscopic thyroidectomy vestibular approach vs conventional open thyroidectomy: Meta-analysis. Head Neck 43(1):345–353. https://doi.org/10.1002/hed.26486 Pan JH, Zhou H, Zhao XX et al (2017) Robotic thyroidectomy versus conventional open thyroidectomy for thyroid cancer: a systematic review and meta-analysis. Surg Endosc 31(10):3985–4001. https://doi.org/10.1007/s00464-017-5433-0 Tae K (2021) Complications of Transoral Thyroidectomy: Overview and Update. Clin Exp Otorhinolaryngol 14(2):169–178. https://doi.org/10.21053/ceo.2020.02110 Fernandez-Ranvier G, Meknat A, Guevara D, Taye A, Suh H, Inabnet WB (2020) 3rd. 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Cite Share Download PDF Status: Published Journal Publication published 19 Mar, 2026 Read the published version in Journal of Robotic Surgery → Version 1 posted Editorial decision: Revision requested 22 Nov, 2025 Reviews received at journal 22 Nov, 2025 Reviews received at journal 15 Nov, 2025 Reviewers agreed at journal 12 Nov, 2025 Reviewers agreed at journal 12 Nov, 2025 Reviewers agreed at journal 10 Nov, 2025 Reviewers agreed at journal 10 Nov, 2025 Reviewers agreed at journal 06 Nov, 2025 Reviewers invited by journal 04 Nov, 2025 Editor assigned by journal 27 Oct, 2025 Submission checks completed at journal 27 Oct, 2025 First submitted to journal 26 Oct, 2025 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-7950983","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":544489126,"identity":"a5d7467c-3b2f-4125-899b-38d64ecfd9bf","order_by":0,"name":"Fu Luo","email":"","orcid":"","institution":"Daping Hospital,Army Medical University","correspondingAuthor":false,"prefix":"","firstName":"Fu","middleName":"","lastName":"Luo","suffix":""},{"id":544489127,"identity":"ab31d153-0360-4508-ad4a-4f897ff1d714","order_by":1,"name":"Jing Xu","email":"","orcid":"","institution":"Daping Hospital,Army Medical 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1","display":"","copyAsset":false,"role":"figure","size":176316,"visible":true,"origin":"","legend":"\u003cp\u003eFlow Diagram of Participant Selection\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7950983/v1/8474c7433f56e181212beb28.png"},{"id":96049251,"identity":"099a20e8-dcfe-49fd-a2b1-786895358ae7","added_by":"auto","created_at":"2025-11-17 06:31:22","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":238493,"visible":true,"origin":"","legend":"\u003cp\u003ePostoperative appearance follow-up at one week: the Transoral vestibular robotic thyroidectomy (TOVRT) versus Open Thyroidectomy (OT)\u003c/p\u003e\n\u003cp\u003ea: Neck appearance in a patient undergoing TOVRT\u003c/p\u003e\n\u003cp\u003eb: Oral vestibular incision in a patient undergoing TOVRT\u003c/p\u003e\n\u003cp\u003ec: Neck appearance in a patient undergoing OT\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-7950983/v1/5eb2210f16c07cd9fa1dd708.png"},{"id":105223309,"identity":"aaf7ca29-3138-406d-accc-561ba8a7d096","added_by":"auto","created_at":"2026-03-23 16:03:34","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1707870,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7950983/v1/a8f329dc-51fe-42f5-8776-b7e08679bc63.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Transoral Vestibular Robotic Thyroidectomy vs Open Thyroidectomy for Thyroid Cancer: A Propensity Score-Matched Analysis","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThyroid carcinoma incidence has risen progressively, especially among women\u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/sup\u003e. While open thyroidectomy (OT) remains the surgical cornerstone\u003csup\u003e[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/sup\u003e, demand for scar-concealing techniques has driven innovations including transaxillary, transoral, and retroauricular approaches\u003csup\u003e[\u003cspan additionalcitationids=\"CR5 CR6 CR7 CR8\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/sup\u003e. Among these, transoral vestibular robotic thyroidectomy (TOVRT) achieves virtually scarless outcomes\u003csup\u003e[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003c/sup\u003e, hrough the da Vinci\u0026reg; system\u0026rsquo;s articulated instruments and magnified 3D visualization, enabling precise dissection while mitigating endoscopic \"chopstick effect\"\u003csup\u003e[\u003cspan additionalcitationids=\"CR13\" citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]\u003c/sup\u003e. Despite these advantages, TOVRT adoption in China remains limited due to its steep learning curve and anatomical triangulation challenges\u003csup\u003e[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]\u003c/sup\u003e. This propensity score-matched cohort study therefore compares TOVRT versus OT for therapeutic efficacy, safety, and patient-reported cosmetic outcomes.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003e\u003cb\u003eEthical Approval and Registration\u003c/b\u003e:\u003c/p\u003e\u003cp\u003eThis retrospective cohort study was conducted in accordance with the Declaration of Helsinki and approved by the Clinical Research Ethics Committee of Daping Hospital, Army Medical University (Chongqing, China; Approval No. 2024\u0026thinsp;\u0026minus;\u0026thinsp;357). The protocol was registered at \u003cem\u003eClinicalTrials.gov\u003c/em\u003e (NCT06958601). Informed consent was waived due to the retrospective design.\u003c/p\u003e\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003ePatient selection and Research design\u003c/h2\u003e\u003cp\u003eThis retrospective cohort study included patients who underwent thyroidectomy performed by senior surgeons(\u0026ge;\u0026thinsp;100 cases/year) at our institution between January 1, 2020, and October 31, 2024. Surgical approach (TOVRT vs OT) was determined by informed patient preference following multidisciplinary confirmation confirming eligibility for TOVRT\u003csup\u003e[\u003cspan additionalcitationids=\"CR18 CR19\" citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]\u003c/sup\u003e. Patients met all of the following: (1) Age 18\u0026ndash;70 years; (2) Histopathologically confirmed papillary thyroid carcinoma (PTC); (3) Complete medical records. Patients were excluded if they met any of the following: (1) Benign pathology; (2) Incomplete records; (3) Preoperative evidence of lateral/distant metastasis; (4) Follow-up \u0026lt;\u0026thinsp;12 months. The patient selection flowchart is detailed in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003ePreoperative Preparation\u003c/h3\u003e\n\u003cp\u003ePreoperative Preparation\u003c/p\u003e\u003cp\u003eAll patients undergo thyroid colour Doppler ultrasound, contrast-enhanced neck CT, and laryngoscopy for assessment prior to surgery. For patients undergoing robotic surgery, oral care is performed by a specialist dental surgeon the day before the procedure, with oral preparation using chlorhexidine mouthwash. Intravenous administration of cephalosporin antibiotics commences half an hour before surgery.\u003c/p\u003e\n\u003ch3\u003eSurgical Approach\u003c/h3\u003e\n\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\u003ch2\u003eOpen Surgery\u003c/h2\u003e\u003cp\u003eA 5\u0026ndash;8 cm transverse incision was created along Langer's skin tension lines, centered 2\u0026ndash;3 cm superior to the suprasternal notch. The incision penetrated sequentially through skin, subcutaneous tissue, and platysma muscle layer. The standardized resection included: Lobectomy of the affected thyroid lobe with capsular dissection; Isthmusectomy at the tracheal insertion level; Therapeutic central compartment lymph node dissection (Level VI) preserving both recurrent laryngeal nerves and parathyroid glands with autotransplantation as needed.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eRobotic surgery\u003c/h3\u003e\n\u003cp\u003eThe principal workflow of transoral robotic thyroidectomy comprises: Surgical space creation; Robotic system docking; Flap dissection; Vessel ligation; Resection of the affected thyroid lobe, isthmus, and central compartment lymph nodes. The detailed procedural steps for the tri-port transoral vestibular approach have been previously reported\u003csup\u003e[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]\u003c/sup\u003e and are not reiterated here.\u003c/p\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eFollow-up\u003c/h2\u003e\u003cp\u003eDrains were removed at 24\u0026ndash;48 hours postoperatively for TOVRT patients. For OT patients, drains were removed when drainage volume was \u0026lt;\u0026thinsp;10 mL/24h for 2 consecutive days. Follow-up Schedule at 1 week postoperatively; 1 month postoperatively; 6 months postoperatively. At each visit, patients completed validated questionnaires via WeChat-mini-program (electronic data capture system): Numerical Rating Scale (NRS)\u003csup\u003e[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]\u003c/sup\u003e; Voice Handicap Index-10 (VHI-10)\u003csup\u003e[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]\u003c/sup\u003e; Short Assessment of Quality of Cosmetic Outcome (SAQCO)\u003csup\u003e[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]\u003c/sup\u003e. These instruments demonstrate established reliability and validity, with brief descriptions provided in digital table.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eSafety Definition\u003c/h3\u003e\n\u003cp\u003eVocal function is assessed by an experienced clinician. Should vocal abnormalities be detected, laryngoscopy is performed. Hypoparathyroidism is defined as postoperative serum calcium\u0026thinsp;\u0026lt;\u0026thinsp;2.0 mmol/L (8.0 mg/dL) or total parathyroid hormone level\u0026thinsp;\u0026lt;\u0026thinsp;15 ng/L. Vocal cord paralysis or hypoparathyroidism persisting beyond 6\u0026ndash;12 months without improvement is classified as permanent.\u003c/p\u003e\n\u003ch3\u003eData Collection\u003c/h3\u003e\n\u003cp\u003eIn accordance with research requirements, clinical characteristics during hospitalization were prospectively collected, including: Demographics (Sex, Age [years], Body Mass Index [kg/m\u0026sup2;]); Preoperative Clinical Status (ASA physical status [I\u0026ndash;V]); Tumor Profile (Location [unilateral/bilateral/isthmus], Maximum diameter [cm], Preoperative FNA cytology, BRAF V600E mutation status); Biochemical Markers (serum parathyroid hormone[(pg/mL], serum calcium[mg/dL], Comorbidities[Thyroiditis]); Surgical Parameters (Operative duration[skin-to-skin, minutes], Intraoperative blood loss [mL], Drain placement [yes/no], Total postoperative drainage volume[mL], pTNM stage[AJCC 8th ed.], Thyroid gland size [cm], Lymph nodes [ harvested/positive]); Hospitalization Metrics (Total hospital costs[\u0026yen;; itemized billing], Length of stay[days; admission-to-discharge], Postoperative hospitalization [days; postop-to-discharge]); Postoperative Outcomes (Complications); and Patient-reported outcomes (NRS, VHI-10 and SAQCO).\u003c/p\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003ePropensity Score Matching\u003c/h2\u003e\u003cp\u003eTo mitigate selection bias, 1:1 propensity score matching was performed using the nearest-neighbor algorithm without replacement (caliper width: 0.2 SD of logit PS). The propensity model included 12 preoperative covariates, incluing sex, age, BMI, ASA classification, thyroiditis (yes/no), Tumor location, preoperative FNA pathology, BRAF mutation status, tumor diameter, Preoperative PTH, serum calcium levels, and Operative approach. All standardized mean differences (SMD) were \u0026lt;\u0026thinsp;0.10 (mean SMD\u0026thinsp;=\u0026thinsp;0.032), propensity score standard deviation was 0.15 post-matching, no significant differences in baseline variables (\u003cem\u003eall P\u0026thinsp;\u0026gt;\u0026thinsp;.05 per McNemar/paired t-test\u003c/em\u003e).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003eStatistical Analysis\u003c/h2\u003e\u003cp\u003eCategorical variables are presented as frequencies and percentages (n [%]). Intergroup comparisons were performed using the chi-square test or Fisher's exact test. Continuous variables were presented as median [interquartile range] or mean (standard deviation) based on distribution assessment. Intergroup comparisons employed the Mann-Whitney U test or t-test. Statistical significance was defined as P\u0026thinsp;\u0026lt;\u0026thinsp;0.05. All analyses used the survival package in R.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cb\u003e1. Comparison of demographic and clinical characteristics before and after patient matching\u003c/b\u003e\u003c/p\u003e\u003cp\u003eDuring the study period, our centre performed 4,371 thyroid surgeries. Ultimately, 417 patients(mean(SD) Age, 42.7 [10.7]years; 315 [75.5%] Female and 102 [24.5%] male) were included in this study: 217 in the transoral vestibular robotic thyroidectomy(TOVRT) group and 200 in the open thyroidectomy (OT) group. Prior to matching, the TOVRT group exhibited lower body mass index (BMI), younger age, lower ASA physical status classification, and fewer patients with concomitant thyroiditis (Table \u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). These demographic findings suggest younger patients are more inclined to opt for TOVRT due to its superior cosmetic outcomes. The purpose of this study is unrelated to ethnicity, and therefore the issue of ethnicity is not discussed.\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\u003eComparison of clinical characteristics between the two groups before and after matching\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"9\"\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=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" 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\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eVariables\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eBefore PSM\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eSMDs\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003eAfter PSM\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c9\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eSMDs\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTOVRT (n\u0026thinsp;=\u0026thinsp;217)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eOT (n\u0026thinsp;=\u0026thinsp;200)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eTOVRT (n\u0026thinsp;=\u0026thinsp;161)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eOT (n\u0026thinsp;=\u0026thinsp;161)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSex, No.(%)\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\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e169 (77.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e146 (73.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.256\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e118 (73.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e113 (70.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.62\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u0026minus;0.06\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e48 (22.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e54 (27.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e43 (26.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e48 (29.8)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBMI, mean (SD),kg/m\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e23.70 ( 2.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e24.9 (3.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.04\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e24.15 ( 2.26)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e24.32 (3.40)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e0.79\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e0.06\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge, median (IQR), years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e39.0 (33.0\u0026ndash;49.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e45.5 (35.0\u0026ndash;54.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.002\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.31\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e41.0 (34.0\u0026ndash;51.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e43.0 (34.0\u0026ndash;52.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e0.69\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e0.05\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTumor diameter, median (IQR), mm\u003csup\u003ed\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e8.0 (6.0\u0026ndash;11.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e8.0 (6.0- 10.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.95\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e8.0 (6.0\u0026ndash;11.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e8.0 (6.0-10.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e0.912\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e\u0026minus;0.10\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eASA, No.(%)\u003csup\u003ec\u003c/sup\u003e\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\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eI\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e168 (77.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e121 (60.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.37\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e114 (70.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e109 (67.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.63\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.07\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=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e49 (22.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e79 (39.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e47 (29.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e52 (32.3)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTumor site, No.(%)\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\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBilateral\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e27 (12.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e19 (9.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e0.52\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e0.15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e21 (13.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e16 (9.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e0.75\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e\u0026minus;0.09\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIsthmus\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e9 (4.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e11 (5.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e3 (1.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e5 (3.1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLeft\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e86 (39.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e90 (45.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e72 (44.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e73 (45.3)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRight\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e95 (43.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e80 (40.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e65 (40.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e67 (41.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSurgical Procedure,No.(%)\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\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUL\u0026thinsp;+\u0026thinsp;UCND\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e149 (68.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e135 (67.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e0.96\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e0.03\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e111 (68.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e111 (68.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e0.62\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTT\u0026thinsp;+\u0026thinsp;UCND\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e40 (18.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e38 (19.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e27 (16.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e32 (19.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTT\u0026thinsp;+\u0026thinsp;BCND\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e28 (12.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e27 (13.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e23 (14.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e18 (11.2)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePreoperative FNA cytology, No.(%)\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\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAtypical lesions\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e8 (3.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e6 (3.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e0.70\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e0.12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e6 (3.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e6 (3.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;.99\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFollicular epithelial cells\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e7 (3.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e6 (3.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e5 (3.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e6 (3.7)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePapillary Thyroid Carcinoma\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e196 (90.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e178 (89.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e144 (89.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e143 (88.8)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eunchart\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e6 (2.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e10 (5.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e6 (3.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e6 (3.7)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePreoperative BRAF Mutation, No.(%)\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\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNegative\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e10 (4.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e12 (6.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e0.27\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e0.16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e9 (5.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e6 (3.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e0.75\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e\u0026minus;0.09\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePositive\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e160 (73.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e133 (66.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e112 (69.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e113 (70.2)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUncharted\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e47 (21.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e55 (27.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e40 (24.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e42 (26.1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eThyroiditis, No.(%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e44 (20.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e67 (33.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.003\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e40 (24.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e46 (28.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e0.53\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e0.08\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePreoperative iPTH,median (IQR), ng/L\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e51.8 (39.0-61.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e50.5 (39.9\u0026ndash;66.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.464\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.09\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e51.99 (41.05\u0026ndash;62.56)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e50.41 (40.22\u0026ndash;64.47)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e0.937\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e0.03\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePreoperative Serum Calcium, mean (SD),mg/dL\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2.4( 0.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2.4 ( 0.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.481\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.03\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e2.36 (0.10)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e2.36 (0.09)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e0.912\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e\u0026minus;0.04\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"9\"\u003eAbbreviations: PSM, Propensity score matching; TOVRT, transoral vestibular robotic thyroidectomy; OT, open thyroidectomy; BMI, body mass index; ASA, American Society of Anesthesiologists Physical Status Classification System; SMD, standardized mean difference; UL, Unilateral lobectomy; UCND, Unilateral central node dissection; TT, Total thyroidectomy; BCND, Bilateral central node dissection; FNA, Fine - needle aspiration; iPTH, Intact parathyroid hormone; SD, Standard Deviation; IQR, Interquartile Range.\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"9\"\u003e\u003csup\u003ea\u003c/sup\u003eA2-sided Pvalue\u0026thinsp;\u0026lt;\u0026thinsp;.05 was considered statitically significant.\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"9\"\u003e\u003csup\u003eb\u003c/sup\u003eSMD is to measure the Mean Difference between the two groups of data and eliminate the dimensional influence of the original data, making variables of different units or magnitude comparable.\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"9\"\u003e\u003csup\u003ec\u003c/sup\u003eASA is a tool used by anaesthetists to assess a patient's overall health status and surgical risk prior to surgery. It comprises six grades, ranging from I to VI, with higher grades indicating greater surgical risk.\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"9\"\u003e\u003csup\u003ed\u003c/sup\u003eTumour diameter refers to the measurement of the tumour's maximum diameter.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003e2. Comparison of surgical outcomes following propensity-matched analysis\u003c/b\u003e\u003c/p\u003e\u003cp\u003eAfter 1:1 propensity score matching (161 pairs per group), TOVRT demonstrated distinct advantages and trade-offs compared to OT in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\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\u003eComparison of clinical characteristics between the two groups after matching\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\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\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariables\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTOVRT (n\u0026thinsp;=\u0026thinsp;161)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eOT (n\u0026thinsp;=\u0026thinsp;161)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMean or risk difference (95% CI)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eT stage, No.(%)\u003csup\u003eb\u003c/sup\u003e\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\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1a\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e115 (71.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e121 (75.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026minus;3.7 (\u0026minus;13.4 to 6)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.08\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1b\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e41 (25.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e40 (25.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026minus;0.6 (\u0026minus;8.9 to 10.1)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.08\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5 (3.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0 (0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3.1 (3.1 to 7.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.08\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eN stage, No.(%)\u003csup\u003eb\u003c/sup\u003e\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\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e84 (52.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e76 (47.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5 (\u0026minus;6 to 15.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.44\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1a\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e77 (48.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e85 (53.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026minus;5 (\u0026minus;15.8 to 6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.44\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDrain Utilization, No.(%)\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\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDrain placed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e99 (61.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e161 (100)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026minus;38.5 (\u0026minus;46.2 to\u0026minus;31.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo drain placed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e62 (38.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0 (0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e38.5 (31.3 to 46.2 )\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGland width, mean (SD), cm\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.7 (0.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.7 (0.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.05 (-0.03 to 0.14)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.20\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGland length, mean (SD), cm\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4.3 (0.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4.3 (0.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.03 (-0.09 to 0.16)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.60\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGland thickness, mean (SD), cm\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.1 (0.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.1 (0.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-0.03 (-0.09 to 0.03)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.30\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSurgery Duration, mean (SD), minutes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e242.0 (55.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e106.3 ( 38.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e136 (125 to 146)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBlood Loss,median (IQR), mL\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e20 (10 to 50)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e20 (10 to 30)\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\u003e0.02\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal Drainage, median (IQR), mL\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0 (0 to 27)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e60 (40 to 80)\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\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal Hospital Stay,mean (SD), days\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4.9 (1.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6.6 (2.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-1.7 (-2.1 to -1.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePostoperative Stay, mean (SD), days\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.8 (1.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.4 (1.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-0.6 (-0.88 to -0.31)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHospitalization Cost, median (IQR), (CNY, \u0026yen;)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e63,351.0 (60,644.5 to 64,948.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e19,009.6 (17,127.7 to 21,774.4)\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\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNumber of Dissected Lymph Nodes, median (IQR)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7 (4 to 11)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8 (5 to 12)\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\u003e0.06\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNumber of metastasis-positive lymph nodes, median (IQR)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0 (0 to 2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1 (0 to 3)\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\u003e0.06\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePostoperative 1d PTH, mean(SD), pg/mL\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e39.9 (21.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e32.3 (25.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e7.6 (2.5 to 13.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.004\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePostoperative 1d Serum Calcium, mean(SD), mg/dL\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.1(0.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.2 (0.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-0.03 (-0.06 to 0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.03\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eComplications, No.(%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e11 (6.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e32 (19.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026minus;13.0 (\u0026minus;19.3 to\u0026minus;6.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTransient Hoarseness\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2 (1.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1 (0.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.6 (\u0026minus;1.2 to 2.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;.99\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePermanent Hoarseness\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0 (0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0 (0)\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\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTransient Hypothyroidism\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5 (3.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e29 (18.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026minus;14.9 (\u0026minus;20.3 to\u0026minus;9.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePermanent Hypothyroidism\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0 (0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1 (0.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026minus;0.6 (\u0026minus;1.8 to 0.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eInfection\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 (0.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0(0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.6 (\u0026minus;0.6 to 1.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNumbness of the Mandible\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2 (1.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0 (0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.2 (\u0026minus;0.4 to 2.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.25\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eConversion to Opening\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 (0.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0 (0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.6 (\u0026minus;0.6 to 1.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFlap perforation\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\u003eNA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eNA\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003eAbbreviations: TOVRT, transoral vestibular robotic thyroidectomy; OT, open thyroidectomy; NA, not applicable; T, Tumor; N, Node; CNY, China Yuan; PTH, parathyroid hormone; SD, Standard Deviation; IQR, Interquartile Range; 95% Cl, Confidence Interval.\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u003csup\u003ea\u003c/sup\u003eA 2-sided Pvalue\u0026thinsp;\u0026lt;\u0026thinsp;.05 was considered statistically significant.\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u003csup\u003eb\u003c/sup\u003eThe TNM staging system employs the 8th edition of the AJCC Cancer Staging Manual.\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u003csup\u003ec\u003c/sup\u003eBlood loss represents an approximate estimate of intraoperative haemorrhage.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eTOVRT required longer operative time (mean [SD],242.0 [55.8]min vs 106.3 [38.4]min;mean difference, 136; 95%Cl, 125\u0026ndash;146; \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001) and incurred higher hospitalization costs (median [IQR], TOVRT: 63,351.0 [60,644.5\u0026ndash;64,948.8]\u0026yen; vs OT: 19,009.6 [17,127.7\u0026ndash;21,774.4]\u0026yen;; \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001). Dissected lymph nodes (median [IQR], TOVRT: 7.0 [4.0\u0026ndash;11.0] vs OT: 8.0 [5.0\u0026ndash;12.0]; \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.06) and metastasis-positive lymph nodes (median [IQR], TOVRT: 0 [0\u0026ndash;2] vs OT: 1 [0\u0026ndash;3]; \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.06) were comparable.It is evident that TOVRT achieves the same therapeutic efficacy as OT, but requires a longer surgical duration and incurs higher surgical costs.\u003c/p\u003e\u003cp\u003eThe TOVRT group exhibited shorter total hospital stays (mean [SD], 4.9 [1.8]days vs 6.6 [2.2]days; mean difference, -1.7; 95%Cl, -2.1 to -1.2; \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001) and postoperative hospital stays (mean [SD], 2.8 [1.4]days vs 3.4 [1.2] days; mean difference, -0.6; 95%Cl, 0.31\u0026ndash;0.88; \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001) were both shorter than in the OT group. The exhibited postoperative drainage total volume was lower in TOVRT group (median [IQR], TOVRT: 0 [0\u0026ndash;27] vs OT: 60 [40\u0026ndash;80] mL; \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001) and 38.5%(62/161) of patients required no drainage tube placement. TOVRT significantly accelerated recovery across multiple metrics.\u003c/p\u003e\u003cp\u003eSerum parathyroid hormone concentrations on postoperative day 1 were higher in the TOVRT group than in the OT group (mean [SD], 39.9 [21.4]pg/mL vs 32.3 [25.2] pg/mL; mean difference, 7.6; 95%Cl, 2.5\u0026ndash;13; \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001), and a lower incidence of transient hypoparathyroidism in TOVRT group (5/161 [3.1%] vs 29/161 [18.0%]; risk difference, -14.9; 95Cl,\u0026minus;20.3 to\u0026minus;9.5; \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001). Although serum calcium levels were lower on postoperative day 1 (mean [SD], 2.1 [0.1]mg/dL vs 2.2 [0.1] mg/dL; mean difference, -0.03; 95%Cl, -0.06-0; \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.03), the incidence of permanent hypoparathyroidism was comparable (0/161 [0%] vs 1/161 [0.6%]; risk difference, -0.6; 95Cl,\u0026minus;1.8 to 0.6; \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.5). These data indicate enhanced functional parathyroid preservation with TOVRT. There was no significant difference between the two groups in the incidence of transient postoperative hoarseness as a complication(2/161 [1.2%] vs 1/161 [0.6]; risk difference, 0.6; 95Cl,\u0026minus;1.2 to 2.4; \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;.99). No patients in either group developed permanent hoarseness as a complication, and all instances of hoarseness were confirmed by laryngoscopy. Although TOVRT introduced a new spectrum of complications, including mumbness of the mandible(2/161 [1.2%] vs 0/161 [0%]; risk difference, 1.2; 95Cl,\u0026minus;0.4 to 2.8; \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.25, conversion to opening(1/161 [0.6%] vs 0/161 [0%]; risk difference, 0.6; 95Cl,\u0026minus;0.6 to 1.8; \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.5), and infection (1/161 [0.6%] vs 0/161 [0%]; risk difference, 0.6; 95Cl,\u0026minus;0.6 to 1.8; \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.5). However, the overall incidence of complications was lower in the TOVRT group than in the OT group༈11/161 [6.8%] vs 32 [19.9]; risk difference, -13.0; 95Cl,\u0026minus;19.3 to\u0026minus;6.8; \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001).\u003c/p\u003e\u003cp\u003e\u003cb\u003e3. Patient-Reported Outcomes Analysis\u003c/b\u003e\u003c/p\u003e\u003cp\u003eFollowing propensity score matching (161 pairs), outcomes assessed one week postoperatively using the Numerical Rating Scale (NRS), Voice Handicap Index-10 (VHI-10), and Short Assessment of Quality of Cosmetic Outcome (SAQCO) scales demonstrated that TOVRT offers advantages in terms of minimal tissue trauma, accelerated recovery, and superior cosmetic outcomes in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.Patients undergoing TOVRT reported significantly lower pain scores than the OT group on NRS (median[IQR], 3.0 [2.0\u0026ndash;4.0] vs 7.0 [6.0\u0026ndash;8.0]; median difference, -4.0; 95% CI, -5.0 to -4.0; \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001). The interquartile range analysis confirmed minimal overlap in pain experience between groups. VHI-10 consistently favored TOVRT across all domains, including functional score (median [IQR], 14.0[5.0\u0026ndash;20.) vs 23.0[19.0\u0026ndash;29.0]; median difference, -10.0; 95% CI, -12.0 to -7.0; \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001), physical score( median[IQR] 16.0[ 7.0\u0026ndash;20.0] vs 25.0[20.0\u0026ndash;30.0]; median difference, -10.0; 95% CI, -12.0 to -8.0; \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001), emotional score( median[IQR], 7.0 [ 0\u0026ndash;18.0] vs 27.0 [20.0\u0026ndash;30.0); median difference, -20.0; 95% CI, -20 to -14.0; \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001). SAQCO outcomes showed marked advantages for the TOVRT approach, including cosmetic satisfaction (median[IQR], 8.0 [7.0\u0026ndash;9.0] vs 6.0 [ 6.0\u0026ndash;7.0]; median difference, 2.0; 95% CI, 1.0 to 2.0; \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001), scar consciousness( median[IQR], 12.0[10.0, 15.0] vs 8.0[ 6.0\u0026ndash;11.0]; median difference, 4.0; 95% CI, 4.0 to 5.0; \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001).Regarding wound recovery, patients treated with TOVRT achieved near-complete resolution of surface lesions across the body, with oral wounds healing satisfactorily and requiring no further wound care. In contrast, patients in the OT group continued to require ongoing wound management (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\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\u003ePatient-reported outcomes after matching\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\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\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariables\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTOVRT (n\u0026thinsp;=\u0026thinsp;161)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eOT (n\u0026thinsp;=\u0026thinsp;161)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMedian difference (95% CI)\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNRS\u003csup\u003ec\u003c/sup\u003e, median[IQR]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3.0 (2.0 to 4.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7.0 (6.0 to 8.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-4.0 (-5.0 to -4.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVHI-10\u003csup\u003ed\u003c/sup\u003e, median[IQR]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e38.0 (12.0 to 59.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e77.0 (59.0 to 89.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-39.0 (-42.0 to -29.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFunctional score, median[IQR]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e14.0 (5.0 to 20.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e23.0 (19.0 to 29.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-10.0 (-12.0 to -7.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePhysical score, median[IQR]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e16.0 (7.0 to 20.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e25.0 (20.0 to 30.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-10.0 (-12.0 to -8.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEmotional score\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7.0 (0 to 18.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e27.0 (20.0 to 30.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-20.0 (-20.0 to -14.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSAQCO\u003csup\u003ee\u003c/sup\u003e, median[IQR]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e20.0 (18.0 to 23.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e14.0 (12.0 to 17.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6.0 (5.0 to 6.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ecosmetic satisfaction, median[IQR]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e8.0 (7.0 to 9.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6.0 (6.0 to 7.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.0 (1.0 to 2.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003escar consciousness, median[IQR]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e12.0 (10.0 to 15.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8.0 (6.0 to 11.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.0 (4.0 to 5.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003eAbbreviations: TOVRT, transoral vestibular robotic thyroidectomy; OT, open thyroidectomy; NRS, numerical rating scale;VHI\u0026minus;10, voice handicap index\u0026minus;10; SAQCO, short assessment of quality of cosmetic outcome.\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u003csup\u003ea\u003c/sup\u003eMedian difference (95% confidence interval) was assessed using the Mann-Whitney U test.\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u003csup\u003eb\u003c/sup\u003eA 2-sided Pvalue\u0026thinsp;\u0026lt;\u0026thinsp;.05 was considered statistically significant.\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u003csup\u003ec\u003c/sup\u003eThe numerical rating scale was used to quantify the intensity of pain.\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u003csup\u003ed\u003c/sup\u003eThe VHI\u0026minus;10 questionnaire evaluates an individual\u0026rsquo;s perception of the handicap degree caused by a voice disorder in three subscales: function, physics, and emotion.\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u003csup\u003ee\u003c/sup\u003eThe aim was to collect patients' subjective evaluations of the effects of aesthetic treatments. The questionnaire covers a wide range of areas, including post-treatment satisfaction, improved appearance, changes in skin health and self-confidence.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe increasing utilization of imaging modalities and fine-needle aspiration biopsy has facilitated earlier detection of subclinical thyroid lesions, contributing to a rising incidence of thyroid carcinoma\u003csup\u003e[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]\u003c/sup\u003e. Surgical resection remains the cornerstone of thyroid cancer management\u003csup\u003e[\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]\u003c/sup\u003e. Open thyroidectomy requires a cervical collar incision, which invariably produces a visible scar\u003csup\u003e[\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]\u003c/sup\u003e. Severe cases may develop hypertrophic scarring or hyperpigmentation, significantly compromising cosmesis\u003csup\u003e[\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]\u003c/sup\u003e.Minimally invasive surgery (MIS) techniques enable surgical incision relocation to concealed anatomical sites while maintaining oncological efficacy comparable to open procedures\u003csup\u003e[\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]\u003c/sup\u003e. For young female patients particularly, prominent scarring frequently induces postoperative psychological distress related to aesthetic outcomes\u003csup\u003e[\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]\u003c/sup\u003e. Consequently, MIS has emerged as the preferred approach for patients prioritizing optimal cosmesis\u003csup\u003e[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]\u003c/sup\u003e. Nevertheless, the adoption of robotic thyroidectomy\u0026mdash;despite its technical advantages in narrow anatomical spaces\u0026mdash;remains constrained by significant economic barriers and regional healthcare disparities. Rigorous comparative studies are warranted to validate the long-term oncological safety, and functional outcomes of robotic versus conventional surgical approaches.\u003c/p\u003e\u003cp\u003eIn our study, propensity score matching of clinical characteristics and postoperative follow-up scale data from 417 patients resulted in 322 patients being included. Consistent with prior research, we confirmed the limitations of robotic surgery, namely higher costs and longer operative times\u003csup\u003e[\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]\u003c/sup\u003e. Nevertheless, TOVRT significantly reduced postoperative hospital stays and accelerated recovery times. Notably, 62/161 [38.5%] of patients in the TOVRT group did not require surgical drain placement, further lowering postoperative care expenses. Regarding therapeutic efficacy, no statistically significant difference was found in the number of lymph nodes retrieved between robotic and open surgery (median[IQR], TOVRT: 7.0 [4.0\u0026ndash;11.0] vs OT: 8.0 [5.0\u0026ndash;12.0]; \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.06). Crucially, during the 5-year follow-up period, no cases of recurrence, metastasis, or death were observed in the robotic surgery group, indicating TOVRT is a safe and reliable approach. Concerning complications, robotic surgery demonstrated a significant advantage in preserving parathyroid function, resulting in a markedly lower incidence of postoperative hypoparathyroidism (TOVRT: 5 [3.11%] vs OT: 29 [18.01%]; risk difference,-14.9; 95%Cl,-20.3 to -9.5; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). While some scholars\u003csup\u003e[\u003cspan additionalcitationids=\"CR36\" citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]\u003c/sup\u003e suggest the transoral approach may increase risks of mental nerve injury and surgical site infection, our study observed only 2 cases of transient mental nerve injury and 1 cases of postoperative infection. Through extensive experience, we identified effective mitigation strategies: positioning trocars away from adjacent mental nerve branches and minimizing intraoperative traction on the trocar reduces the risk of mental nerve injury; additionally, preoperative prophylactic antibiotic administration and strict postoperative adherence to prescribed antiseptic mouthwash protocols significantly reduce infection risk.\u003c/p\u003e\u003cp\u003eDuring postoperative follow-up assessments using standardized scales, we observed a notable divergence from previous studies\u003csup\u003e[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]\u003c/sup\u003e: patients undergoing robotic surgery experienced significantly less postoperative pain compared to the open surgery group (NRS: median[IQR], TOVRT: 3.0 [2.0\u0026ndash;4.0] vs OT: 7.0 [6.0\u0026ndash;8.0], median difference,\u0026minus;4.0; 95%Cl,\u0026minus;5.0 to\u0026minus;4.0; \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). This reduction is primarily attributed to our center's exclusive use of a pure transoral three-port robotic approach without supplementary transaxillary ports, thereby minimizing additional tissue trauma. Robotic surgery also demonstrated superior voice outcomes (VHI: TOVRT: 38.0 [12.0\u0026ndash;59.0] vs OT: 77.0 [59.0\u0026ndash;89.0]; median difference,\u0026minus;39; 95%Cl,\u0026minus;42.0 to\u0026minus;29.0; \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Furthermore, assessment via the SAQCO scale revealed that patients treated with the transoral robotic approach exhibited heightened scar consciousness(TOVRT: 12.0 [10.0\u0026ndash;15.0] vs OT: 8.0[6.0\u0026ndash;11.0]; median difference, 4.0; 95%Cl, 4.0 to 5.0; \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and significantly higher scar satisfaction(TOVRT: 8.0 [7.0\u0026ndash;9.0] vs OT: 6.0[6.0\u0026ndash;7.0]; median difference, 2.0; 95%Cl, 1.0 to 2.0; \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001) than the open surgery group, achieving a near absence of visible scarring on the body surface.\u003c/p\u003e\u003cp\u003eThis study has three main limitations. First, its design as a single-center, small-sample, retrospective investigation provides limited validation. Second, the use of subjective scales for postoperative recovery assessment introduces inherent bias. Third, the study did not perform a formal cost-effectiveness analysis. Future prospective studies are warranted to further validate the relationship between the efficacy of transoral robotic thyroidectomy and its cost-effectiveness ratio compared to open surgery.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eCompared to traditional surgery, TOVRT shows no significant difference in therapeutic efficacy. Not only does TOVRT reduce the occurrence of some related complications, but it also significantly preserves patients' cosmetic appearance needs. In the future, it could become an alternative treatment to open surgery.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgments:\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research was supported by the following projects:\u003c/p\u003e\n\u003cp\u003e(1) Chongqing Natural Science Foundation: Mechanistic study of ZNF831 inhibiting breast cancer metastasis by transcriptionally downregulating CTNNB1, Project No. CSTB 2024NSCQ-KJFZMSX0103.\u003c/p\u003e\n\u003cp\u003e(2) University Scientific and Technological Innovation Capacity Enhancement Programme: Investigation into the Tissue Levels of Persistent Organic Pollutants and Breast Cancer Risk, Project No. 2023XLC09.\u003c/p\u003e\n\u003cp\u003e(3) Centre \u0026lsquo;Artificial Intelligence+\u0026rsquo; Medical Research Programme: Accurate Diagnosis of Early-Stage Breast Cancer through AI Model-Assisted Clinical Practice, Project No. ZXAIYB014.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRole of the Funder/Sponsor:\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Sharing Statement:\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request. Data can be provided after the Article is published. The corresponding authors have the right to decide whether to share the data or not based on the research objectives and plan provided.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eThis research was supported by the following projects:\u003c/p\u003e\n\u003cp\u003e(1) Chongqing Natural Science Foundation: Mechanistic study of ZNF831 inhibiting breast cancer metastasis by transcriptionally downregulating CTNNB1, Project No. CSTB 2024NSCQ-KJFZMSX0103.\u003c/p\u003e\n\u003cp\u003e(2) University Scientific and Technological Innovation Capacity Enhancement Programme: Investigation into the Tissue Levels of Persistent Organic Pollutants and Breast Cancer Risk, Project No. 2023XLC09.\u003c/p\u003e\n\u003cp\u003e(3) Centre \u0026lsquo;Artificial Intelligence+\u0026rsquo; Medical Research Programme: Accurate Diagnosis of Early-Stage Breast Cancer through AI Model-Assisted Clinical Practice, Project No. ZXAIYB014.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflicts of Interest\u003c/strong\u003e\u003cstrong\u003e:\u0026nbsp;\u003c/strong\u003eAny potential conflicts of interest \u0026quot;involving the work under consideration for publication\u0026quot;.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions:\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eYan Xu responsible for the integrity and accuracy of the data, and had full access to the study.\u003c/p\u003e\n\u003cp\u003econceive and designe: Yan Xu, Fu Luo and Jing Xu.\u003c/p\u003e\n\u003cp\u003eDraft and write: Fu Luo and Jing Xu\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eRecord the follow-up data and confirm data accuracy:Zhang, Ling-ji Guo and Yan Jiang. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eData analysis and interpretion: Fu Luo, Jing Xu Jie Yan and Fan Yu\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSupervised data collection, reviewed and approved the final manuscript: Yan Xu\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval:\u003c/strong\u003e This retrospective cohort study was conducted in accordance with the Declaration of Helsinki and approved by the Clinical Research Ethics Committee of Daping Hospital, Army Medical University (Chongqing, China; Approval No. 2024-357). The protocol was registered at \u003cem\u003eClinicalTrials.gov\u003c/em\u003e (NCT06958601). Informed consent was waived due to the retrospective design.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to participate:\u0026nbsp;\u003c/strong\u003einformed consent was obtained from all individual participants included in the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to publish\u003c/strong\u003e: Verbal informed consent was obtained prior to the interview.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eKitahara CM, Sosa JA (2020) Understanding the ever-changing incidence of thyroid cancer. 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Surg Endosc 38(3):1512\u0026ndash;1522. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s00464-023-10656-z\u003c/span\u003e\u003cspan address=\"10.1007/s00464-023-10656-z\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\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":"Thyroid carcinoma, Transoral vestibular robotic thyroidectomy, Open thyroidectomy, Patient-reported outcomes","lastPublishedDoi":"10.21203/rs.3.rs-7950983/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7950983/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTransoral vestibular robotic thyroidectomy (TOVRT) provides minimal scarring but requires comparative validation against open thyroidectomy (OT).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePatients undergoing thyroid surgery at our centre between January 2020 and October 2024 were included. Ultimately, through propensity score matching analysis, 322 adults (161 per group) with pathologically confirmed thyroid cancer. Analyse and compare the clinical outcomes of the two patient groups, as well as patient-reported outcomes (NRS pain, VHI-10 voice, SAQCO scar satisfaction at 1 week).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAmong 322 matched patients (age median [IQR], 41.0 [34.0–51.0] vs 43.0 [34.0–52.0]; [71.7%] female, 91[28.3%] male).The TOVRT group demonstrated significantly higher operative costs (median [IQR], TOVRT: 63,351.0 [60,644.5–64,948.8]¥ vs OT: 19,009.6 [17,127.7–21,774.4]¥; \u003cem\u003eP\u003c/em\u003e \u0026lt; .001) and longer surgical duration (mean [SD], 242.0 [55.8]min vs 106.3 [38.4] min; mean difference, 136; 95% CI, 125–146; \u003cem\u003eP\u003c/em\u003e \u0026lt; .001) than the OT group. However, the TOVRT group showed significantly shorter postoperative hospitalization time (mean [SD], 2.8 [1.4]days vs 3.4 [1.2] days; mean difference, 0.6 days; 95% CI, 0.31–0.88; \u003cem\u003eP\u003c/em\u003e \u0026lt; .001), as well as a lower incidence of transient hypoparathyroidism (5 [3.1%] vs 29 [18.0%]; risk difference, -14.9%; 95% CI, -20.3 to -9.5; \u003cem\u003eP\u003c/em\u003e \u0026lt; .001). Postoperative Numerical Rating Scale (NRS)( median [IQR], 3.0 [2.0–4.0] vs 7.0 [6.0–8.0]; median difference, -4.0; 95% CI, -5.0 to -4.0; \u003cem\u003eP\u003c/em\u003e \u0026lt; .001) and Voice Handicap Index-10 (VHI-10) scores (median [IQR], 38.0 [12.0–59.0] vs 77.0 [59.0–89.0]; median difference, -39.0; 95% CI, -42.0 to -29.0; \u003cem\u003eP\u003c/em\u003e \u0026lt; .001)were significantly lower in the TOVRT group, while scar satisfaction assessed by the Short Assessment of Quality of Cosmetic Outcome (SAQCO) (median [IQR], 20.0 [18.0–23.0] vs 14.0 [12.0–17.0]; difference, 6.0; 95% CI, 5.0 to 6.0; \u003cem\u003eP\u003c/em\u003e \u0026lt; .001) was significantly superior.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTOVRT achieves comparable oncologic outcomes to OT with superior cosmesis, shorter hospitalization, and reduced transient hypoparathyroidism, but incurs significantly higher costs and longer operative times.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTrial Registration: \u003c/strong\u003eNational clinical trials registry: NCT06958601, registered April 25th,\u003c/p\u003e\n\u003cp\u003e2025.\u003c/p\u003e","manuscriptTitle":"Transoral Vestibular Robotic Thyroidectomy vs Open Thyroidectomy for Thyroid Cancer: A Propensity Score-Matched Analysis","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-11-17 06:31:17","doi":"10.21203/rs.3.rs-7950983/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-11-22T11:52:09+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-11-22T10:09:55+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-11-15T17:06:56+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"212527477349233111750513261175805758775","date":"2025-11-12T14:08:40+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"79665193461986538485360497562532623608","date":"2025-11-12T06:37:30+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"162688636197530652428135710596919447641","date":"2025-11-10T15:44:03+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"106428927082084382872992268757483173833","date":"2025-11-10T11:02:21+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"142940022211871885835356803680216999495","date":"2025-11-06T20:44:47+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-11-05T01:37:51+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-10-27T22:28:26+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-10-27T13:58:12+00:00","index":"","fulltext":""},{"type":"submitted","content":"Journal of Robotic Surgery","date":"2025-10-26T14:48:22+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":"286551f1-c7db-42a3-9935-6ef1f8164124","owner":[],"postedDate":"November 17th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-03-23T16:01:01+00:00","versionOfRecord":{"articleIdentity":"rs-7950983","link":"https://doi.org/10.1007/s11701-025-03050-5","journal":{"identity":"journal-of-robotic-surgery","isVorOnly":false,"title":"Journal of Robotic Surgery"},"publishedOn":"2026-03-19 15:58:28","publishedOnDateReadable":"March 19th, 2026"},"versionCreatedAt":"2025-11-17 06:31:17","video":"","vorDoi":"10.1007/s11701-025-03050-5","vorDoiUrl":"https://doi.org/10.1007/s11701-025-03050-5","workflowStages":[]},"version":"v1","identity":"rs-7950983","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7950983","identity":"rs-7950983","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}