Transoral thyroidectomy in a consecutive cancer-enriched cohort of 1–000 patients: a single-surgeon experience with endoscopic and robotic platforms

Introduction Transoral vestibular thyroidectomy, performed using an endoscopic (transoral endoscopic thyroidectomy via the vestibular approach [TOETVA]) or robot-assisted (transoral robotic thyroidectomy [TORT]) approach, is a scar-concealing alternative to open thyroidectomy. Given the paucity of large-scale single-surgeon studies spanning both platforms, the aim of this study was to characterize the clinicopathological and perioperative outcomes of a large cancer-enriched transoral thyroidectomy series and to examine differences between TOETVA and TORT. Methods We retrospectively reviewed 1–000 consecutive patients who underwent TOETVA (n=450) or TORT (n=550) performed by a single endocrine surgeon between September 2016 and May 2024. An additional propensity score-matched analysis incorporating clinical characteristics and calendar time, with exact matching on extent of surgery, was performed in the contemporaneous cohort after TORT introduction, yielding 221 matched pairs. Results Among the 1–000 cases, 986 (98.6%) were malignant, predominantly papillary thyroid carcinoma, with 99.8% at pathological stage I. Overall perioperative outcomes were acceptable, with low complication rates and infrequent drain use; recurrent laryngeal nerve palsy and mental nerve injury were confined to the early TOETVA period. In the overall cohort, TORT patients had larger tumors and more frequent T1b and N1a disease, with shorter operative time and hospital stay. After propensity score matching, between-platform differences were modest: TORT was associated with a 5.05-min longer operative time (95% CI, 0.39–9.72) and a 0.79-node higher central compartment node yield (95% CI, 0.18–1.41), whereas histopathological characteristics, hospital stay, and measured postoperative complications did not differ significantly. Sensitivity analyses yielded similar operative-time estimates. Conclusions In this large cancer-enriched single-surgeon cohort, transoral thyroidectomy was associated with acceptable perioperative outcomes in carefully selected patients. Although TOETVA and TORT showed differences in the overall cohort, adjusted differences were modest and did not establish superiority of either platform. Both approaches may retain practical value within an evolving transoral thyroidectomy practice.