Comparison between transoral endoscopic thyroidectomy vestibular approach and gasless endoscopic thyroidectomy trans-subclavian approach: A comparative study

Purpose This study aimed to compare the safety and surgical completeness of the gasless endoscopic thyroidectomy trans-subclavian approach (GETTSA) with the transoral endoscopic thyroidectomy vestibular approach (TOETVA) in patients with papillary thyroid carcinoma undergoing unilateral thyroidectomy and central lymph node dissection. Methods Data of patients who underwent TOETVA from March 2019 to August 2023 and GETTSA from August 2022 to August 2023 were retrospectively reviewed. Propensity score matching (PSM) was applied to adjust for differences in baseline clinicopathological characteristics. Results After PSM, 400 patients (TOETVA: 200, GETTSA: 200) remained in the study population. The TOETVA group had longer operative time [TOETVA: 157.5 (140–180) vs. GETTSA: 109 (90–130) min, P < 0.001] and greater postoperative drainage volume [TOETVA: 80 (66.25–108.75) vs. GETTSA: 50 (40–55) mL, P < 0.001] than the GETTSA group. The groups showed no significant differences in the mean number of metastatic central lymph nodes [TOETVA: 0 (0–0) vs. GETTSA: 0 (0–1), P = 0.085] and rate of transient vocal cord palsy (TOETVA: 1.5% vs. GETTSA: 1.0%, P = 1.000). However, the mean number of retrieved central lymph nodes significantly differed between the groups [TOETVA: 6 (4–9) vs. GETTSA: 5 (3–8), P = 0.008]. Conclusion TOETVA and GETTSA for well-selected patients are safe procedures with good cervical cosmetic outcomes. However, TOETVA has better cosmetic effects and allows for more thorough removal of lymph nodes in the central compartment. GETTSA offers advantages such as shorter operative time, lower hospitalization cost, faster postoperative recovery, and fewer postoperative swallowing disorders.