Truly scarless three-port transoral robotic thyroidectomy: a feasible and efficient alternative to the four-port approach for thyroid cancer patients

Background: Transoral robotic thyroidectomy (TORT) has traditionally been performed using a four-port technique. A newer three-port technique, which eliminates the axillary port, makes TORT truly scarless. However, there is a limited number of studies comparing the two approaches. This study evaluates the outcomes of four-port versus three-port TORT. Methods: A retrospective review was conducted on patients who underwent lobectomy using TORT between August 2021 and October 2024. From August 2021 to January 2024, patients underwent four-port TORT, while from January 2024 to October 2024, patients underwent three-port TORT. Results: Seventy-two patients (31 in the four-port group and 41 in the three-port group) were included. The mean ages were 35.2 years (four-port group) and 39.9 years (three-port group). The mean operative time was significantly shorter in the three-port group compared to the four-port group (107.7 minutes vs. 141.0 minutes, p < 0.001). One patient in the four-port group experienced transient recurrent laryngeal nerve injury, while none occurred in the three-port group. In the three-port group, one patient developed postoperative seroma, and another experienced wound inflammation, whereas no such complications occurred in the four-port group. One patient in the four-port group required an additional mini-incision in the neck for tumor shaving of the trachea due to tumor adhesion. There was no difference in hospital stay between the two groups (1.8 days in the four-port group vs. 2.0 days in the three-port group). Conclusions: Three-port transoral robotic thyroidectomy is a feasible and efficient alternative to the four-port method for selected patients undergoing thyroidectomy.