A Systematic Review and Meta-Analysis: Surgical Outcomes Comparing Transoral Robotic and Open Approaches to Thyroidectomy

Background: The rate of thyroid cancer has continued to rise, especially among young women. Although conventional open thyroidectomy (OT) is effective in disease control, the inevitable neck scar has a potential negative effect on the patients’ mental health. In an attempt to minimize cosmetic deformity, transoral robotic thyroidectomy (TORT) has emerged as a scarless and minimally invasive technique. However, its safety and completeness need to be assessed. Methods: PubMed, Embase, the Cochrane Library, and Web of Science were systematically queried for clinical trials comparing transoral robotic thyroidectomy and open thyroidectomy for thyroid disease. The primary endpoints were the central lymph node yield, the rates of complications such as recurrent laryngeal nerve injury, hypoparathyroidism, hematoma, seroma, and skin flap perforation, whereas the secondary endpoints included the operation time, length of hospitalization, and postoperative pain. The results were synthesized using a random effects model. Results: A total of five studies were included in this meta-analysis. Compared to OT, TORT was associated with increased operative time (MD = -79.19, 95% CI [-128.55, -29.83], P < 0.05; MD = -107.6, 95% CI [-167.63, -47.58], P < 0.05), increased length of stay (MD = -0.35, 95% CI [-0.52, -0.18], P < 0.05), and increased early postoperative pain scores. The central lymph node yield, transient or permanent recurrent laryngeal nerve injury, and hypoparathyroidism were comparable. The incidence of skin flap perforation was noted only in the TORT group. Conclusions: TORT has the advantage of providing superior cosmetic results without compromising the completeness of oncological clearance or increasing the risk of significant nerve and parathyroid gland damage. However, the cost of this approach is increased operative time, pain, length of stay, and the possibility of skin flap perforation. Further studies are required to assess the long-term oncological outcome.