Comparing trans-oral endoscopic thyroidectomy vestibular approach and trans-areolar approaches regarding postoperative infections and swallowing difficulty

Abstract

BACKGROUND

Due to the increasing rate of thyroid nodules diagnosis, and the desire to avoid the unsightly cervical scar, remote thyroidectomies were invented and are increasingly performed. Transoral endoscopic thyroidectomy vestibular approach and trans-areolar approaches (TAA) are the two most commonly used remote approaches. No previous meta-analysis has compared postoperative infections and swallowing difficulties among the two procedures.

AIM

To compared the same among patients undergoing lobectomy for unilateral thyroid carcinoma/benign thyroid nodule.

METHODS

We searched PubMed MEDLINE, Google Scholar, and Cochrane Library from the date of the first published article up to August 2025. The term used were transoral thyroidectomy vestibular approach, trans areolar thyroidectomy, scarless thyroidectomy, remote thyroidectomy, infections, postoperative, inflammation, dysphagia, and swallowing difficulties. We identified 130 studies, of them, 30 full texts were screened and only six studies were included in the final meta-analysis.

RESULTS

Postoperative infections were not different between the two approaches, odd ratio = 1.33, 95% confidence interval: 0.50-3.53, the χ² was 1.92 and the P-value for overall effect of 0.57. Similarly, transient swallowing difficulty was not different between the two forms of surgery, with odd ratio = 0.91, 95% confidence interval: 0.35-2.40; the χ² was 1.32, and the P-value for overall effect of 0.85.

CONCLUSION

No significant statistical differences were evident between trans-oral endoscopic thyroidectomy vestibular approach and trans-areolar approach regarding postoperative infection and transient swallowing difficulties. Further longer randomized trials are needed.

Keywords: Trans-oral endoscopic thyroidectomy vestibular approach; Trans-areolar approaches; Postoperative; Infections; swallowing difficulty

Core Tip: Due to the increasing rate of thyroid nodules diagnosis, and the desire to avoid the unsightly cervical scar, remote thyroidectomies were invented and are increasingly performed. Transoral endoscopic thyroidectomy vestibular approach and trans-areolar approaches are the two most commonly used remote approaches. No previous meta-analysis has compared postoperative infections and swallowing difficulties among the two procedures. Therefore, we reviewed the literature on this important topic to the better choice of scarless surgery procedure.