Perioperative outcomes of transoral endoscopic vs. robotic thyroidectomy: a systematic review and meta-analysis
Clinical Snapshot
PICO Framework
| P — Population | Patients undergoing thyroid surgery via minimally invasive transoral approaches |
| I — Intervention | Transoral robotic thyroidectomy (TORT) |
| C — Comparator | Transoral endoscopic thyroidectomy vestibular approach (TOETVA) |
| O — Outcomes | Perioperative outcomes including recurrent laryngeal nerve injury, hypoparathyroidism, mental nerve injury, seroma, surgical site infection, postoperative hemorrhage, operation time, length of hospital stay, lymph nodes dissected, and postoperative pain |
Bottom Line
This meta-analysis of 1,080 patients across 5 studies suggests that transoral robotic thyroidectomy (TORT) may offer superior neuroprotection compared to transoral endoscopic thyroidectomy (TOETVA), with significantly lower rates of transient recurrent laryngeal nerve injury (OR 3.56). However, TORT requires longer operative time (approximately 57 minutes) but results in shorter hospital stays. Both techniques demonstrate comparable oncological adequacy in terms of lymph node dissection and low complication rates. The evidence base remains limited with only 5 studies included, and the authors appropriately acknowledge the need for larger multicentre studies with longer follow-up to establish long-term oncological safety. For Australian practice, these findings may inform technique selection in centres offering minimally invasive thyroid surgery, particularly for patients prioritising cosmetic outcomes, though the evidence is insufficient to mandate practice change at this time.
Key Findings
P Value: p = 0.03
Effect Size: OR = 3.56 for transient RLN injury (TOETVA vs TORT)
Primary Outcome: TORT associated with significantly lower transient recurrent laryngeal nerve injury compared to TOETVA
Nnt Or Sensitivity: Operation time difference: TORT 56.74 minutes longer (95% CI [40.07, 73.41]); Hospital stay 0.26 days shorter with TORT
Confidence Interval: 95% CI [1.14, 11.06]
Clinical Application
Limited to centres with expertise in advanced minimally invasive thyroid surgery and robotic surgical capabilities Relevant to Australian ENT and endocrine surgery practice, though robotic surgery availability may be limited to major tertiary centres. No specific PBS or TGA considerations for surgical technique selection Patients requiring thyroidectomy who are candidates for minimally invasive transoral approaches and prioritise cosmetic outcomes
Abstract
BACKGROUND: Transoral endoscopic thyroidectomy vestibular approach (TOETVA) and transoral robotic thyroidectomy (TORT) have emerged as scarless alternatives to conventional open thyroidectomy, offering excellent cosmetic outcomes. However, the comparative perioperative outcomes between these two minimally invasive techniques remain to be systematically evaluated. This meta-analysis aimed to compare the perioperative outcomes of TOETVA and TORT in patients undergoing thyroid surgery. METHODS: A systematic search was performed in PubMed, Embase, the Cochrane Library, and Web of Science from inception to March 1, 2026, for studies comparing TOETVA and TORT. The primary outcomes included recurrent laryngeal nerve injury, hypoparathyroidism, mental nerve injury, seroma, surgical site infection, and postoperative hemorrhage. The secondary outcome included operation time, length of hospital stay, number of lymph nodes dissected, and postoperative pain score. Pooled weighted mean differences (MD) or odds ratios (OR) with 95% confidence intervals (CI) were calculated using a random-effects model. Study quality was assessed using the ROBINS-I tool. RESULTS: A total of 5 studies involving 1,080 patients were included (639 in the TOETVA group and 441 in the TORT group). Compared with TOETVA, TORT was associated with significantly longer operation time (MD = -56.74 min, 95% CI [-73.41, -40.07], p < 0.05) but shorter hospital stay (MD = 0.26 days, 95% CI [0.03, 0.49], p < 0.05). The incidence of transient recurrent laryngeal nerve injury was significantly higher in the TOETVA group than in the TORT group (OR = 3.56, 95% CI [1.14, 11.06], p = 0.03). There were no significant differences between the two groups in the number of lymph nodes dissected, the number of metastatic central compartment lymph nodes, the incidence of permanent recurrent laryngeal nerve injury, mental nerve injury, transient or permanent hypoparathyroidism, seroma, surgical site infection, or postoperative hemorrhage. CONCLUSION: Although TORT is associated with longer operative time, it demonstrates potential advantages in terms of length of hospital stay and neuroprotection.The two procedures are comparable in terms of radicality of lymph node dissection, postoperative pain, and low complication rates. TORT is a safe and effective minimally invasive surgical option with better neural protection, especially suitable for patients prioritizing cosmetic outcomes. Long-term oncological safety still needs to be verified in future multicenter studies with larger samples and longer follow-up durations.
References
- 1.Zhu, D., Liu, Y., Pu, X., Zhang, X., Niu, Y., & Yang, H. (2026). Perioperative outcomes of transoral endoscopic vs. robotic thyroidectomy: a systematic review and meta-analysis. Journal of Robotic Surgery. https://doi.org/10.1007/s11701-026-03449-8
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