Complication and conversion outcomes in transoral endoscopic thyroidectomy vestibular approach (TOETVA): a retrospective multicenter propensity score-matched cohort study

Transoral endoscopic thyroidectomy with vestibular approach (TOETVA) is a scarless thyroid surgery used as an alternative to open conventional surgery. Our aim was to investigate possible risk factors for complications and conversion during TOETVA. The study was conducted internationally by centres from Turkiye, the Republic of Korea, Italy, and Peru. A total of 406 patients who underwent TOETVA and were >= 18 years of age were included in the study. Demographic, pre-, intra-, and postoperative data were collected and compared between the groups with/without complication/conversion to identify possible predictors of complication/conversion. Subsequently, patients with complication/conversion were matched by the hospital, age, sex, and American Society of Anesthesiologists classification score using a propensity score (PSM) of 1:3 to eliminate confounding differences. Results were reported for the un-matched and matched groups. Complications occurred in 11 (2.7%) patients. High body mass index (26.4 +/- 3.4 vs. 23.3 +/- 3.7, p = 0.007), larger tumor size (1.7 +/- 1.3 cm. vs. 1.1 +/- 1.0 cm, p = 0.012), larger thyroid volume (20.0 +/- 9.2 vs. 12.8 +/- 8.5, p = 0.007) and long operation time (127.8 +/- 45.0 min. vs. 97.7 +/- 38.5 min., p = 0.008) were significantly associated with complications in un-matched analyses. Older age (42.7 +/- 8.0 vs. 34.9 +/- 9.2, p = 0.023), high BMI (26.7 +/- 3.2 vs. 23.3 +/- 3.7, p = 0.012), and longer operation time (160.1 +/- 54.1 min. vs. 97.4 +/- 37.8, p = 0.001) were significantly related to conversion in un-matched analyses. However, significance was lost after PSM for both complication and conversion. The data from this study conducted on TOETVA cases do not suggest a risk factor for complications and conversion with PSM.

Automated summary

This study investigated possible risk factors for complications and conversion during transoral endoscopic thyroidectomy with vestibular approach (TOETVA). The results showed that high body mass index, larger tumor size, larger thyroid volume, and long operation time were significantly associated with complications in un-matched analyses. Older age, high body mass index, and longer operation time were significantly related to conversion in un-matched analyses. However, these significances were lost after propensity score matching.