Transoral endoscopic thyroidectomy: current state of the art—a systematic literature review and results of a bi-center study

Transoral endoscopic approaches for thyroidectomy (TOET) have been developing since 2008. To date, single centers have gained great experience and patients treated worldwide (477 by February 2016) have resulted in complication rates [transient recurrent laryngeal nerve palsy (RLNP) 2.5%, permanent RLNP 0.4%, transient mental paraesthesia 5.9%, local or neck site infections 1.2%] comparable to conventional open and other endoscopic or robotic approaches. The conversion rate from TOET to open surgery is very low (0.6%). This data is based on a systematic literature review (PubMed search) and the results of a bi-centric study in Xiamen, P.R. China and Borna, Germany. TOET was performed on thyroid nodules or cervical masses in 93 patients. Isthmus resections, hemi, subtotal and total thyroidectomies were performed. A learning curve could be shown and cut-suture-times approached those of conventional thyroid surgery. One permanent RLNP was observed and a transient mental paraesthesia, which resolved within 3–4 weeks, was noted in 15 cases. In conclusion, TOET has left the stage of infancy and has proven to be a good alternative to conventional open or endoscopic/robotic-assisted thyroidectomy with the advantage of decreased postoperative pain and diminished swallowing disorders following thyroid surgery. Lastly, it secures an optimal cosmetic result since TOET leaves no visible scars even at the access points in the mouth.