Transoral vestibular robotic
thyroidectomy can really make the patient's body surface free of
scar. This study aimed to compare the surgical and patient-related outcomes between the transoral vestibular robotic
thyroidectomy and traditional low-collar incision
thyroidectomy. The clinical data of 120 patients underwent transoral vestibular robotic
thyroidectomy (TOVRT) or traditional low-collar incision
thyroidectomy (TLCIT) were collected from May 2020 to October 2021. Propensity score matching analysis was used to minimize selection bias. All these patients were diagnosed with
papillary thyroid carcinoma (PTC) through ultrasound-guided fine-needle aspiration prior to surgical intervention and surgical plan was tailored for each patient. An intraoperative recurrent laryngeal nerve (RLN) detection system was used in all patients, whose RLNs were identified and protected. We performed transoral vestibular robotic
thyroidectomy with three intraoral incisions. Additional right axillary fold incisions were adopted occasionally to enhance fine reverse
traction of tissue for radical
tumor dissection. Clinical data including gender, age,
tumor size, BMI, operation time, postoperative drainage volume and time,
pain score, postoperative
length of stay (LOS),number of lymph nodes removed, complications, and medical expense were observed and analyzed. Propensity score matching was used for 1:1 matching between the TOVRT group and the TLCIT group. All these patients accepted total
thyroidectomy(or lobectomy) plus central
lymph node dissection and all suffered from PTC confirmed by postoperative pathology. No
conversion to open surgery happened in TOVRT group. The
operative time of TOVRT group was longer than that of TLCIT group (P < 0.05). The postoperative drainage volume of TOVRT group was more than that of TLCIT group (P < 0.05). The drainage tube placement time of TOVRT group were longer than that of TLCIT group (P < 0.05). Significant differences were also found in intraoperative
bleeding volume,
pain score and medical expense between the two groups (P < 0.05). The incidence of perioperative common complications such as
hypoparathyroidism and
vocal cord paralysis in the two groups was almost identical (P > 0.05). However, there were some specific complications such as surgical area
infection (one case), skin
burn (one case), oral tear (two cases), and
paresthesia of the lower lip and the chin (two cases) were found in TOVRT group. Obviously, the postoperative cosmetic effect of the TOVRT group was better than TLCIT group (P < 0.05). TOVRT is safe and feasible for low to moderate-risk PTC patients and is a potential alternative for patients who require no
scar on their neck. Patients accepted TOVRT can get more satisfaction and have less psychologic injury caused by surgery.