Title : Scarless thyroidectomy through the Transoral Endoscopic Vestibular Approach (TOETVA): A systematic review of clinical outcomes and global relevance in low-resource settings
Abstract:
Background: Transoral endoscopic thyroidectomy vestibular approach (TOETVA) is a scarless, minimally invasive technique avoiding visible neck incisions. It may improve surgical access in low-resource settings where aesthetic concerns, stigma, or limited wound care impact treatment uptake. This systematic review evaluates global clinical outcomes, complications, and the potential role of TOETVA in resource-constrained healthcare systems.
Methods: We systematically searched major databases to May 2025. From 1,986 records, 112 studies involving over 6,000 adults undergoing TOETVA were included. Study designs included RCTs, cohort studies, and case series. Outcomes analysed included nerve injury, hypoparathyroidism, infection, operative time, hospital stay, and cosmetic satisfaction. Thematic relevance to surgical delivery in low-resource settings was also explored.
Results: Transient recurrent laryngeal nerve injury occurred in 0–20%, permanent injury in up to 1.5%. Transient mental nerve symptoms were common but usually mild and self-limiting. Conversion to open surgery and infections were rare (<3%). Operative times averaged 110–210 minutes, improving with experience. Hospital stays were short (1–5 days). Patient satisfaction with cosmetic outcomes was consistently high.
Discussion and importance to the field: TOETVA provides a safe, cosmetically favourable surgical option that could reduce barriers to care in low-resource settings. Minimising visible scars may improve acceptability and uptake of surgery. Challenges remain around affordability, training, and infrastructure. This review highlights TOETVA’s global potential and the importance of adapting surgical innovations to suit varied resource environments.
