Objective:

To systematically evaluate the efficacy and safety of the transoral endoscopic thyroidectomy vestibular approach (TOETVA) compared with open thyroidectomy (OT) and the endoscopic thyroidectomy via axillary breast approach (ABA) for treating papillary thyroid carcinoma (PTC).

Approach:

• Study Design: A network meta-analysis was conducted using data from five databases, including PubMed and Cochrane Library, to compare TOETVA, OT, and ABA in patients with PTC.
• Data Analysis: Standardized mean differences and odds ratios with 95% confidence intervals were calculated, with statistical significance set at P < 0.05.

Key Findings:

• Both OT and ABA were associated with shorter operative times than TOETVA (MD = −73.85 minutes, P < 0.001 for OT; MD = −30.59 minutes, P < 0.001 for ABA).
• OT was superior to TOETVA in terms of shorter postoperative hospital stay (MD = −0.49 days, P = 0.042) and lower drainage volume (MD = −58.03 mL, P = 0.012).
• No statistically significant differences were found among the three approaches regarding tumor radicality, including the number of lymph nodes dissected, the number of metastatic lymph nodes, or postoperative recurrence rate.
• OT was superior to TOETVA in sensory nerve protection (OR = 0.09, P = 0.010).
• TOETVA was superior to OT in preventing temporary hypoparathyroidism (OR = 0.48, P = 0.023).
• No significant differences were found among the three approaches in terms of complications such as bleeding, hematoma, seroma, or infection.

Interpretation:

TOETVA, OT, and ABA all demonstrated safe and reliable clinical efficacy for PTC, with TOETVA offering comparable outcomes and better parathyroid protection.

Limitations:

• The analysis included studies with varying methodologies and patient populations.
• The follow-up duration for some studies may not have been sufficient to assess long-term outcomes.

Conclusion:

TOETVA is a safe and feasible alternative to OT, providing comparable surgical and oncological outcomes with the added benefits of better parathyroid protection.