Advances in Scarless Thyroid Surgery: Enhanced Nerve and Parathyroid Preservation with Increased Surgical Demands
A groundbreaking study compares scarless transoral thyroidectomy with traditional minimally invasive methods, highlighting improved nerve and parathyroid protection amid longer operative times and higher costs.
A comprehensive study conducted by researchers at National Taiwan University Hospital has shed light on the benefits and challenges of scarless thyroid surgery. The research compared two minimally invasive techniques: the transoral endoscopic thyroidectomy vestibular approach (TOETVA), which leaves no visible neck scar, and the minimally invasive nonendoscopic thyroidectomy (MINET). Analyzing data from 720 patients treated between 2021 and 2023, with propensity score matching, the study revealed that TOETVA offers superior protection of critical structures like nerves and parathyroid glands, enhancing surgical precision and cosmetic outcomes.
However, these benefits come with notable trade-offs. TOETVA procedures tend to take nearly twice as long as MINET, incur approximately 70% higher hospital costs, and are associated with increased early postoperative pain and a greater risk of specimen disruption. The longer operative times and higher resource utilization highlight the demanding nature of scarless thyroid surgery.
Despite the increased surgical complexity and costs, the cosmetic and structural preservation advantages make TOETVA an attractive option for suitable candidates. The study emphasizes the importance of careful patient selection and personalized surgical planning. As Dr. Ting-Chun Kuo states, "Scarless surgery offers clear benefits but also important trade-offs," underscoring the need for balanced decision-making. The findings also demonstrate how large-scale, data-driven research can influence future guidelines and standards in thyroid surgery.
This research represents a significant step toward optimizing thyroidectomy techniques, balancing aesthetic outcomes, functional preservation, and procedural efficiency. For more detailed insights, refer to the original publication in JAMA Surgery (2025). Source: https://medicalxpress.com/news/2025-09-scarless-thyroid-surgery-nerve-parathyroid.html
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