Scarless thyroid surgery in children: a pediatric TOETVA cohort for differentiated thyroid carcinoma.
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BACKGROUND/PURPOSE: Conventional open thyroidectomy leaves a visible cervical scar that can adversely affect the psychosocial well-being of pediatric patients. The transoral endoscopic thyroidectomy vestibular approach (TOETVA) offers a scarless alternative, but data regarding its application in pediatric malignancies remain scarce. This study aims to evaluate the surgical, cosmetic outcomes of TOETVA in pediatric patients with differentiated thyroid carcinoma (DTC). METHODS: We retrospectively reviewed consecutive pediatric patients ([Formula: see text] 18 years) who underwent TOETVA for DTC (cT1N0M0) at a high-volume center between June 2020 and June 2026. Postoperative complications and cosmetic satisfaction were evaluated. RESULTS: Twenty-six patients (mean age: 16.7 ± 1.9 years; 84.6% female) were enrolled. All procedures were successfully completed with a 0% conversion rate to open surgery. Twenty-four patients (92.3%) underwent thyroid lobectomy with isthmusectomy and prophylactic central neck dissection (CND) (mean operative time: 87.9 ± 9.5 min), while two (7.7%) underwent total thyroidectomy with CND (mean operative time: 132.5 min). Final histopathology confirmed papillary thyroid carcinoma in all cases. No major perioperative complications occurred. Transient adverse events included minor chin ecchymosis (11.5%), hoarseness (7.7%), and mental nerve injury (7.7%), all resolving completely within 3 months. No permanent recurrent laryngeal nerve injury, mental nerve dysfunction, or hypocalcemia was observed. Cosmetic outcomes were highly favorable, with all patients expressing excellent post-operative aesthetic satisfaction. CONCLUSIONS: TOETVA appears to be a safe and feasible surgical approach for carefully selected pediatric patients with DTC. In this largest reported pediatric TOETVA series to date, the procedure achieved favorable surgical and cosmetic outcomes with low complication rates. TOETVA may therefore represent an effective scarless alternative for selected pediatric thyroid cancer when performed by experienced surgeons in high-volume centers.