Ren Huixia, Wang Mengyang, Sun Xuan, Yuan Yin, Zhang Naijin, Liu Ying, Yue Shujiao, Li Yonghui, Guan Yuanyuan, Bu Huaien, Wang Hongwu
School of Public Health, Tianjin University of Traditional Chinese Medicine, Tianjin, China.
PLoS One. 2025 Jul 2;20(7):e0326318. doi: 10.1371/journal.pone.0326318. eCollection 2025.
Many systematic reviews (SRs) and meta-analyses (MAs) have recently assessed the short-term outcomes of the transoral thyroidectomy vestibular approach (TOTVA) compared with conventional open thyroidectomy (COT) and non-transoral endoscopic thyroidectomy (NTET). However, their conclusions remain controversial. This overview aimed to evaluate the safety and feasibility of TOTVA by appraising the quality of existing SRs/MAs.
Seven Chinese and English databases were systematically searched from their inception to December 10, 2023. Eligible SRs/MAs, published between 2020 and 2023, compared the safety and efficacy of TOTVA with COT or NTET. The PRISMA, AMSTAR-2, and ROBIS tools were used to assess reporting quality, methodological quality, and risk of bias, respectively.
Eleven SRs/MAs were finally included. According AMSTAR-2, one study was assessed as high-quality, with the remainder as very low-quality. Using PRISMA 2020, the "Yes" response rate for Q5, Q8, and Q15 was below 55 percent. Per ROBIS, all SRs/MAs exhibited low risk in phase 1 and domain 1 but high risk in domain 2. Efficacy was assessed through intraoperative outcomes, primary postoperative outcomes, and statistically significant postoperative outcomes. Patients with thyroid disorders undergoing TOTVA experienced longer overall operative time and hospital stays, reduced intraoperative blood loss, increased lymph node retrieval, higher incidence of infection, lower postoperative pain scores, reduced incidence of hypocalcemia, larger drainage volumes, and higher cosmetic effect scores compared with those undergoing.
The TOTVA may enhance cosmetic satisfaction, improve lymph node retrieval, and decreased postoperative complications. Nevertheless, these findings warrant cautious interpretation due to low methodological quality, high risk of bias, and limited evidence quality. More rigorous and standardized SRs/MAs are required to provide robust scientific evidence for definitive conclusions.
与传统开放性甲状腺切除术（COT）和非经口内镜甲状腺切除术（NTET）相比，近期许多系统评价（SRs）和荟萃分析（MAs）评估了经口甲状腺切除术前庭入路（TOTVA）的短期结局。然而，它们的结论仍存在争议。本综述旨在通过评估现有SRs/MAs的质量来评价TOTVA的安全性和可行性。
对7个中英文数据库从建库至2023年12月10日进行系统检索。纳入2020年至2023年间发表的、比较TOTVA与COT或NTET安全性和有效性的合格SRs/MAs。分别使用PRISMA、AMSTAR-2和ROBIS工具评估报告质量、方法学质量和偏倚风险。
最终纳入11项SRs/MAs。根据AMSTAR-2，1项研究被评估为高质量，其余为极低质量。使用PRISMA 2020，Q5、Q8和Q15的“是”回答率低于55%。根据ROBIS，所有SRs/MAs在第1阶段和领域1表现出低风险，但在领域2表现出高风险。通过术中结局、术后主要结局和具有统计学意义的术后结局评估疗效。与接受COT或NTET的患者相比，接受TOTVA的甲状腺疾病患者总体手术时间和住院时间更长，术中失血减少，淋巴结清扫增加，感染发生率增加，但术后疼痛评分更低，低钙血症发生率降低，引流量更大，美容效果评分更高。
TOTVA可能提高美容满意度，改善淋巴结清扫，并减少术后并发症。然而，由于方法学质量低、偏倚风险高和证据质量有限，这些发现需要谨慎解读。需要更严格和标准化的SRs/MAs来为明确结论提供有力的科学证据。
