{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,26]],"date-time":"2026-10-26T18:36:16Z","timestamp":1793039776063,"version":"4.5.0"},"reference-count":24,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T00:00:00Z","timestamp":1792627200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Journal of Laparoendoscopic &amp; Advanced Surgical Techniques"],"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>The transoral endoscopic thyroidectomy vestibular approach (TOETVA) has emerged as a scarless, minimally invasive alternative to conventional open thyroidectomy (OT). Although TOETVA has shown acceptable safety outcomes in thyroid surgery, its role in Graves\u2019 disease remains uncertain because of the technical complexity associated with hypervascular thyroid glands.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>\n                      A systematic search was conducted across PubMed, Scopus, Web of Science, and the Cochrane Central Register of Controlled Trials through May 2026. Comparative studies evaluating TOETVA versus OT in adults with Graves\u2019 disease were included. Pooled odds ratios (ORs) and mean differences (MDs) with 95% confidence intervals (CIs) were calculated. Heterogeneity was assessed using the\n                      <jats:italic toggle=\"yes\">I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      statistic. Risk of bias and certainty of evidence were evaluated using ROBINS-I and GRADE.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Three retrospective comparative studies including 357 patients with Graves\u2019 disease were analyzed; 141 underwent TOETVA, and 216 underwent open thyroidectomy (OT). TOETVA was associated with significantly longer operative time (MD +44.4 minutes; 95% CI: 22.7\u201366.2;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; .01;\n                      <jats:italic toggle=\"yes\">\n                        I\n                        <jats:sup>2<\/jats:sup>\n                        =\n                      <\/jats:italic>\n                      70.4%). No significant differences were observed regarding recurrent laryngeal nerve dysfunction, parathyroid dysfunction, hematoma, or surgical site infection. Mental nerve injury (2.13%) and conversion to open surgery (0.71%) were uncommon after TOETVA. Sensitivity analyses confirmed the robustness of operative time findings.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>TOETVA appears to be a safe and feasible alternative to OT for Graves\u2019 disease, with comparable postoperative complication rates but longer operative times. Further prospective multicenter studies are needed to confirm these findings.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/10926429261501336","type":"journal-article","created":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T01:50:12Z","timestamp":1792720212000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Transoral Endoscopic Thyroidectomy Vestibular Approach Versus Open Thyroidectomy for Graves\u2019 Disease: A Systematic Review and Meta-Analysis"],"prefix":"10.1177","author":[{"given":"Maria Eduarda Caetano Batista","family":"de Paiva","sequence":"first","affiliation":[{"name":"Department of Surgery, Heliopolis Hospital, S\u00e3o Paulo, Brazil."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tha\u00eds Henriques","family":"Abud","sequence":"additional","affiliation":[{"name":"Department of Surgery, Heliopolis Hospital, S\u00e3o Paulo, Brazil."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mateus Lima Ulisses","family":"Trindade","sequence":"additional","affiliation":[{"name":"Department of Surgery, Heliopolis Hospital, S\u00e3o Paulo, Brazil."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucas Monteiro","family":"Delgado","sequence":"additional","affiliation":[{"name":"Federal University of Minas Gerais, Belo Horizonte, Brazil."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thiago Celestino","family":"Chulam","sequence":"additional","affiliation":[{"name":"Department of Head and Neck Surgery, AC Camargo Cancer Center, S\u00e3o Paulo, Brazil."},{"name":"Department of Surgery, Federal University of Espirito Santo, Espirito Santo, Brazil."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudia","family":"Theis","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of North Carolina, Chapel Hill, North Carolina, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristina Bellotti Formiga","family":"Bueno","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Faculdade de Ci\u00eancias M\u00e9dicas Santa Casa Miseric\u00f3rdia de S\u00e3o Paulo, S\u00e3o Caetano do Sul, Brazil."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-2960-3810","authenticated-orcid":false,"given":"Bernardo Fontel","family":"Pompeu","sequence":"additional","affiliation":[{"name":"Department of Surgery, Heliopolis Hospital, S\u00e3o Paulo, Brazil."},{"name":"USCS\u2014University of S\u00e3o Caetano do Sul, S\u00e3o Paulo, Brazil."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,10,22]]},"reference":[{"key":"e_1_3_2_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/ohn.70076"},{"key":"e_1_3_2_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/SLE.0000000000001261"},{"key":"e_1_3_2_4_1","doi-asserted-by":"publisher","DOI":"10.1089\/thy.2016.0229"},{"key":"e_1_3_2_5_1","doi-asserted-by":"publisher","DOI":"10.21037\/gs.2016.11.04"},{"key":"e_1_3_2_6_1","doi-asserted-by":"publisher","DOI":"10.1177\/01945998221108050"},{"key":"e_1_3_2_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijsu.2017.02.054"},{"key":"e_1_3_2_8_1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm10040863"},{"key":"e_1_3_2_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.oraloncology.2020.104871"},{"key":"e_1_3_2_10_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00464-023-10339-9"},{"key":"e_1_3_2_11_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00268-015-3320-1"},{"key":"e_1_3_2_12_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamasurg.2017.3366"},{"key":"e_1_3_2_13_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.n71"},{"key":"e_1_3_2_14_1","unstructured":"13.Paiva MECB Pompeu BF. Transoral Endoscopic Thyroidectomy Vestibular Approach(TOETVA) versus open thyroidectomy for graves\u2019 disease: Systematic review andmeta-analysis of comparative studies. PROSPERO; 2026. CRD420261395838. Available from: https:\/\/www.crd.york.ac.uk\/PROSPERO\/view\/CRD420261395838"},{"key":"e_1_3_2_15_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.i4919"},{"key":"e_1_3_2_16_1","doi-asserted-by":"publisher","DOI":"10.1177\/0962280216669183"},{"key":"e_1_3_2_17_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2288-14-135"},{"key":"e_1_3_2_18_1","doi-asserted-by":"publisher","DOI":"10.1002\/sim.4780131602"},{"key":"e_1_3_2_19_1","doi-asserted-by":"publisher","DOI":"10.1002\/sim.4040"},{"key":"e_1_3_2_20_1","doi-asserted-by":"publisher","DOI":"10.1002\/sim.1221"},{"key":"e_1_3_2_21_1","doi-asserted-by":"publisher","DOI":"10.1002\/hed.25484"},{"key":"e_1_3_2_22_1","doi-asserted-by":"publisher","DOI":"10.1002\/hed.26846"},{"key":"e_1_3_2_23_1","doi-asserted-by":"publisher","DOI":"10.1002\/oto2.70142"},{"key":"e_1_3_2_24_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00464-019-06841-8"},{"key":"e_1_3_2_25_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00268-023-06932-7"}],"container-title":["Journal of Laparoendoscopic &amp; Advanced Surgical Techniques"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/10926429261501336","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/10926429261501336","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/10926429261501336","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,26]],"date-time":"2026-10-26T17:56:17Z","timestamp":1793037377000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/10926429261501336"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,22]]},"references-count":24,"alternative-id":["10.1177\/10926429261501336"],"URL":"https:\/\/doi.org\/10.1177\/10926429261501336","relation":{},"ISSN":["1092-6429","1557-9034"],"issn-type":[{"value":"1092-6429","type":"print"},{"value":"1557-9034","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,22]]},"article-number":"10926429261501336"}}