Determinants of patient preference for TOETVA versus open thyroidectomy: Patient-reported outcome measures
Issued Date
2026-01-01
Resource Type
ISSN
10159584
eISSN
02193108
Scopus ID
2-s2.0-105037758867
Journal Title
Asian Journal of Surgery
Rights Holder(s)
SCOPUS
Bibliographic Citation
Asian Journal of Surgery (2026)
Suggested Citation
Aungsusiripong A., Pongsapich W., Pithuksurachai P., Maneeprasopchoke P. Determinants of patient preference for TOETVA versus open thyroidectomy: Patient-reported outcome measures. Asian Journal of Surgery (2026). doi:10.1016/j.asjsur.2026.04.035 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/116670
Title
Determinants of patient preference for TOETVA versus open thyroidectomy: Patient-reported outcome measures
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Abstract
Background: Transoral endoscopic thyroidectomy via vestibular approach (TOETVA) is a minimally invasive, scarless technique increasingly adopted in selected centers. However, patient-centered data exploring decision making factors and preferences regarding TOETVA compared with open thyroidectomy remain limited. Methods: We enrolled 90 adults with surgically indicated thyroid nodules who viewed a standardized educational video comparing both techniques. They then completed newly developed, investigator-designed patient-reported outcome measure (PROM) questionnaires assessing factors influencing decision making, perceived benefits, acceptable trade-offs, costs, and recovery expectations. Results: Participants were predominantly female (83.3%) with a mean age of 51.3 ± 15.0 years. Overall, 71% preferred TOETVA. Physician recommendation was the primary determinant, cited by 57.8%. TOETVA was perceived to reduce blood loss and neck stiffness, enhance wound healing, and expedite recovery. Most respondents accepted TOETVA-specific risks only if the risk of hoarseness remained < 5% and surgical site infection < 10%. Additionally, 33% were willing to pay a USD 601–1200 surcharge, and most found hospitalization of ≤ 3 days acceptable. However, a 61% mismatch was observed between preference and actual surgery, mainly due to clinical eligibility, financial issues, or surgeon limitations. In multivariable analysis, TOETVA preference was associated with female sex (OR, 6.14; P = 0.01), younger age (OR, 0.95 per year; P = 0.01), and monthly income ≥ 300 USD (OR, 3.56; P = 0.03). Conclusions: Patients preferred TOETVA for its cosmetic and recovery benefits, but real-world uptake was constrained by clinical, financial, and expertise factors. TOETVA is a feasible option for selected patients.