Determinants of patient preference for TOETVA versus open thyroidectomy: Patient-reported outcome measures

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.