Is male sex a barrier to transoral endoscopic thyroidectomy? A comparative study of surgical outcomes.

PURPOSE: Transoral endoscopic thyroidectomy vestibular approach (TOETVA) presents technical challenges in male patients because of their anatomical characteristics. However, the impact of sex on clinical outcomes following TOETVA remains unclear. METHODS: This retrospective study analyzed the baseline characteristics and clinicopathological outcomes of male and female patients who underwent TOETVA between 2019 and 2023. Factors associated with prolonged operative time (above the 75th percentile) were examined using a multivariable logistic regression analysis. RESULTS: Of 131 patients who underwent unilateral lobectomy via the transoral approach, 20 (15.3%) were male. Male patients had significantly higher drainage volumes (75.7 mL vs. 59.3 mL, P = 0.045) and shorter postoperative stays (2.5 days vs. 2.8 days, P = 0.016) compared to females. Ecchymosis lasting >1 week was also more frequent in males (20.0% vs. 5.4%, P = 0.044), and 1 male patient (5.0%, 1/20) experienced chin flap perforation during workspace creation. Other perioperative outcomes, including operative time, blood loss, thyroid gland weight, and pain scores, were comparable between sexes. The rates of vocal cord palsy and incidental parathyroidectomy were also similar. Notably, logistic regression analysis revealed that thyroid gland weight was the sole independent predictor of prolonged operative time (odds ratio, 1.11; 95% confidence interval, 1.03-1.21; P = 0.008), while sex was not associated. CONCLUSION: TOETVA is feasible in male patients with outcomes generally comparable to females. Surgeons should exercise caution when operating on male patients to minimize soft tissue trauma. Thyroid weight, rather than sex, is the main determinant of operative duration.