Key Considerations in Choosing Between Scarless (TOETVA) and Minimally Invasive (MINET) Thyroidectomy: This infographic summarizes the main factors guiding surgical choice between TOETVA (transoral endoscopic thyroidectomy vestibular approach) and MINET (minimally invasive nonendoscopic thyroidectomy). Careful patient selection ensures appropriate candidates, while surgeon experience is crucial for safe implementation. A thorough risk-benefit analysis balances the cosmetic advantages of scarless surgery against increased operative time, cost, and pathological challenges. Ultimately, an evidence-based choice highlights that both approaches are safe when performed by experienced surgeons with individualized patient care. The surgical team at National Taiwan University Hospital analyzed over 700 patients to compare scarless TOETVA with minimally invasive nonendoscopic thyroidectomy (MINET).
A large-scale study from National Taiwan University Hospital, published in JAMA Surgery (September 2025), compared two minimally invasive thyroidectomy techniques: the scarless transoral endoscopic thyroidectomy vestibular approach (TOETVA) and minimally invasive nonendoscopic thyroidectomy (MINET).
The team analyzed 720 patients between 2021 and 2023, using propensity score matching to compare 210 patients in each group.
TOETVA offered better protection of nerves and parathyroid glands and left no visible neck scar, a feature valued by patients. However, it required nearly twice the operative time, was associated with higher early pain, a greater risk of specimen disruption, and hospital costs about 70% higher than MINET.
“These findings provide robust evidence to guide patients and surgeons,” says first author Dr. Ting-Chun Kuo. “Scarless surgery offers clear benefits but also important trade-offs.”
“Our study underscores the importance of individualized patient selection and shows how large-scale, data-driven research can shape future surgical standards worldwide,” adds corresponding author Dr. Ming-Hsun Wu.
Dr. Ting-Chun Kuo's email address: [email protected]
Dr. Ming-Hsun Wu’s email address: [email protected]
