Objective: To compare the efficacy, safety, and feasibility of axillary-breast-shoulder (ABS) and transoral endoscopic thyroidectomy vestibular (TOETVA) approaches for thyroid surgery in Vietnam, considering the historical dominance of ABS in our country.

Methods: A retrospective study analyzed 83 patients undergoing thyroid surgery between June 2021 and March 2024. Patients were divided into ABS (n=47) and TOETVA (n=36) groups. All surgeries were performed by a single surgeon.

Results: TOETVA had a longer operative time (197 ± 35 minutes vs. 132 ± 88 minutes) but similar complication rates (hoarseness, hypocalcemia). TOETVA patients experienced more postoperative swelling and bruising but fewer wound seromas and a shorter hospital stay. TOETVA was more frequently used for total thyroidectomy due to cancer cases. Both techniques were effective for large thyroid nodules. Endoscopic surgery offers good cosmetic results, with TOETVA patients reporting higher satisfaction.

Conclusion: Both ABS and TOETVA have their advantages and disadvantages. The choice of approach depends on factors like tumor size, location, and surgeon experience. TOETVA offers superior cosmetic outcomes but requires longer operative times. This study demonstrates the feasibility of TOETVA in Vietnam. TOETVA implementation is feasible and can benefit patients, but requires investment in training and equipment.