PROSPECTIVE OBSERVATIONAL STUDY ON TRANSORAL ENDOSCOPIC NECK SURGERY (TOENS) AS A TREATMENT MODALITY FOR NECK SWELLING IN A TERTIARY CARE CENTRE IN CENTRAL INDIA

Abstract

Background: Transoral Endoscopic Neck Surgery (TOENS), particularly the transoral endoscopic vestibular approach, has emerged as an innovative scarless minimally invasive technique for the management of selected neck swellings. By eliminating the need for a visible cervical incision, TOENS offers improved cosmetic outcomes while maintaining surgical safety and efficacy comparable to conventional open surgery. However, evidence regarding its feasibility and clinical outcomes from Indian tertiary care centers remains limited. The present study was undertaken to evaluate the feasibility, safety, and clinical outcomes of TOENS in the management of selected neck swellings at a tertiary care center in Central India. Methodology: This prospective observational study included 40 consecutive patients with selected neck swellings who underwent TOENS after obtaining Institutional Ethics Committee approval and written informed consent. Preoperative evaluation included detailed clinical examination, ultrasonography, thyroid function tests (where indicated), contrast-enhanced computed tomography in selected patients, and fine-needle aspiration cytology. Intraoperative parameters such as operative time, blood loss, technical difficulty, conversion to open surgery, and intraoperative complications were recorded. Postoperative outcomes including pain (Visual Analog Scale), complications, hospital stay, cosmetic satisfaction, patient-reported outcomes, histopathological findings, and follow-up results were prospectively assessed. Data were analyzed using IBM SPSS software, with a p-value of <0.05 considered statistically significant. Results: The median age of the study population was 38 years, with females comprising 77.5% of patients. Successful completion of TOENS without conversion was achieved in 95.0% of cases. The median operative time was 118 minutes, and median estimated blood loss was 37.5 mL. Transient hypocalcaemia (15.0%), transient mental nerve neuropraxia (7.5%), and transient recurrent laryngeal nerve palsy (5.0%) were the most common postoperative complications, while no permanent nerve injury, permanent hypocalcaemia, surgical site infection, hematoma, or mortality was observed. The median hospital stay was 2 days, and patients resumed routine activities after a median of 7 days. Cosmetic outcomes were excellent or good in 95.0% of patients, with 100% remaining free of a visible cervical scar. Histopathological examination revealed predominantly benign thyroid lesions, and concordance between preoperative FNAC and final histopathology was observed in 87.5% of cases. Conclusion: TOENS is a feasible, safe, and effective scarless surgical option for carefully selected patients with neck swellings. The procedure demonstrated favorable perioperative outcomes, low complication rates, rapid postoperative recovery, excellent cosmetic satisfaction, and high patient acceptance. With appropriate patient selection, standardized surgical technique, and adequate training, TOENS represents a promising minimally invasive alternative to conventional open neck surgery in tertiary care settings.