Building bridges between public health and computer science departments in academia to foster artificial intelligence knowledge and skills for the digital age.

With the increasing emphasis on aesthetic outcomes and the growing demand for minimally invasive procedures, endoscopic thyroidectomy has gained considerable attention in recent years (, ). Various techniques for endoscopic thyroidectomy have been developed, including approaches through the breast, axilla, subclavian area, and transoral vestibular route (–). Among these, the transoral endoscopic thyroidectomy vestibular approach (TOETVA) stands out as the only technique aligned with the principles of Natural Orifice Transluminal Endoscopic Surgery. TOETVA offers distinct advantages, such as a completely scarless exterior, minimal flap dissection, and comprehensive central lymph node clearance (–). Since Anuwong et al.'s seminal report in 2015, which outlined the initial indications and contraindications for TOETVA (), the technique has seen increasing global adoption. However, challenges such as limited visual field, complex operational angles, and prolonged operation times have hindered the widespread use and application of this technique (, ). In response, many surgeons have sought to optimize the original procedure to address these issues (–). These efforts aim to reduce surgical difficulty and expand the applicability of TOETVA, with various improvements contributing to enhanced safety and efficiency. However, due to variations in surgical experience and skill levels among different surgeons, significant variability exists among research centers regarding the criteria for TOETVA. This variability is particularly pronounced concerning acceptable thyroid size, volume, and tumor dimensions for both benign and malignant lesions. Although the 2025 international consensus statement on remote-access thyroid surgery has established selection criteria for TOETVA (), it also recognizes that patient eligibility may vary depending on surgeon skill, experience, and the specific technique employed. Consequently, clinical scenarios that fall outside strict parametric criteria are increasingly encountered in practice, yet evidence regarding their safety and feasibility remains limited. To address these issues, our study provides a structured narrative review of current TOETVA indications, integrating the latest findings from the literature. In addition, we present our clinical experience with seven unique cases that extend beyond conventional indications, including bulky thyroid gland, larger benign nodule, advanced malignancies, and concomitant neck masses. These cases explore the technical feasibility and oncologic safety of TOETVA in more complex scenarios. Through this study, we seek to provide valuable clinical insights that emphasize the necessity of meticulous patient selection and specialized surgical expertise, rather than advocating for a generalized expansion of TOETVA indications.