AIM: Transoral robotic thyroidectomy has emerged as a scarless alternative to conventional and remote-access approaches; however, technical standardization and outcome data for truly scarless three-port configurations remain limited. The aim of this study was to describe the surgical technique and early clinical outcomes of three-port transoral robotic thyroidectomy (TORT) as a truly scarless remote-access approach to the thyroid gland.

METHODS: This technical note reports a consecutive series of 25 patients who underwent three-port transoral robotic thyroidectomy between June 2017 and May 2019 at Korea University Hospital. Surgical steps, including vestibular port placement, working-space creation, robotic docking, and lobectomy procedures, are detailed. Perioperative data, postoperative outcomes, and complications were retrospectively analyzed.

RESULTS: The median age was 41.0 years, and 76.0% of patients were female. Unilateral thyroidectomy was performed in 80.0% of cases, and central neck dissection in 52.0%. The median operative time was 308.0 minutes, with minimal blood loss (3.0 mL). No intraoperative complications occurred. Transient hypoparathyroidism and recurrent laryngeal nerve palsy were observed in 4.0% of patients each, while one permanent recurrent laryngeal nerve injury (4.0%) was recorded. No cases of mental nerve injury or surgical site infection were observed. Postoperative pain was low, and the median hospital stay was 3 days.

CONCLUSIONS: Three-port transoral robotic thyroidectomy is a feasible and safe technique in carefully selected patients when performed in experienced centers. Despite a prolonged operative time during the initial learning phase, complication rates were acceptable and cosmetic outcomes were excellent. This approach should currently be reserved for high-volume endocrine robotic units under strict indication criteria and structured training pathways.