Is transoral surgery safe?
In experienced hands, published studies show complication rates similar to traditional surgery. Three differences are worth knowing: a small chance of temporary chin firmness, a small chance of temporary lower-lip numbness, and a slightly higher chance of wound infection.
What the largest comparison found
Anuwong et al., JAMA Surgery 2018; 216 transoral vs 216 traditional patients, matched.
Out of every 100 patients (pain is a 0 to 10 score)
Temporary voice change (nerve irritation)
Transoral: about 4
Permanent voice change
Traditional: about 4
Transoral: 0
Temporary low calcium
Traditional: 0
Transoral: about 11
Traditional: about 9
Permanent low calcium
Transoral: 0
Traditional: 0
Temporary lower-lip numbness
Transoral: about 1
Traditional: 0
Infection
Transoral: 0 in this study; 0 to 1 in other large studies.
Traditional: 0 in this study.
Pain the day after surgery (0 to 10 scale)
Transoral: 2.1
Traditional: 4.9
About infection: a few early studies reported wound infection in up to 5 or 6 of every 100 transoral patients, counting even mild redness or swelling, and nearly all cleared with antibiotics. A 2025 consensus statement from six international thyroid and surgical societies found results similar to traditional surgery.
In the US
In 200 consecutive transoral thyroidectomies at Johns Hopkins, serious complications occurred in 1.5% of patients, compared with 2.1% after traditional surgery (Russell et al., World Journal of Surgery 2021).
Across studies
A 2023 review of 15 studies and nearly 3,000 patients found no difference in voice nerve injury, but a higher rate of wound infection with transoral surgery, and operations that took about an hour longer (Zhou et al., Endocrine 2023).
Appearance
Patients who had transoral surgery rated their scar outcome far better than patients after traditional surgery (Chen et al., Head and Neck 2020).
Parathyroid surgery
In 101 transoral parathyroid operations at several centers worldwide, calcium-regulating hormone returned to normal right away in 98% of patients, with no permanent nerve or calcium problems (Surgical Endoscopy 2022).
Expert consensus
In 2025, six international surgical and thyroid societies, including the American Association of Endocrine Surgeons and the American Thyroid Association, published a consensus statement on remote-access thyroid and parathyroid surgery, including the transoral approach (Thyroid 2025).