Background and Aims Currently, there is limited literature on the use of indocyanine green (ICG) fluorescence imaging technique for identification and protection of the parathyroid glands in robotic thyroid surgery, and further research is needed to explore its clinical utility. This study was performed to explore the safety and effectiveness of employing ICG fluorescence imaging technique during transoral robotic thyroidectomy vestibular approach (TORTVA) by comparing cases with and without its use.Methods Data of patients who underwent TORTVA between December 2018 and November 2021 were retrospectively collected. After screening, 80 patients were included. Among them, 45 patients underwent surgery with the use of ICG fluorescence imaging technique (ICG group), while 35 patients did not use this technique (control group). Propensity score matching (PSM) was performed using a 1∶1 nearest-neighbor matching method to eliminate confounding bias between the two groups. Then, the intraoperative and postoperative parameters were compared between the two groups of patients.Results After PSM, 24 patients were included in each group, with balanced baseline characteristics. There was no statistically significant difference in intraoperative blood loss between the ICG group and the control group (P=0.910). However, the ICG group demonstrated a significantly shorter average operative time compared to the control group (223 min vs. 251 min, P=0.032). There were no statistically significant differences in the number of lymph nodes dissected, positive lymph nodes, and lymph node positivity rate between the two groups (all P>0.05). Total hospital stay and postoperative hospital stay showed no statistically significant differences between the two groups (both P>0.05). There were no significant differences in postoperative parathyroid hormone and serum calcium levels between the two groups (all P>0.05). The incidence of complications was 12.5% in the ICG group and 25.0% in the control group, with no statistically significant difference (P=0.461). Both groups had no patients undergoing intraoperative autotransplantation of the parathyroid glands, and there were no occurrences of permanent recurrent laryngeal nerve injury or hypoparathyroidism in the either group.Conclusion The use of ICG fluorescence imaging technology during TORTVA does not increase the risk of postoperative complications, demonstrating reliable safety. Additionally, it provides clearer visualization of the parathyroid glands, significantly reducing operative time and exhibiting certain effectiveness.