Background and Aims Transoral endoscopic thyroidectomy vestibular approach (TOETVA) can not only thoroughly remove the lesion but also be utterly traceless after operation. However, there are some difficulties in carrying out this technique, and surgical complications are inevitable. This study was conducted to summarize the experience in prevention and treatment of the complications of this procedure by analyzing the clinical data from the authors' center combined with the data from other centers.Methods The clinical data of 2 710 patients with thyroid tumors undergoing surgical treatment in the authors' center from March 2016 to October 2022 were analyzed retrospectively. Of the patients, 1 941 cases underwent TOETVA, 49 cases underwent transoral and submental endoscopic thyroidectomy (TOaST), 110 cases underwent transoral robotic thyroidectomy (TORT), and 610 cases underwent thyroidectomy via conventional transcervical approach (TCA). The incidence rates of surgical complications of each procedure and their treatment, as well as the clinical data concerning surgical complications of TOETVA from a study across 5 independent medical institutions, were analyzed.Results The data of the authors' center showed that skin injury occurred in 16 cases (0.82%), trachea injury occurred in 2 cases (0.1%), temporary recurrent laryngeal nerve injury occurred in 38 cases (1.96%), postoperative infection occurred in 5 cases (0.26%), and permanent hypoparathyroidism occurred in 1 case (0.05%) in TOETVA group; In the traditional cervical skin thyroidectomy group, there was 1 case (2.29%) of trachea injury, 14 cases (2.29%) of temporary recurrent laryngeal nerve injury, and 3 cases (0.49%) of postoperative infection; there were no significant differences in the main surgical complications in TOETVA group compared with other procedure groups (all P>0.05); all complications were resolved after appropriate treatments or spontaneously. The statistics of surgical complications in 152 TOETVA cases from the other 5 independent medical institutions showed that there were 9 cases (5.9%) of skin injury, 3 cases (1.3%) of trachea injury, 5 cases (4.7%) of temporary recurrent laryngeal nerve injury, and 1 case (0.7%) of postoperative infection.Conclusion In addition to its advantages, TOETVA will not increase the incidence of complications. The lower incidence rate of complications after TOETVA in the authors' center than that in literature reports suggests that the increase in operation cases and accumulation of surgical experience are the keys to reducing the surgical complications of TOETVA and improving the surgical quality.