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Objective To evaluate the clinical and oncological outcomes of transoral endoscopic thyroidectomy via the vestibular approach (TOETVA) in the management of pediatric patients with benign and malignant thyroid lesions in Vietnam.Methods A cross-sectional study was performed on pediatric patients (≤18 years old) who underwent TOETVA for thyroid cancer and benign thyroid nodules between August 2019 to September 2024.Results Of the 28 patients included in the study, 23 were female (82.1%), and 5 were male (17.9%) with a mean age of 15.86±2.45 years. Mean tumor size on ultrasound was 19.47±13.63 mm. TOETVA was completed successfully in all cases. Postoperative histopathological findings revealed benign lesions in 13 patients, differentiated thyroid carcinoma in 14 patients and non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) in one patient; central neck dissection (CND) was performed in 15 patients; nine of them had occult lymph node metastasis. Postoperative complications included transient hypoparathyroidism (3.6%) and vocal cord palsy (7.1%), all of which resolved. No permanent complications or recurrences were observed over a median follow-up of 26.5 months.Conclusions TOETVA appears feasible for the treatment of thyroid nodules in children. However, larger prospective studies are needed to confirm these findings.