AbstractBackgroundTransoral endoscopic thyroidectomy vestibular approach (TOETVA) is a relatively safe procedure with comparable safety profile as open thyroidectomy. While gas insufflation complications such as subcutaneous emphysema and pneumomediastinum have been reported postoperatively, there have been no reports of pneumoperitoneum.Case reportOur patient underwent an uneventful TOETVA to remove her left thyroid lobe. Postoperatively, she developed subcutaneous emphysema, pneumomediastinum, and pneumoperitoneum, which were confirmed on CT scan. She was managed conservatively and recovered uneventfully.ConclusionThe authors report the first case of pneumoperitoneum following TOETVA. Surgeons performing TOETVA should be aware of pneumoperitoneum as a possible complication of this procedure after excluding other possible causes.