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Minimally Invasive Thyroidectomy Not Inferior to Conventional Surgery

by Linda Kossoff •

How do invasive and remote surgical approaches for thyroid tumors compare in morbidity rate and patients’ cosmetic satisfaction?

BOTTOM LINE

Minimally invasive thyroidectomy achieves high cosmetic satisfaction and is not inferior to conventional thyroidectomy in terms of surgical results or perioperative complications.

BACKGROUND: Conventional thyroidectomy provides a good view of the surgical field, potentially lowering the chance of complications; however, the resulting neck scar is cosmetically undesirable to many patients. Minimally invasive and remote-access surgical approaches, most of which are endoscopically or robotically assisted, have been developed to improve cosmetic outcomes.

STUDY DESIGN: Network meta-analysis.

SETTING: Department of Otolaryngology–Head and Neck Surgery, Seoul Saint Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.

SYNOPSIS: Researchers mined multiple databases for studies in which adult patients underwent thyroid surgery with conventional thyroidectomy or one of eight endoscopic and robotic approaches. Their analysis included 13,008 subjects enrolled in 72 studies. Operative outcomes and perioperative complications were recorded. Findings showed that overall, a minimally invasive approach to thyroid surgery was not inferior to conventional thyroidectomy in surgical outcomes or perioperative complications. Endoscopic and robotic transaxillary thyroidectomy (EAx and RAx, respectively), endoscopic and robotic bilateral axillo-breast (EBAB and RBAB, respectively), and endoscopic transoral approaches were associated with more postoperative drainage than other methods. Postoperatively, more flap problems and wound infections were found in the robotic transoral approach than in the control group, and more transient vocal cord palsy was seen in the EAx and EBAB groups. Minimally invasive video-assisted thyroidectomy ranked first in operative time, postoperative drainage, postoperative pain, and hospitalization, but cosmetic satisfaction was low. Authors state that choice of surgical method should consider method characteristics, location/extent of lesion, patient’s anatomical structure, and patient preference. Study limitations included sole use of numerical data.

CITATION: Kim DH, Kim SW, Kim G-J, et al. Efficacy and safety of minimally invasive thyroid surgery: a network meta-analysis. Laryngoscope. 2023;133:2470–2479.