Minimally Invasive Techniques in Thyroid Surgery

Over the past two decades, thyroid surgery has evolved from a conventional open neck incision to a spectrum of minimally invasive approaches that prioritise cosmetic outcomes, reduced pain and rapid recovery while preserving oncological safety. Techniques now range from minimally invasive video-assisted thyroidectomy, which uses a small cervical port and endoscopic instruments, to remote-access procedures such as robot-assisted transaxillary surgery and truly scarless transoral vestibular approaches. Innovations in gasless retraction, intraoperative nerve monitoring and refined parathyroid preservation have widened patient selection and expanded indications, including larger nodules and bilateral disease. Collectively, these methods demonstrate comparable complication rates to open surgery, with benefits in patient satisfaction, shorter hospital stay and earlier return to normal activities. As instrumentation, training and clinical evidence accumulate worldwide, minimally invasive thyroidectomy continues to redefine standards of care in endocrine surgery.

Research from Nature Portfolio

A single-institution series of 10 000 robot-assisted transaxillary thyroidectomies demonstrated both safety and feasibility as indications have gradually broadened. The investigators reported that even patients with nodules over 5 cm underwent remote-access removal without significant increase in major complications. Transient hypoparathyroidism remained the most frequent postoperative event, while oncological outcomes, including recurrence rates, paralleled those of conventional approaches. Findings underscore the potential to extend robotic techniques to diverse thyroid pathologies and reinforce the role of high-volume experience in optimising procedural efficiency and patient selection.

Research from all publishers

A network meta-analysis of seven endoscopic thyroidectomy approaches synthesised data from over 8 000 patients, revealing that axillo-bilateral-breast and unilateral axillo-breast methods offered the shortest operative times, whereas anterior chest and unilateral axillo-breast routes excelled in controlling intraoperative bleeding and reducing length of hospital stay. A systematic review and meta-analysis of the transoral endoscopic vestibular approach affirmed its safety and efficacy compared with open thyroidectomy, noting equivalent complication rates but significantly lower postoperative pain and superior cosmetic satisfaction. Early reports of a single-incision, gasless transaxillary endoscopic technique for bilateral central neck dissection also indicated complete resection with minimal complications and high patient satisfaction, supporting the feasibility of scarless or remote approaches even in bilateral microcarcinoma.

Minimally Invasive Techniques in Thyroid Surgery publication trend

The graph below shows the total number of articles in minimally invasive techniques in thyroid surgery across all publications each year (not limited to Nature Index journals).

Technical terms

Minimally invasive video-assisted thyroidectomy (MIVAT): A procedure employing a small cervical incision and endoscopic assistance for thyroid removal.

Robot-assisted transaxillary thyroidectomy: Remote-access thyroid surgery via an axillary incision using a multi-arm robotic system.

Transoral endoscopic thyroidectomy vestibular approach (TOETVA): A scarless thyroidectomy performed through incisions in the oral vestibule under the lower lip.

Gasless technique: Use of mechanical retractors instead of CO₂ insufflation to create working space in endoscopic thyroid surgery.

Central neck dissection: Surgical removal of lymphatic tissue in the central compartment of the neck for thyroid malignancy staging and treatment.

References

1. Expansion of thyroid surgical territory through 10,000 cases under the da Vinci robotic knife. Scientific Reports (2024).
2. Surgical outcomes of endoscopic thyroidectomy approaches for thyroid cancer: a systematic review and network meta-analysis. Frontiers in Endocrinology (2023).
3. Transoral endoscopic thyroidectomy vestibular approach as a safe and feasible alternative to open thyroidectomy: a systematic review and meta-analysis. International Journal of Surgery (2023).
4. A modified, single-incision, gasless, endoscopic thyroidectomy and bilateral central neck dissection via axillary approach technique for bilateral papillary thyroid microcarcinoma: A preliminary report. Heliyon (2024).