Current surgical status of thyroid diseases

Figures & data

Figure 1 Different incision margins based on the technique used.

Abbreviation: MIVAT, minimally invasive video-assisted thyroidectomy.

Table 2 Indications, advantages, and disadvantages of surgical techniques for thyroid surgery

Surgical techniques	Indications	Advantages	Disadvantages
Open thyroidectomy	Any indication for thyroidectomy, lymph node dissection Extrathyroid invasion History of thyroiditis	Standardized method Easy learning curve Reduced operating time	Poor cosmetic result Hyper- or paresthesia in the neck
Minimally invasive methods	≤30 mL of thyroid volume <30 mm diameter of nodule <20 mm diameter of cancer Level IV node dissection	Better cosmetic result Less postoperative pain	Difficult learning curve Limits in nodules size
Breast and axillary-breast approaches	<6 cm diameter of thyroid <1 cm diameter of cancer No central or lateral lymph nodes	Scarless technique	Greater postoperative pain Difficult learning curve Longer operating time Complications from CO2 insufflation Higher cost
Robot-assisted thyroidectomy	<6 cm diameter of thyroid <2 cm diameter of cancer No central or lateral lymph nodes No previous neck operations	Better cosmetic result Three-dimensional working field Magnified view Eliminate tremor	Highest cost Greater postoperative pain Longer operating time Very difficult learning curve

Table 1 Published data from large studies comparing operation outcomes between surgical techniques

Study	Number of patients	Open thyroidectomy	MIVAT	SET	Robotic thyroidectomy	Operating time	Hospital stay	Complications	Postoperative pain	Quality of life#	Outcomes for P value ≤ 0.05
Miccoli et al^Citation15	1320	√	√	–	–	√	√	√	√	√	Operating time was 66 ± 24 in MIVAT group, 45 ± 14.9 in Open group (P = 0.01). Cosmetic result (scale 0–10) was 9.2 ± 1 in MIVAT, 8 ± 1.8 in open group (P = 0.01)
Del Rio et al^Citation48	200	√	√	–	–	–	–	√	√	–	The postoperative pain at 24 hours in MIVAT group was 1.033 ± 0.87, whereas in open group it was 1.915 ± 1.24 (P < 0.05)
Lombardi et al^Citation55	20	√	√	–	–	√	–	–	√	√	VAS at 48 hours was 10 ± 3 in MIVAT group, 8 ± 8 in Open group (P = 0.05). Cosmetic result (scale 0–10) was 9.3 ± 0.8 in MIVAT, 8.4 ± 0.1 in open group (P = 0.05)
El-Labban^Citation54	76	√	√	–	–	√	√	√	√	√	VAS at 24 hours was 2.6 ± 0.2 in MIVAT group, 3.4 ± 0.6 in open group (P < 0.001). Incision length (cm) was 3.2 ± 0.9 in MIVAT, 5.4 ± 0.7 in open group, and cosmetic result (scale 0–10) was 9.1 ± 0.5 in MIVAT, 4.9 ± 0.6 in open group (P < 0.001)
Lang and Chow^Citation71	46	–	–	√	√	√	√	√	√	–	Operating time was higher in robotic group (P = 0.018). Pain score on operation day was higher in robotic group (P = 0.025)
Tae et al^Citation72	67	√	–	√	–	√	√	√	√	√	Operating time was 192.4 ± 56.6 in endoscopic group vs 101.6 ± 33.3 in open group (P < 0.001) Bleeding (mL) was 231.5 ± 99.5 in endoscopic group vs 88.5 ± 42.7 in “open group (P < 0.001) Cosmetic satisfaction was better in endoscopic group (P < 0.001)
Lee et al^Citation73	84	√	–	–	√	√	√	√	√	√	Operating time was 128.6 ± 36.3 for robotic group, 98 ± 22 for open group (P = 0.001). Patient complaints for hyper- or paresthesia in the neck after 3 months was 9.8% in the robotic group, 65.1% in the open group (P = 0.002). Greater satisfaction for cosmetic result was found in the robotic group (P < 0.0001)

Notes: We present random studies that compare the operative outcomes between various surgical techniques in thyroid surgery.

# Quality of life shows patient satisfaction on the cosmetic results of surgery.

Abbreviations: MIVAT, minimally invasive video-assisted thyroidectomy; SET, scarless endoscopic thyroidectomy (noncervical technique); VAS, visual analog scale from 1 to 10.

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