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Updated: Feb 15, 2026
05:25
Identification and Protection of the Recurrent Laryngeal Nerve during Transoral Robotic Thyroidectomy
Published on: October 24, 2025
602
Indications and contraindications to transoral thyroidectomy
Christopher R Razavi1, Jonathon O Russell1
1Division of Head and Neck Endocrine Surgery, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Annals of Thyroid
|February 2, 2018
Summary
Transoral robotic or endoscopic thyroidectomy vestibular approach (TOR/ETVA) offers a scarless alternative for thyroid surgery. This review establishes clear indications and contraindications for patient selection to ensure safety and efficacy.
Area of Science:
- Endocrinology
- Surgical Oncology
- Minimally Invasive Surgery
Background:
- Patient desire to avoid neck scarring drives development of remote access thyroid surgery.
- Transoral robotic or endoscopic thyroidectomy vestibular approach (TOR/ETVA) is gaining prevalence globally.
- Standardized criteria are needed to optimize patient selection and prevent complications.
Purpose of the Study:
- To review existing literature on TOR/ETVA inclusion and exclusion criteria.
- To establish uniform indications and contraindications for TOR/ETVA.
- To provide evidence-based recommendations for patient selection.
Main Methods:
- Comprehensive review of English literature on TOR/ETVA.
- Compilation and analysis of author-specific inclusion/exclusion criteria.
- Synthesis of findings with author experience to formulate recommendations.
Main Results:
- Recommended indications include avoidance of cervical scar, thyroid size ≤ 10 cm, dominant nodule ≤ 6 cm, and specific benign to early-stage malignant pathologies.
- Contraindications encompass prior head/neck surgery or radiation, inability to tolerate anesthesia, hyperthyroidism, nerve palsy, metastasis, and extensive local invasion.
- Relative contraindications include smoking and oral pathology; obesity may pose technical challenges.
Conclusions:
- Clear indications and contraindications for TOR/ETVA are crucial for safe and effective patient selection.
- Adherence to these criteria can minimize surgical complications and optimize outcomes.
- TOR/ETVA represents a viable, scarless surgical option for carefully selected thyroid patients.
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