Related Experiment Video
Updated: Aug 5, 2025
Transoral Robotic Total Thyroidectomy and Bilateral Central Regional Lymph Node Dissection for Papillary Thyroid Carcinoma
Published on: September 15, 2023
Surgical completeness and safety of minimally invasive thyroidectomy in patients with thyroid cancer: A network
Yun Jin Kang1, Gulnaz Stybayeva2, Se Hwan Hwang3
1Department of Otorhinolaryngology-Head and Neck Surgery, Soonchunhyang University College of Medicine, Cheonan, Republic of Korea.
Background:
To assess the surgical outcomes of various minimally invasive and remote-access surgical approaches for thyroid cancer patients.
Methods:
We collected studies from January 2020 to July 2022 in 6 databases. Pairwise and network meta-analyses were performed for outcomes and complications of 9 minimally invasive interventions (minimally invasive video-assisted, endoscopic or robotic bilateral axillo-breast approach, endoscopic or robotic postauricular, endoscopic or robot transaxillary approach, transoral endoscopic thyroidectomy vestibular approach or robotic thyroidectomy) and conventional thyroidectomy (control).
Results:
Multiplicity and bilaterality of cancer, lymph node metastasis, and coincidence of thyroiditis showed no significant difference between minimally invasive interventions and control. However, larger tumor size (robotic bilateral axillo-breast approach standardized mean difference -1.3989, 95% confidence interval [-2.1717 to -0.6262]), higher body mass index (robot transaxillary approach standardized mean difference -0.5350, 95% confidence interval [-0.9557 to -0.1144], robotic bilateral axillo-breast approach standardized mean difference -0.2301, 95% confidence interval [-0.4389 to -0.0214]), and frequent extrathyroidal extension (robotic bilateral axillo-breast approach standardized mean difference 0.7435, 95% confidence interval [0.5602-0.9869]) were observed in control. In surgical outcomes and adverse effects, there was no significant difference in hospitalization or retrieved lymph node number between minimally invasive interventions and control. However, longer operative time was observed in the robotic bilateral axillo-breast approach(standardized mean difference 6.5393, 95% confidence interval [5.0476-8.0309]) and transoral robotic thyroidectomy (standardized mean difference 5.4946, 95% confidence interval [2.9984-7.9907]) groups than in control. In surgical completion, the rate of low postoperative serum thyroglobulin, postoperative thyroglobulin level, and postoperative radioactive iodine ablation dose showed no significant difference between minimally invasive interventions and control.
Conclusion:
Minimally invasive thyroidectomy did not show inferior results compared to conventional thyroidectomy despite the longer operative time. Surgeons need to prudently consider all aspects of patients to determine the proper surgical approach for thyroid cancer.
Insights
Minimally invasive thyroidectomy offers comparable outcomes to conventional surgery for thyroid cancer. While operative times may be longer, these approaches are not inferior, allowing surgeons to choose the best method for each patient.
Area of Science:
- Endocrinology
- Surgical Oncology
- Minimally Invasive Surgery
Background:
- Thyroid cancer treatment often involves conventional thyroidectomy.
- Minimally invasive and remote-access surgical techniques are emerging alternatives.
Purpose of the Study:
- To compare the surgical outcomes and complications of various minimally invasive thyroidectomy approaches against conventional methods.
Main Methods:
- A systematic review and meta-analysis of studies published between January 2020 and July 2022.
- Inclusion of 9 minimally invasive techniques and conventional thyroidectomy (control).
- Pairwise and network meta-analyses were conducted on outcomes and complications.
Main Results:
- No significant differences in cancer characteristics (multiplicity, bilaterality, lymph node metastasis, thyroiditis) between groups.
- Conventional surgery was associated with larger tumor size, higher BMI, and more extrathyroidal extension.
- Hospitalization and lymph node yield were similar; however, robotic bilateral axillo-breast and transoral robotic thyroidectomy showed longer operative times.
Conclusions:
- Minimally invasive thyroidectomy demonstrates non-inferior surgical outcomes compared to conventional thyroidectomy.
- Despite longer operative times for some minimally invasive procedures, they are a viable option.
- Patient-specific factors should guide the selection of the optimal surgical approach for thyroid cancer.
