Association of long-term quality of life, safety, and efficacy: robotic vs. open thyroidectomy for benign thyroid nodules

To compare the safety, efficacy, and quality of life (QoL) of robotic thyroidectomy (RT) and open thyroidectomy (OT) for benign thyroid nodules.

Traditional OT lacks aesthetic advantages, while endoscopic thyroidectomy has limitations for larger nodules. Advances in RT provide a minimally invasive option, offering improved aesthetics and efficacy for larger benign thyroid nodules.

This retrospective cohort study included 1614 benign thyroid nodules patients from 2014 to 2024. Following propensity score matching (1:2 ratio), 1079 patients who underwent OT or RT were analyzed. Postoperative complications were recorded, and patients were assessed using QoL and aesthetic outcome scales.

In the OT group, 186 patients (25.34%) had inadvertent parathyroid resection vs. none in the RT group ( P < 0.001). Transient hypoparathyroidism affected 129 OT patients (17.57%) vs. 36 RT patients (10.43%), respectively ( P = 0.002). Swallowing Impairment Score and Voice Impairment Score were higher in the OT group after 5 years ( P < 0.001). The RT group showed better "general health" and "vitality" at 0.5-3 years and >5 years, and better "social function," "mental health," and "role emotional" at >5 years ( P < 0.05). Scar lengths were shorter in the RT group at all time points ( P < 0.001), while SCAR-Q appearance scores were higher in the OT group ( P < 0.001).

Robotic thyroidectomy demonstrated superior cosmetic outcomes, lower complication rates, and minimal impact on postoperative QoL compared to open surgery for benign thyroid nodules, including larger ones. Therefore, with appropriate patient selection, robotic thyroidectomy may be the preferred approach for benign thyroid disease.