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Transoral Robotic Total Thyroidectomy and Bilateral Central Regional Lymph Node Dissection for Papillary Thyroid Carcinoma
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Minimally Invasive Remote Approaches Versus Conventional Open Approach in Central Neck Dissection for Patients
Claudia Valenziano1,2, Andrea Costantino2, Martina Sebastiani1,2
1Department of Biomedical Sciences, Humanitas University, Milan, Italy.
Head & Neck
|July 21, 2026
Summary
Minimally invasive remote approaches (MIRA) for thyroid cancer surgery offer comparable safety to conventional open approaches (COA) but require longer operative times. MIRA may be suitable for select patients in specialized centers.
Area of Science:
- Surgical Oncology
- Endocrine Surgery
- Minimally Invasive Surgery
Background:
- Total thyroidectomy (TT) with central neck dissection (CND) is standard for thyroid cancer.
- Minimally invasive remote approaches (MIRA) aim for better cosmetic results but raise safety concerns.
- Oncological safety and efficacy of MIRA versus conventional open approaches (COA) require evaluation.
Purpose of the Study:
- To compare MIRA and COA for CND during TT.
- Evaluate surgical outcomes, postoperative complications, and oncologic adequacy.
- Assess operative time, vocal fold paralysis, and hypoparathyroidism rates.
Main Methods:
- Systematic review and meta-analysis following PRISMA 2020 guidelines.
- Searched PubMed/MEDLINE, Cochrane Library, and Scopus databases.
- Included comparative studies of TT with CND in thyroid carcinoma patients.
Main Results:
- Eleven studies with 1626 patients analyzed.
- MIRA showed significantly longer operative times (SMD 1.75).
- No significant differences in transient vocal fold paralysis or hypoparathyroidism; comparable blood loss, drainage, and hospital stay.
Conclusions:
- MIRA is feasible and safe for select thyroid cancer patients, with comparable complication rates to COA.
- Longer operative times and limited long-term oncologic data favor COA as the standard.
- MIRA can be considered for select patients in high-volume specialized centers.
