Extracervical Approaches to Thyroid Surgery: Evolution and Review

Abstract

Over the last two decades, advances and adaptation of technology have led to a variety of endoscopic thyroidectomy procedures being performed. The drive for extracervical procedures has been predominantly influenced by the desire for improved cosmesis via avoidance of visible scars. Extracervical techniques have shown considerable evolution with approaches that have included transaxillary, breast, postauricular, and transoral routes. There has been a varied evidence base for each of these approaches with regard to technical feasibility, safety, patient satisfaction, and cost-effectiveness. In recent years, robotic-assisted thyroid surgery has gained increased popularity worldwide with the introduction of the da Vinci Robot. Reports of improved postoperative outcomes and patient satisfaction have been in contrast to the financial burden, longer operative time, and increased training required which, to date, have limited widespread application. The aim of this review is to describe the evolution of extracervical procedures including surgical approaches, outcomes, advantages, and disadvantages. Consideration is also given to the future direction of extracervical thyroid surgery with regard to the safety, feasibility, and application of robotic systems.

Evaluation of the clinical value of carbon nanoparticles in endoscopic thyroidectomy and prophylactic central neck dissection through total mammary areolas approach for thyroid cancer

“…Compared with the traditional open thyroidectomy, endoscopic approaches are recommended to minimize the surgical extent for well-differentiated TC and to meet the growing demand for improved cosmesis [ 14 ]. Transaxillary, retroauricular, transoral, and bilateral axillo-breast approach (BABA) robotic approaches have been reported to achieve endoscopic thyroidectomy [ 15 , 16 ]. Jiang et al evaluated the safety and effectiveness of endoscopic thyroidectomy compared with conventional thyroidectomy in PTC by meta-analysis, showing that the two procedures were similar in safety, efficacy, and tumor recurrence [ 17 ].…”

Efficacy and safety of single-session radiofrequency ablation for intrathoracic goiter: preliminary results and short-term evaluation

“…Of note, complications associated with surgery for ITG are slightly higher than those of standard thyroid surgeries, which include laryngeal nerve injury, hypoparathyroidism, bleeding, and hematoma. Meanwhile, although incidence of tracheomalacia and pneumothorax are rare, they may be of importance to patients with ITG [6,8,34,35]. When compared with surgical intervention for ITG, RFA exhibits relatively fewer and less severe complications, generally not requiring inpatient care.…”

Endocrine surgery during and after the COVID-19 epidemic: Expert guidelines from AFCE

“…Surgery requiring a thoracic or mediastinal approach and/or postoperative intensive care [27] must be deferred whenever possible until after the epidemic is over. Endoscopic surgical approaches, with or without robotic assistance, are not recommended [28]. If there is no dysphonia, laryngoscopy before or after surgery is not recommended [29] because of the high risk of airborne SARS-CoV-2 transmission during such examination [30].…”