Extracervical Approaches to Thyroid Surgery: Evolution and Review.

B M Sephton

doi:10.1155/2019/5961690

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.

Highlights

Thyroid surgery has progressed considerably over the past 30 years from the original surgical approach of an open thyroidectomy performed through an 8-10 cm collar incision [1]
Technical modifications to the original minimally invasive thyroidectomy (MIT) techniques have been continually tried to further improve the results of MIT and such experimentation led to the development of minimally invasive video-assisted thyroidectomy (MIVAT)
Due to the smaller neck incision and decreased dissection, MIVAT is associated with improved patient satisfaction, less postoperative pain, decreased length of stay, and less surgical complications than open thyroidectomy [1, 8]

Summary

Introduction

Thyroid surgery has progressed considerably over the past 30 years from the original surgical approach of an open thyroidectomy performed through an 8-10 cm collar incision [1]. Towards the end of the twentieth century, new techniques for thyroidectomy were developed to include both minimally invasive and extracervical remote access surgery. The technique progressed to include total thyroidectomy and subsequent studies reported no major complications, better cosmetic results, and an earlier return to activity when compared to conventional thyroidectomy [5, 6]. Technical modifications to the original minimally invasive thyroidectomy (MIT) techniques have been continually tried to further improve the results of MIT and such experimentation led to the development of minimally invasive video-assisted thyroidectomy (MIVAT). Due to the smaller neck incision and decreased dissection, MIVAT is associated with improved patient satisfaction, less postoperative pain, decreased length of stay, and less surgical complications than open thyroidectomy [1, 8]

Objectives

Findings

Discussion

Conclusion