Efficacy and Safety of Minimally Invasive Thyroid Surgery: A Network Meta‐Analysis

Abstract

ObjectivesMinimally invasive and remote surgical approaches for thyroid tumors have been developed primarily for cosmetic benefit. However, conventional meta‐analysis could not provide comparative data between new techniques. This network meta‐analysis would be able to provide data for clinicians and patients to compare cosmetic satisfaction and morbidity by comparing surgical methods.Data SourcesThe PubMed, EMBASE, MEDLINE, SCOPUS, Web of Science, Cochrane Trials, and Google Scholar.Review methodsThe nine interventions included minimally invasive video‐assisted thyroidectomy (MIVA), endoscopic and robotic bilateral axillo‐breast‐approach thyroidectomy (EBAB and RBAB, respectively), endoscopic and robotic retro‐auricular thyroidectomy (EPA and RPA, respectively), endoscopic or robotic transaxillary thyroidectomy (EAx and RAx, respectively), endoscopic and robotic transoral approaches (EO and RO, respectively), and a conventional thyroidectomy. We recorded the operative outcomes and perioperative complications; pairwise and network meta‐analyses were performed.ResultsEO, RBAB, and RO were associated with good patient cosmetic satisfaction. EAx, EBAB, EO, RAx, and RBAB were associated with significantly more postoperative drainage than the other methods. Postoperatively, more flap problems and wound infections were found in the RO than control group, and more transient vocal cord palsy was found in the EAx and EBAB groups. MIVA ranked first in terms of operative time, postoperative drainage amount, postoperative pain, and hospitalization, but cosmetic satisfaction was low. EAx, RAx, and MIVA ranked higher than the other approaches in terms of operative bleeding.ConclusionIt was confirmed that minimally invasive thyroidectomy achieves high cosmetic satisfaction and is not inferior to conventional thyroidectomy in terms of surgical results or perioperative complications. Laryngoscope, 133:2470–2479, 2023

Feasibility and safety of modified en-bloc resection in endoscopic thyroid surgery via bilateral areolar approach – long-term institutional analysis ten years after surgery

“…Preoperative diagnosis of PTC has been significantly bolstered by advanced examinations such as ultrasound elastography, real-time elastography, and fine-needle aspiration biopsy ( 14 , 15 ), contributing to more precise diagnostic assessments. The primary objectives of endoscopic thyroidectomy techniques include achieving optimal efficacy and safety while concurrently improving perioperative outcomes and cosmetic results ( 16 ). Previous studies, including our own, have showcased the feasibility of this technique, particularly in treating papillary thyroid non-microcarcinoma (PTNMC), leveraging intraoperative neuromonitoring and energy-based devices ( 17 – 19 ).…”

Endoscopy‐Assisted Thyroglossal Duct Cyst Resection: A Scoping Review

“…4,5 In recent years, promising results have been achieved using endoscopy-assisted approaches to manage various neck lesions. [7][8][9] From this successful experience, otolaryngologists have begun to explore the application of endoscopy in TGDC surgery. 13,14 In this scoping review, we summarize the existing evidence on endoscopy-assisted TGDC surgery.…”

“…Its applications have gradually expanded, from thyroidectomy to parotidectomy and cervical lymph node dissection. [7][8][9] Researchers have also recently explored endoscopy-assisted surgery for TGDC resection. 10 Several teams have reported successful endoscopy-assisted TGDC resection with satisfactory aesthetic results.…”

“…The endoscopy‐assisted approach aims to achieve better cosmetic outcomes by minimizing visible neck scarring. Its applications have gradually expanded, from thyroidectomy to parotidectomy and cervical lymph node dissection 7–9 . Researchers have also recently explored endoscopy‐assisted surgery for TGDC resection 10 .…”

Seeding recurrence of follicular thyroid carcinoma after transoral endoscopic thyroidectomy vestibular approach: a case report

“…Minimally invasive and remote access thyroid surgeries have become increasingly popular among thyroid cancer patients seeking improved cosmetic outcomes on top of oncologic outcomes ( 1 ). Remote access thyroidectomies can be performed via endoscopic or robotic approaches, including bilateral axillo breast, transaxillary, and transoral techniques ( 2 - 4 ).…”