Recent Trends in Surgical Approach to Thyroid Cancer

Abstract

Over the past decade, the incidence of thyroid cancer has rapidly increased worldwide, and thyroid surgery has become one of the most common performed surgical procedure. Even though conventional open thyroidectomy remains the gold standard, this approach leaves a neck scar which could be worrying mainly for young women. The recent progress in surgical technology, as well as patient cosmetic requests, have led to the development of alternative access to the thyroid lodge. Thus, alternative techniques have been established in order to potentially provide a more appealing cosmetic result, both with a minimally-invasive cervical or remote-access approach. However, the introduction of these new techniques was initially approached with caution due to technical challenges, the introduction of new complications and, above all, skepticism about the oncologic effectiveness. Among several alternative approaches proposed, the minimally invasive video-assisted thyroidectomy and the robot-assisted transaxillary thyroidectomy became popular and obtained the favor of the scientific community. Moreover, the recent introduction of the trans-oral endoscopic thyroidectomy with vestibular approach, although the safety and the efficacy are still under discussion, deserves particular attention since it represents the only technique truly scarless and provides the best cometic result. The purpose of this article is to provide an overview of the current main alternative approaches for the treatment of thyroid cancer with particular focus on the oncological effectiveness of the procedures.

Papillary Thyroid Cancer Prognosis: An Evolving Field

“…Thyroid surgery represents the first line therapeutic approach for DTC patients [ 60 , 61 , 62 ]. Although conventional open thyroidectomy is still the main intervention, over the last decades alternative surgical procedures have been established in order to achieve more pleasing cosmetic results, especially in young women worried about the neck scar [ 60 ].…”

“…Thyroid surgery represents the first line therapeutic approach for DTC patients [ 60 , 61 , 62 ]. Although conventional open thyroidectomy is still the main intervention, over the last decades alternative surgical procedures have been established in order to achieve more pleasing cosmetic results, especially in young women worried about the neck scar [ 60 ]. These include the minimally invasive video-assisted thyroidectomy (MIVAT), introduced in the late 1990s, the robot-assisted transaxillary thyroidectomy (RATT), first reported in 2001, and the most recent transoral endoscopic thyroidectomy with vestibular approach (TOETVA) [ 63 , 64 , 65 , 66 ].…”

Levothyroxine Treatment and the Risk of Cardiac Arrhythmias – Focus on the Patient Submitted to Thyroid Surgery

“…Thyroidectomy is a surgical procedure, performed either as a standard open surgery or as an alternative approach surgery, such as minimally invasive video-assisted thyroidectomy (MIVAT) or robot-assisted transaxillary thyroidectomy, aiming to remove all or part of the thyroid gland ( 1 ). The procedure is commonly used to treat a range of thyroid-related disorders, including thyroid cancer, hyperthyroidism goiters, and thyroid nodules that can be obstructive and cause swallowing or breathing difficulties ( 2 ).…”

“…The introduction of MIVAT improved the treatment options for some thyroid conditions. Despite superiority regarding patients’ satisfaction with faster recovery and decreased complications associated with standard open thyroidectomy (neck pain, voice problems, anxiety), it is confirmed as a reliable procedure in only strictly indicated cases ( 1 ). It is not suitable for patients with thyroiditis, large multinodular goiters, locally invasive thyroid carcinoma, or the presence of lateral neck compartment malignant lymph nodes.…”

Endoscopic Lateral Neck Dissection: A New Frontier in Endoscopic Thyroid Surgery

“…Some of them with cosmetic needs may even seek out further plastic surgery to improve the appearance of the scar ( 5 , 6 ). With the growing appreciation of cosmetic needs, as well as the progression of endoscopic technologies, many thyroidectomy approaches have undergone significant development and modification to minimize potential scars, including minimally invasive cervical approaches and remote-access approaches ( 7 ).…”