Modern approaches to thyroid surgery

In recent years, techniques have been developed that aim to remove the thyroid gland without an external incision in the neck, offering an aesthetically improved result. The term used today is Scarless Thyroid Surgery, as the previous term “Minimal Invasive” has been abandoned – since all techniques, despite the external absence of a scar, are accompanied by increased surgical trauma..

Robotic Assisted Thyroidectomy

The Robotic thyroidectomy is performed through multiple incisions at remote sites (axilla, thoracic region), aiming to avoid an incision in the neck. The path from the entry points to the thyroid is extensively prepared, which increases the overall trauma and time of the operation.

This technique was developed particularly in Korea, where due to cultural and religious traditions, an incision in the cervix is ​​considered undesirable. The development of robotic systems has helped to popularize the method, with its main application in radical prostatectomy.

Intraoral Endoscopic Thyroidectomy

This is the most common “scarless” technique today, in which access to the thyroid is achieved through small incisions inside the mouth. At least three entrances are required for the placement of endoscopic instruments, and the gland is removed without an external incision.

Limitations and concerns

Despite their aesthetic superiority, these techniques are accompanied by disadvantages that must be evaluated:

• Increased surgical trauma and time

• Higher complication rates (drowsiness up to 5%, transient hypoparathyroidism up to 15%)

• Limited application – not indicated for large nodules or multinodular goiters

In practice, a large thyroid nodule (e.g. >5-6 cm cannot be safely removed, equivalent to an open incision, neither robotically nor transoral, due to physical limitations of access. For the above reasons, the indications remain quite limited (total thyroid volume less than 20ml, thyroid nodules up to 2-3cm, absence of thyroiditis that complicates surgery, history of radiation, etc.). Furthermore, they have not gained the trust of most thyroid surgeons and our scientific community.

The “open” technique today

Modern “open” thyroidectomy has evolved aesthetically to a very great extent. The incisions are small (about 3-4cm), placed in natural folds of the skin, and almost invisible after a few monthsAt the same time, they offer the greatest safety and the possibility of surgical treatment of more complex cases.