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The current status of remote access thyroidectomy in the United States

2020; Elsevier BV; Volume: 168; Issue: 5 Linguagem: Inglês

10.1016/j.surg.2020.05.021

1532-7361

Claire E. Graves, Insoo Suh,

Head and Neck Anomalies

Since the first description of endoscopic thyroid lobectomy in 1997, 1 Hüscher C.S. Chiodini S. Napolitano C. Recher A. Endoscopic right thyroid lobectomy. Surg Endosc. 1997; 11: 877 Crossref PubMed Scopus (457) Google Scholar a variety of techniques have been developed to avoid the visible cervical scar that has classically been required for thyroidectomy. Typically using either endoscopic or robotic instrumentation, these so-called “remote access” approaches have included access from the anterior chest, axilla, breast or areola, retroauricular hairline, oral vestibule, and more hidden areas of the anterior neck, in addition to numerous combinations of these. In the United States, remote access thyroidectomy has largely failed to gain the widespread popularity it has developed in parts of Asia, and initial growth and interest in robotic thyroidectomy was stalled in 2011 by withdrawal of support by the surgical robot manufacturer. 2 Hinson A.M. Kandil E. O’Brien S. et al. Trends in robotic thyroid surgery in the United States from 2009 through 2013. Thyroid Off J Am Thyroid Assoc. 2015; 25: 919-926 Crossref PubMed Scopus (30) Google Scholar However, remote access techniques have continued to develop in the United States in select centers, and a resurgence in popularity has occurred during the past several years, particularly in the transoral technique via vestibular approach. Increasing data suggest comparable outcomes with these techniques in the United States to the traditional open technique in carefully selected patients. 3 Russell J.O. Razavi C.R. Garstka M.E. et al. Remote-access thyroidectomy: A multi-institutional North American experience with transaxillary, robotic facelift, and transoral endoscopic vestibular approaches. J Am Coll Surg. 2019; 228: 516-522 Abstract Full Text Full Text PDF PubMed Scopus (39) Google Scholar In this focused review and commentary, we aim to explore the rationale behind these approaches; describe and discuss some of the more commonly performed remote-access thyroidectomy approaches in the United States today: transaxillary, bilateral axillo-breast, retroauricular or “facelift,” and transoral and also comment on the value, future directions, and best practices for implementation of remote-access thyroidectomy.