Eren Berber1, Victor Bernet2, Thomas J Fahey3, Electron Kebebew4, Ashok Shaha5, Brendan C Stack6, Michael Stang7, David L Steward8, David J Terris9. 1. 1 Department of Endocrine Surgery, Cleveland Clinic , Cleveland, Ohio. 2. 2 Division of Endocrinology, Mayo Clinic , Jacksonville, Florida. 3. 3 Department of Endocrine Surgery, Weill Cornell Medical College/New York Presbyterian Hospital , New York, New York. 4. 4 Endocrine Oncology Branch, National Cancer Institutes of Health , Bethesda, Maryland. 5. 5 Department of Head and Neck Surgery, Memorial Sloan-Kettering Cancer Center , New York, New York. 6. 6 Department of Otolaryngology-Head and Neck Surgery, University of Arkansas for Medical Sciences , Little Rock, Arkansas. 7. 7 Division of Endocrine Surgery, University of Pittsburgh Medical Center , Pittsburgh, Pennsylvania. 8. 8 Department of Otolaryngology-Head and Neck Surgery, University Hospital , Cincinnati, Ohio. 9. 9 Department of Otolaryngology, Augusta University , Augusta, Georgia .
Abstract
BACKGROUND: Remote-access techniques have been described over the recent years as a method of removing the thyroid gland without an incision in the neck. However, there is confusion related to the number of techniques available and the ideal patient selection criteria for a given technique. The aims of this review were to develop a simple classification of these approaches, describe the optimal patient selection criteria, evaluate the outcomes objectively, and define the barriers to adoption. METHODS: A review of the literature was performed to identify the described techniques. A simple classification was developed. Technical details, outcomes, and the learning curve were described. Expert opinion consensus was formulated regarding recommendations for patient selection and performance of remote-access thyroid surgery. RESULTS: Remote-access thyroid procedures can be categorized into endoscopic or robotic breast, bilateral axillo-breast, axillary, and facelift approaches. The experience in the United States involves the latter two techniques. The limited data in the literature suggest long operative times, a steep learning curve, and higher costs with remote-access thyroid surgery compared with conventional thyroidectomy. Nevertheless, a consensus was reached that, in appropriate hands, it can be a viable option for patients with unilateral small nodules who wish to avoid a neck incision. CONCLUSIONS: Remote-access thyroidectomy has a role in a small group of patients who fit strict selection criteria. These approaches require an additional level of expertise, and therefore should be done by surgeons performing a high volume of thyroid and robotic surgery.
BACKGROUND: Remote-access techniques have been described over the recent years as a method of removing the thyroid gland without an incision in the neck. However, there is confusion related to the number of techniques available and the ideal patient selection criteria for a given technique. The aims of this review were to develop a simple classification of these approaches, describe the optimal patient selection criteria, evaluate the outcomes objectively, and define the barriers to adoption. METHODS: A review of the literature was performed to identify the described techniques. A simple classification was developed. Technical details, outcomes, and the learning curve were described. Expert opinion consensus was formulated regarding recommendations for patient selection and performance of remote-access thyroid surgery. RESULTS: Remote-access thyroid procedures can be categorized into endoscopic or robotic breast, bilateral axillo-breast, axillary, and facelift approaches. The experience in the United States involves the latter two techniques. The limited data in the literature suggest long operative times, a steep learning curve, and higher costs with remote-access thyroid surgery compared with conventional thyroidectomy. Nevertheless, a consensus was reached that, in appropriate hands, it can be a viable option for patients with unilateral small nodules who wish to avoid a neck incision. CONCLUSIONS: Remote-access thyroidectomy has a role in a small group of patients who fit strict selection criteria. These approaches require an additional level of expertise, and therefore should be done by surgeons performing a high volume of thyroid and robotic surgery.
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