If your doctor has advised thyroid surgery, one of the first questions is: open, endoscopic or robotic? You may also have heard names such as TOETVA, BABA and MIVAT, or the phrase “scarless thyroid surgery”. This guide explains each approach in plain language, who it suits and what to ask your surgeon. The aim of every approach is the same: to remove the diseased part of the thyroid safely and completely.
Thyroidectomy approaches at a glance
| Approach | Where the incisions are | Scar | Usually considered for |
|---|---|---|---|
| Open (conventional) thyroidectomy | One incision in a skin crease at the front of the neck | A thin line on the neck that fades with time | Almost every patient, including large goitres, cancers that need lymph node removal and repeat surgery |
| MIVAT (minimally invasive video-assisted thyroidectomy) | One small incision in the neck, with an endoscope for a magnified view | Smaller neck scar | Smaller nodules and selected low-risk cancers; the longest-established minimally invasive method |
| Transoral endoscopic (TOETVA) | Small incisions inside the lower lip, in the mouth | No skin scar on the neck | Carefully selected patients with small to moderate-sized nodules and selected low-risk cancers |
| Axillary or BABA (bilateral axillo-breast approach) | Small incisions in the armpits and on the chest or around the areola | Scars hidden under clothes, none on the neck | Selected patients who want no neck scar; the endoscope or a robot is used through the incisions |
| Robotic thyroidectomy | Robotic arms through armpit, chest or mouth incisions | No neck scar | Same selected patients as above; availability is limited and cost is higher |
What does “endoscopic thyroid surgery” mean?
In endoscopic thyroid surgery the surgeon looks at a screen, working with a thin camera and long, fine instruments passed through small incisions. Depending on the technique, the incisions can be in the neck (MIVAT), in the mouth (TOETVA) or away from the neck (axillary and BABA). Robotic surgery uses the same remote-access routes with a robotic system holding the instruments.
Is endoscopic thyroidectomy as safe as open surgery?
Medical reviews report that, in carefully chosen patients and in the hands of experienced surgeons, the minimally invasive approaches give results comparable to open surgery for removing the thyroid. The same reviews stress two things: patient selection and surgeon experience. Only a minority of patients are suitable for the remote-access techniques, and these operations can take longer than open surgery. Every approach carries the usual risks of thyroid surgery (see below). If anything looks unsafe during the operation, a good surgeon converts to open surgery.
Who is usually not suitable for endoscopic or robotic surgery?
- A very large goitre, or a goitre that extends behind the breastbone
- Thyroid cancer that is advanced, or that has spread to lymph nodes at the side of the neck
- Earlier neck surgery or neck radiation
- An overactive thyroid (hyperthyroidism) that is not controlled, or severe thyroid inflammation
- Poor fitness for a longer general anaesthesia
- For the transoral route, an infection in the mouth
For these patients, open surgery is the safe choice, and choosing it is no loss. Your surgeon decides after examining you and studying your ultrasound, needle-test (FNAC) and blood reports.
Risks to know about
- All approaches: bleeding, infection, change in voice (usually temporary), low calcium because of the parathyroid glands (usually temporary), and the need for thyroid tablets if the whole gland is removed.
- Transoral (TOETVA): temporary numbness of the lower lip or chin, and infection risk in the mouth incisions.
- Axillary and BABA: a larger area is lifted under the skin, so swelling, fluid collection or numbness over the chest can occur.
- Any remote approach: a longer operation, and the chance that the operation is converted to open surgery.
How much does endoscopic thyroidectomy cost?
There is no single price. The cost depends on the approach (endoscopic and robotic surgery usually cost more than open surgery because of the equipment and longer operating time), the extent of surgery (half or whole thyroid, with or without lymph nodes), the hospital stay, the type of room, tests, the pathology report and any complications. Ask the hospital for a written estimate after your examination, so that you know what is included.
Recovery: how do the approaches compare?
Most patients walk and eat soon after any of these operations and stay in hospital for a short time. Neck swelling and a sore throat are common for a few days. The wound care differs: neck incisions need scar care, mouth incisions need mouth hygiene as advised, and armpit or chest incisions need a few weeks of care with arm movement. Heavy exertion is avoided for the period your surgeon advises. Read about life after thyroid surgery and caring for the scar.
Questions to ask your surgeon
- What is my diagnosis, and which approaches are possible for me?
- Where exactly will the incisions and scars be?
- How often do you perform this approach, and what is your plan if it has to be converted to open surgery?
- What are the risks for me, such as voice change or low calcium?
- Will I need thyroid tablets afterwards?
- Can I have a written estimate of the cost and the length of stay?
Our advice: safety first, then the scar
A small or hidden scar is a real benefit, but the first goal is a safe and complete operation for your condition. For many patients, a carefully made neck incision gives an excellent result; for selected patients, an endoscopic approach can reduce or hide the scar. You can discuss the options with Dr. Om Prakash Prajapati, endocrine and breast cancer surgeon, at Delta Clinic & Hospital, Varanasi, in person or by video consultation. Bring your ultrasound, FNAC and blood reports. See also thyroid surgery without a visible neck scar, robotic thyroid surgery and goitre and thyroid nodule.
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This article is for general information and is not a substitute for a medical consultation.
