Minimally invasive thyroid surgery: development and future

doi:10.16139/j.1007-9610.2025.01.02

Abstract

Abstract:

Since the 90s of the 20th century, thyroid endoscopic surgery has undergone the development from multi-port to single-site, from endoscopy to robot. In recent years, the emergence of da Vinci single-port robots and domestic single-port robots have further promoted the technological innovation of minimally invasive thyroid surgery. This article reviewed the development process of minimally invasive thyroid surgery from the development of endoscopic thyroid surgery, the breakthrough of single-site endoscopic surgery, and the realization of robotic thyroid surgery and single-port robotic thyroid surgery, and discussed the future of thyroid surgery in the era of artificial intelligence.

Key words: Minimally invasive thyroid surgery, Endoscopic surgery, Robotic surgery, Single-site(port), Artificial intelligence

CLC Number:

R653

CHEN Lingxie, ZHAO Qiwu, QIU Weihua. Minimally invasive thyroid surgery: development and future[J]. Journal of Surgery Concepts & Practice, 2025, 30(01): 7-12.

References 48

[1]	HÜSCHER C S, CHIODINI S, NAPOLITANO C, et al. Endoscopic right thyroid lobectomy[J]. Surgical endoscopy, 1997, 11(8):877.
[2]	DE VRIES L H, AYKAN D, LODEWIJK L, et al. Outcomes of minimally invasive thyroid surgery —— a systematic review and meta-analysis[J]. Front Endocrinol(Lausanne), 2021,12:719397.
[3]	LIANG J, ZHAN L, XUAN M, et al. Thyroidectomy for thyroid cancer via transareola single-site endoscopic approach: results of a case-match study with large-scale population[J]. Surg Endosc, 2022, 36(2):1394-1406.
[4]	JIANG Z G, ZHANG W, JIANG D Z, et al. Clinical be-nefits of scarless endoscopic thyroidectomy: an expert's experience[J]. World J Surg, 2011, 35(3):553-557.
[5]	WANG M, ZHANG T, MAO Z, et al. Effect of endoscopic thyroidectomy via anterior chest wall approach on treatment of benign thyroid tumors[J]. J Laparoendosc Adv Surg Tech A, 2009, 19(2):149-152.
[6]	ZHANG W, JIANG Z G, JIANG D Z, et al. The minimally invasive effect of breast approach endoscopic thyroidectomy: an expert's experience[J]. Clin Dev Immunol, 2010,2010:459143.
[7]	PAEK S H, KANG K H, KANG H, et al. Comparison of postoperative surgical stress following robotic thyroidectomy and open thyroidectomy: a prospective pilot study[J]. Surg Endosc, 2016, 30(9):3861-3866. doi: 10.1007/s00464-015-4689-5 pmid: 27071929
[8]	KASOULI A, SPARTALIS E, GIANNAKODIMOS A, et al. Comparison of cosmetic outcomes between remote-access and conventional thyroidectomy: a review of the current literature[J]. World J Otorhinolaryngol Head Neck Surg, 2022, 9(1):1-8.
[9]	仇明, 丁尔迅, 江道振, 等. 颈部无瘢痕内镜甲状腺腺瘤切除术一例[J]. 中华普通外科杂志, 2002, 17(2):127.
	QIU M, DING E X, JIANG D Z, et al. One case of neck scar free endoscopic thyroidectomy for thyroid adenoma[J]. Chin J Gen Surg, 2002, 17(2):127.
[10]	中国医师协会外科医师分会甲状腺外科医师委员会, 中国研究型医院学会甲状腺疾病专业委员会, 海峡两岸医药卫生交流协会海西甲状腺微创美容外科专家委员会, 等. 经胸前入路腔镜甲状腺手术专家共识(2017版)[J]. 中国实用外科杂志, 2017, 37(12):1369-1373. doi: 10.19538/j.cjps.issn1005-2208.2017.12.14
	Chinese College of Surgeons, Thyroid Surgeons Committee; Thyroid Disease Committee of Chinese Society of Research Hospitals; Cross Strait Medical and Health Exchange Association Haixi Thyroid Minimally Invasive Cosmetic Surgery Expert Committee, et al. Expert consensus on transthoracic endoscopic thyroid surgery (2017 Edition)[J]. Chin J Pract Surg, 2017, 37(12):1369-1373.
[11]	MICCOLI P, BERTI P, CONTE M, et al. Minimally invasive surgery for thyroid small nodules: preliminary report[J]. J Endocrinol Invest, 1999, 22(11):849-851. doi: 10.1007/BF03343657 pmid: 10710272
[12]	高力, 谢磊, 李华, 等. 应用高频超声刀实施小切口无气腔室内镜下甲状腺手术[J]. 中华外科杂志, 2003, 41(10):733-737.
	GAO L, XIE L, LI H, et al. Using ultrasonically activated scalpels as major instrument for vessel dividing and bleeding control in minimally invasive video-assisted thyroidectomy[J]. Chin J Surg, 2003, 41(10):733-737.
[13]	高力. 改良Miccolil模式内镜甲状腺手术[J]. 中华腔镜外科杂志(电子版), 2011, 4(4):245-253.
	GAO L. Improved Miccolil mode endoscopic thyroidectomy[J]. Chin J Laparoscopic Surg(electronic edition), 2011, 4(4):245-253.
[14]	中国医师协会外科医师分会甲状腺外科医师委员会, 中国研究型医院学会甲状腺疾病专业委员会. 颈前小切口腔镜辅助甲状腺癌颈侧区淋巴结清扫术中国专家共识(2023版)[J]. 中国实用外科杂志, 2023, 43(2):144-150.
	Chinese College of Surgeons, Thyroid Surgeons Committee; Thyroid Disease Committee of Chinese Society of Research Hospitals. Chinese expert consensus on anterior mini-incision video-assisted lateral neck lymph node dissection for thyroid cancer(2023 edition)[J]. Chin J Pract Surg, 2023, 43(2):144-150.
[15]	IKEDA Y, TAKAMI H, SASAKI Y, et al. Endoscopic neck surgery by the axillary approach[J]. J Am Coll Surg, 2000, 191(3):336-340.
[16]	中国抗癌协会甲状腺癌专业委员会, 中华医学会肿瘤学分会甲状腺肿瘤专业委员会, 中国研究型医院学会甲状腺疾病专业委员会, 等. 无充气腋窝入路腔镜甲状腺手术专家共识(2022版)[J]. 中华内分泌外科杂志, 2021, 15(6):557-563.
	Thyroid Cancer Specialized Committee of the Chinese Anti-Cancer Association, Thyroid Cancer Specialized Committee of the Chinese Society of Oncology, Thyroid Disease Specialized Committee of the Chinese Society of Research Hospitals, et al. Expert consensus on endoscopic thyroidectomy by a gasless unilateral axillary approach (version 2022)[J]. Chin J Endocr Surg, 2021, 15(6):557-563.
[17]	傅锦波, 陈清贵, 罗晔哲, 等. 经口入路腔镜下甲状腺切除手术五例经验[J]. 中华普通外科杂志, 2012, 27(4):279-281.
	FU J B, CHEN Q G, LUO Y Z, et al. Transoral laparoscopic thyroidectomy: an experience of 5 cases[J]. Chin J Gen Surg, 2012, 27(4):279-281.
[18]	王存川, 翟贺宁, 刘卫军, 等. 经口腔前庭腔镜甲状腺切除术6例经验[J]. 中国内镜杂志, 2013, 19(4):363-366.
	WANG C C, ZHAI H N, LIU W J, et al. Transoral-vestibule endoscopic thyroidectomy:experience in 6 cases[J]. China J Endosc, 2013, 19(4):363-366.
[19]	王平, 吴国洋, 田文, 等. 经口腔前庭入路腔镜甲状腺手术专家共识(2018版)[J]. 中国实用外科杂志, 2018, 38(10):1104-1107. doi: 10.19538/j.cjps.issn1005-2208.2018.10.02
	WANG P, WU G Y, TIAN W, et al. Expert consensus on lumpectomy thyroid surgery via oral vestibular approach (2018 edition)[J]. Chin J Pract Surg, 2018, 38(10):1104-1107.
[20]	GUO B M, WU B, KANG J, et al. New endoscopic thyroidectomy with the transareola single-site approach: a comparison with the bilateral areolar approach[J]. Surg Laparosc Endosc Percutan Tech, 2015, 25(2):178-184.
[21]	LIU W, ZHOU M. A comparative study on the transareola single-site versus three-port endoscopic thyroidectomy[J]. J Laparoendosc Adv Surg Tech A, 2017, 27(3):242-246.
[22]	陈灵勰. 单孔腔镜甲状腺手术应用现状与前景[J]. 中国普通外科杂志, 2018, 27(11):1471-1476.
	CHEN L X. Application status and prospects of single-site endoscopic thyroidectomy[J]. Chin J Gen Surg, 2018, 27(11):1471-1476.
[23]	ZHAN L, XUAN M, DING H, et al. Learning curve of trans-areola single-site endoscopic thyroidectomy in a high-volume center: a CUSUM-based assessment[J]. Cancer Med, 2023, 12(16):16846-16858.
[24]	LOBE T E, WRIGHT S K, IRISH M S. Novel uses of surgical robotics in head and neck surgery[J]. J Laparoendosc Adv Surg Tech A, 2005, 15(6):647-652.
[25]	WANG J P, LI D P, LIU Y C, et al. Comparison of learning curves and related postoperative indicators between endoscopic and robotic thyroidectomy: a systematic review and meta-analysis[J]. Int J Surg, 2025, 111(1):1123-1134.
[26]	贺青卿, 周鹏, 庄大勇, 等. 经腋窝与胸前径路da Vinci Si机器人甲状腺腺叶切除二例[J]. 国际外科学杂志, 2014, 41(2):104-107,封4.
	HE Q Q, ZHOU P, ZHUANG D Y, et al. Technical particularities of robotic-assisted thyroidectomy by a axillary approach or anterior chest approach: a report of two cases[J]. Int J Surg, 2014, 41(2):104-107,cover 4.
[27]	中国医师协会外科医师分会甲状腺外科专家工作组, 中国研究型医院学会甲状腺疾病专业委员会, 中国医疗保健国际交流促进会普通外科学分会. 机器人手术系统辅助甲状腺和甲状旁腺手术临床实践指南(2024版)[J]. 中华外科杂志, 2024, 62(9):805-817.
	Thyroid Surgery Expert Working Group, Chinese Physicians Association of Surgeons, Thyroid Disease Committee of Chinese Society of Research Hospitals, General Surgery Branch of China Association for the Promotion of International Exchange in Healthcare. Clinical practice guideline for robotic surgical system-assisted thyroid and parathyroid surgery (2024 edition)[J]. Chin J Surg, 2024, 62(9):805-817.
[28]	中国医师协会外科医师分会甲状腺外科专家工作组, 中国研究型医院学会甲状腺疾病专业委员会, 中国医疗保健国际交流促进会普通外科学分会, 等. 经口腔前庭入路机器人甲状腺和甲状旁腺手术中国专家共识(2023版)[J]. 中国实用外科杂志, 2023, 43(12):1328-1334.
	Working Group of Thyroid Surgery Experts, Chinese Physicians Association of Surgeons, Thyroid Disease Committee of Chinese Society of Research Hospitals, General Surgery Branch of China Association for the Promotion of International Exchange in Healthcare, et al. Chinese expert consensus on transoral vestibular approach robotic thyroidectomy and parathyroidectomy(2023 edition)[J]. Chin J Pract Surg, 2023, 43(12):1328-1334.
[29]	CELOTTO F, RAMACCIOTTI N, MANGANO A, et al. Da Vinci single-port robotic system current application and future perspective in general surgery: a scoping review[J]. Surg Endosc, 2024, 38(9):4814-4830. doi: 10.1007/s00464-024-11126-w pmid: 39110221
[30]	WU Z, WANG Z, MOSCHOVAS M C, et al. Robot-assisted single-port radical prostatectomy with the SHURUI SP and da Vinci SP platforms: comparison of the technology, intraoperative performance, and outcomes[J]. Eur Urol Open Sci, 2024,67:26-37.
[31]	KIM K, KANG S W, KIM J K, et al. Robotic transaxillary hemithyroidectomy using the da Vinci SP robotic system: initial experience with 10 consecutive cases[J]. Surg Innov, 2020, 27(3):256-264. doi: 10.1177/1553350620909279 pmid: 32129140
[32]	HO J, KIM D, LEE J E, et al. Single-port transaxillary robotic modified radical neck dissection (STAR-RND): initial experiences[J]. Laryngoscope, 2023, 133(3):709-714.
[33]	AN S, PARK J, KIM K, et al. Safety and surgical outcomes of single-port trans-axillary robot-assisted thyroi-dectomy: experience from a consecutive series of 300 patients[J]. J Robot Surg, 2024, 18(1):13.
[34]	PARK J, KANG L K, KIM K, et al. The learning curve for single-port transaxillary robotic thyroidectomy (SP-TART): experience through initial 50 cases of lobectomy[J]. Updates Surg, 2023, 75(3):691-700.
[35]	PARK Y M, KIM D H, MOON Y M, et al. Gasless transoral robotic thyroidectomy using the Da Vinci SP system: feasibility, safety, and operative technique[J]. Oral Oncology, 2019,95:136-142.
[36]	KIM T K, SEO M, PARK S H, et al. Feasibility of robotic thyroidectomy via hairline incision using da Vinci single port system: initial experience with 40 consecutive cases[J]. Head Neck, 2022, 44(10):2197-2205.
[37]	CHOI Y S, CHOI J H, JEON M S, et al. First experience of single-port robotic areolar approach thyroidectomy[J]. Clin Exp Otorhinolaryngol, 2023, 16(3):275-281.
[38]	LEE S M, HWANG H, SHIN M H, et al. One-year clinical experience of single-port and multi-port robotic thyroid surgery in a single institution[J]. J Clin Med, 2024, 13(18):5486.
[39]	汪旭, 刘瑾源, 李超, 等. 国产单孔机器人系统辅助下经腋腔镜甲状腺切除术2例[J]. 中华耳鼻咽喉头颈外科杂志, 2025, 60(1):58-60.
	WANG X, LIU J Y, LI C, et al. Two cases of transaxillary thyroidectomy assisted by a domestic single-port robotic system[J]. Chin J Otorhinolaryngol Head Neck Surg, 2025, 60(1):58-60.
[40]	MARESCAUX J, LEROY J, GAGNER M, et al. Transatlantic robot-assisted telesurgery[J]. Nature, 2001, 413(6854):379-380.
[41]	田文, 姚京, 王冰, 等. 5G远程手术机器人辅助甲状腺癌根治术初步研究[J]. 中国实用外科杂志, 2024, 44(9):1075-1077,1080.
	TIAN W, YAO J, WANG B, et al. Preliminary study on 5G remote robot-assisted radical thyroidectomy[J]. Chin J Pract Surg, 2024, 44(9):1075-1077,1080.
[42]	SAEIDI H, OPFERMANN J D, KAM M, et al. Autonomous robotic laparoscopic surgery for intestinal anastomosis[J]. Sci Robot, 2022, 7(62):eabj2908.
[43]	GE J, KAM M, OPFERMANN J D, et al. Autonomous system for tumor resection (ASTR)-dual-arm robotic midline partial glossectomy[J]. IEEE Robot Autom Lett, 2024, 9(2):1166-1173.
[44]	陈灵勰, 宣明, 丁昊, 等. 三维可视化模型经乳晕单通道腔镜切除甲状腺大结节(附33例报告)[J]. 外科理论与实践, 2020, 25(4):331-335.
	CHEN L X, XUAN M, DING H, et al. Virtual 3D modeling in trans-areola single-site endoscopic thyroidectomy for large nodular goiter: a report of 33 cases[J]. J Surg Concepts Pract, 2020, 25(4):331-335.
[45]	LEE D, KONG H J, KIM D, et al. Preliminary study on application of augmented reality visualization in robotic thyroid surgery[J]. Ann Surg Treat Res, 2018, 95(6):297-302. doi: 10.4174/astr.2018.95.6.297 pmid: 30505820
[46]	LEE D, YU H W, KIM S, et al. Vision-based tracking system for augmented reality to localize recurrent laryngeal nerve during robotic thyroid surgery[J]. Sci Rep, 2020, 10(1):8437. doi: 10.1038/s41598-020-65439-6 pmid: 32439970
[47]	ZHANG P, KE Y, WU J, et al. Mixed reality assisted radical endoscopic thyroidectomy[J]. J Vis Exp, 2025,215.
[48]	WANG B, YU J F, LIN S Y, et al. Intraoperative AI‐assisted early prediction of parathyroid and ischemia alert in endoscopic thyroid surgery[J]. Head Neck, 2024, 46(8):1975-1987.