BACKGROUND

Remote-access endoscopic and robotic thyroid surgery has progressively evolved over the decades to minimize visible neck scarring. Various approaches, including axillary, anterior chest, breast, postauricular, and transoral routes, have been developed, extending their application to lateral neck dissection (LND) in thyroid cancer. This study aims to comprehensively review and synthesize recent literature on remote-access endoscopic and robotic techniques for LND, with a focus on outcomes, advantages, and limitations.

METHODS

A systematic literature review was conducted using PubMed and Cochrane Library databases. Search terms included "lateral neck dissection", "thyroid cancer", "remote-access", "robotic", "endoscopic", and "video-assisted". Eligible studies were analyzed to provide an in-depth overview of current techniques, addressing the following aspects: (I) incision location; (II) surgical procedures; (III) complications and surgical outcomes; and (IV) advantages and limitations of each approach.

RESULTS

Various remote-access techniques for LND were identified, including gasless infraclavicular, breast-chest, gasless transaxillary, bilateral axillo-breast, gasless retroauricular, transoral, and combined approaches. Outcomes, including the number of removed lateral lymph nodes, complication rates, and recurrence rates, were comparable across remote-access approaches. The extent of dissection achieved with these techniques was equivalent to conventional approaches for levels IIa, III, IV, and V, except for the transoral approach, which was generally limited to levels III and IV. Postoperative cosmetic outcomes were significantly superior with remote-access techniques.

CONCLUSIONS

Remote-access approaches for thyroidectomy combined with LND are both feasible and safe, achieving complete resection of targeted neck levels with excellent surgical and cosmetic outcomes. The unique advantages and limitations of each method underscore the importance of careful patient selection to optimize clinical benefits.