When it comes to thyroid cancer surgery, one often imagines a long incision in the center of the neck. This leads to fears about the surgery and concerns about scarring. However, recently, 'minimally invasive thyroid cancer surgery,' which maintains the effectiveness of thyroid cancer treatment while minimizing scars, is gaining attention. While completely removing the cancer, it also considers the importance of returning to daily life and cosmetic satisfaction, making minimally invasive surgery an increasingly suitable option for many patients.

Minimally invasive surgery is not applicable to all thyroid cancer surgeries. It can be applied to thyroid lobectomy when the thyroid cancer is localized and there is minimal lymph node metastasis or surrounding tissue invasion, providing sufficient therapeutic effects in such cases.

Many people mistakenly believe that thyroid surgery using robots or endoscopes is minimally invasive surgery, but this is a misconception. Unlike surgeries in general surgery, urology, or gynecology, where air is injected into the abdominal cavity to create space for surgery, robotic surgery on the thyroid or neck is not minimally invasive. Robotic thyroid surgery involves incising less visible areas to avoid visible neck scars. To insert robotic surgical equipment from the incision site to the thyroid, a significant dissection of subcutaneous tissue and muscle is required, leading to extensive tissue damage. Compared to conventional surgical methods, it has disadvantages such as increased cost, surgery time, and recovery period. Moreover, despite significant tissue damage, it does not offer superiority in cancer treatment, leading health authorities in the United States and Europe not to approve robotic thyroid surgery, and it is not used for thyroid cancer surgery.

True minimally invasive surgery focuses on preserving normal tissue as much as possible while precisely removing the lesion. It involves making a small incision along the skin folds on the side of the neck rather than the center. This minimizes skin incisions and subcutaneous tissue and muscle dissection. The side neck incision heals surprisingly well, is less noticeable than central scars, and has the advantage of less hypertrophic scarring or keloid formation.

Minimally invasive surgery using lateral incisions results in less subcutaneous adhesion post-surgery. This is because subcutaneous tissue and muscle dissection are minimized. Various efforts are made to prevent adhesion, such as minimizing the output of electrocautery to reduce thermal damage to tissues and shortening surgery time to reduce the exposure time of subcutaneous tissue to air.

Additionally, minimally invasive surgery involves less bleeding, allowing most surgeries to be completed without inserting a drainage tube. It also results in less pain. Due to the shorter surgery time, the anesthesia time is reduced, and the recovery speed is fast, allowing discharge usually the day after surgery. These advantages have been published in papers by domestic researchers and have been presented by the author at the Korean Thyroid Association academic conference.

Thus, minimally invasive thyroid cancer surgery is an evolved surgical method that goes beyond merely reducing the incision area, minimizing damage to normal tissue, precisely removing the lesion, and considering rapid recovery and cosmetic outcomes. With a short surgery time and quick recovery, one-day thyroid cancer surgery, where patients are admitted and discharged the next day, is possible. As thyroid cancer surgery must consider not only cancer treatment effects but also scars, pain, recovery speed, and return to daily life, minimally invasive surgery is expected to play an increasingly important role for more patients in the future.

Ha Jung-hoon, Director of ENT, Thank You Seoul Clinic

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