腔镜甲状腺手术30年:技术演进、现状与思考OA

Over the past three decades,endoscopic thyroid surgery has evolved from minimally invasive video-assisted thyroidectomy through a range of remote-access procedures,including anterior chest/areolar,transaxillary,and bilateral axillo-breast approaches,to the transoral vestibular approach and robotic platform-assisted techniques.Existing research indicates that,with strict patient selection,standardized training,and performance in high-volume centers,the overall incidence of major complications,including recurrent laryngeal nerve injury,hypocalcemia,and postoperative hematoma,shows no statistically significant differences compared with conventional open surgery.However,prolonged operative time,increased costs,a substantial learning curve,and approach-specific complications remain key factors limiting its clinical adoption.The primary advantage of remote-access procedures is the avoidance of a visible cervical scar,but this does not necessarily indicate reduced overall tissue trauma.The transoral endoscopic thyroidectomy vestibular approach offers a truly scarless option with a symmetric midline view,but is also associated with new complications such as oral contamination and mental nerve injury.Robotic platforms significantly improve visualization and instrument dexterity for the primary surgeon,yet their wider adoption is constrained by cost-effectiveness and accessibility challenges.Future research should shift from mere"approach innovation"to a quality management-centric focus,further clarifying the evidence for endoscopic thyroid surgery in long-term oncologic outcomes,functional outcomes(voice,swallowing,sensation),patient-reported outcomes(PROs),and health economic evaluations.Leveraging its large case volume,diverse technical pathways,and evolving consensus system,China is well positioned to promote stratified access management,establish a national registry database,and conduct multicenter prospective studies,thereby ensuring that the clinical practice of endoscopic thyroid surgery remains anchored in safety,functional preservation,and oncologic benefit.