Preservation of thyroid cartilage mobility via lateral cervical approach mitigates anterior neck dysfunction following hemithyroidectomy.

BACKGROUND: The conventional Kocher approach (KA) for hemithyroidectomy often leads to anterior neck morbidities, including discomfort, swallowing impairment, and hypertrophic scarring. This study aimed to evaluate whether the lateral cervical approach (LCA) could mitigate these issues by preserving thyroid cartilage mobility (TCM). METHODS: A prospective cohort study was conducted involving 220 consecutive patients with unilateral papillary thyroid carcinoma (PTC) who underwent hemithyroidectomy via either LCA (n = 110) or KA (n = 110) between June 2022 and December 2024. TCM was quantified using dynamic ultrasonography at baseline and postoperatively at 1 week, 1, 3, and 6 months. Anterior neck function and scar appearance were assessed using validated scoring systems. RESULTS: Compared with KA, LCA demonstrated significantly better preservation of TCM at 1 and 3 months postoperatively (both p < 0.001). Patients in the LCA group also reported lower anterior neck dysfunction scores and improved scar cosmesis at 6 months (POSAS, p < 0.001). Additionally, LCA was associated with shorter operative time, reduced drainage volume, and shorter hospital stay (all p < 0.05). CONCLUSION: LCA offers a function-preserving and cosmetically superior alternative to KA in selected patients undergoing hemithyroidectomy. By minimizing tissue disruption and preserving anatomical planes, LCA facilitates faster recovery and improved quality of life.