Minimally Invasive Remote Approaches Versus Conventional Open Approach in Central Neck Dissection for Patients Undergoing Total Thyroidectomy: A Systematic Review and Meta-Analysis.

BACKGROUND

Total thyroidectomy (TT) with central neck dissection (CND) is the standard surgical approach in selected thyroid cancer patients. Minimally invasive remote approaches (MIRA), either robotic or endoscopic, have been developed to improve cosmetic outcomes, but their oncological safety and efficacy remain debated.

OBJECTIVE

To compare MIRA and the conventional open approach (COA) for CND during TT in terms of surgical outcomes, postoperative complications, and oncologic adequacy.

METHODS

Following PRISMA 2020 guidelines, a systematic review and meta-analysis was conducted. PubMed/MEDLINE, Cochrane Library, and Scopus databases were searched up to November 24, 2025. Only comparative studies including TT and CND (either ipsilateral or bilateral) in thyroid carcinoma patients were included. Primary outcomes of interest were differences in operative time, rates of transient and permanent vocal fold paralysis, and incidence of transient and permanent hypoparathyroidism.

RESULTS

Eleven comparative studies including 1626 patients were analyzed. MIRA was associated with a significantly longer operative time compared with COA (standardized mean difference (SMD) 1.75; 95% CI 1.39-2.11). No significant differences were observed between the two techniques in terms of transient vocal fold paralysis (OR 1.38; 95% CI 0.93-2.04) or transient hypoparathyroidism (OR 0.83; 95% CI 0.46-1.49). Intraoperative blood loss, postoperative drainage volume, and length of hospital stay were comparable between groups. The number of retrieved lymph nodes was slightly lower in the MIRA group, although the effect size was small (SMD -0.12; 95% CI -0.26 to -0.003). Due to limited and inconsistent reporting, permanent vocal fold paralysis and permanent hypoparathyroidism could not be quantitatively analyzed.

CONCLUSION

MIRA for CND during TT appears to be feasible and safe in carefully selected thyroid cancer patients, with postoperative complication rates comparable to those of the COA. However, given the longer operative times and the limited evidence on long-term oncologic outcomes, the COA should remain the reference standard, while MIRA may be considered in selected patients at specialized high-volume centers.