Thyroidectomy and Neck Exploration: New Surgical Approaches

Well-differentiated thyroid carcinoma (WDTC) has an excellent prognosis, especially for low-risk patients. Due to the indolent natural history, low recurrence, and mortality rates of WDTC, the surgical strategy is not determined with a high level of evidence. Total or near-total thyroidectomy seems to be the primary purpose of the initial surgery. There is also a debate concerning the role for routine neck dissections, central with or without lateral compartments, since many authors do not agree about the impact of the lymph node metastases on survival. Ultrasonography has insufficient specificity to define the metastatic nature of an enlarged lymph node, necessitating innovation and implementation of new technologies. Sentinel lymph node techniques have been developed to assist the surgeon with these decisions, but at present, the false negative rates are too high. Clinical decision making for an optimal surgical approach, as well as laryngeal nerve monitoring, is also discussed. Minimally invasive thyroidectomy and other new surgical techniques, initially used for benign thyroid disease, have proven their efficacy and ability to achieve excellent cosmetic results.