Mini-incision Thyroidectomy in Contemporary Practice: Safety, Efficiency, and Cosmetic Outcomes from a Large Consecutive Cohort

Mini-incision Thyroidectomy in Contemporary Practice: Safety, Efficiency, and Cosmetic Outcomes from a Large Consecutive Cohort | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Mini-incision Thyroidectomy in Contemporary Practice: Safety, Efficiency, and Cosmetic Outcomes from a Large Consecutive Cohort Waleed Gado, Ahmed Taki-Eldin, Mohammed Elghandour, Mohammed Tarek, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9328096/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 6 You are reading this latest preprint version Abstract Background Conventional open thyroidectomy remains the standard approach for most thyroid diseases but may result in a visible cervical scar that affects patient satisfaction. Mini-incision thyroidectomy (MIT) is a reduced-access modification of open surgery designed to limit incision length while preserving established operative principles. Evidence describing its performance in routine clinical practice remains limited. Methods We conducted a retrospective cohort study of consecutive patients who underwent MIT at a high-volume endocrine surgery unit between December 2014 and December 2019. Demographic, clinical, and operative data were analyzed, including incision length, perioperative outcomes, and patient-reported cosmetic satisfaction. All procedures were performed using a standardized non-endoscopic technique. Given the single-cohort design without a contemporaneous control group, outcomes were analyzed descriptively. Results A total of 209 patients were included (79.9% female; mean age 39.6 years). Mean incision length was 2.81 cm, and MIT was completed in all cases without conversion. Mean operative time was 59.4 minutes, with minimal blood loss. Transient hypocalcemia occurred in 9.6% of patients, and transient recurrent laryngeal nerve palsy in 7.7%, with no permanent nerve injury. Permanent hypoparathyroidism occurred in one patient (0.5%). Reoperation for bleeding was required in 1.0% of cases. Cosmetic dissatisfaction was reported by 4.8% of patients. Conclusions In this single-center retrospective cohort, MIT was safely performed in carefully selected patients, with perioperative outcomes within ranges reported for conventional thyroidectomy. These findings support MIT as a reduced-incision variation of open thyroidectomy rather than a comparative alternative. Interpretation is limited by the retrospective design, absence of a control group, and non-validated cosmetic assessment. Prospective comparative studies are required to further define its role. Mini-incision thyroidectomy Thyroidectomy Thyroid neoplasms Postoperative complications Cosmetic outcomes Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Figure 8 Figure 9 Figure 10 Figure 11 Figure 12 Introduction One of the most common endocrine surgery procedures is thyroidectomy. Conventional open thyroidectomy remains the standard approach for both benign and malignant thyroid diseases, providing dependable exposure and established oncologic safety. However, the visible neck scar associated with the conventional transverse cervical incision—which typically measures 6 to 10 cm—may be undesirable for some patients. Concerns about scar appearance and postoperative neck pain are frequently voiced in routine clinical practice, especially by younger patients and women, who make up a significant portion of patients having thyroid surgery ( 1 ). Increasing emphasis on patient-reported outcomes and quality-of-life measures has led to growing interest in surgical approaches that aim to reduce the external impact of thyroid surgery while maintaining established safety standards.In this setting, several limited-access techniques have been developed. Minimally invasive video-assisted thyroidectomy (MIVAT) demonstrated that a shorter midline incision combined with endoscopic visualization could replicate the essential steps of open thyroidectomy in carefully selected patients ( 2 , 3 ). More recently, remote-access approaches—including transaxillary, bilateral axillo-breast, and transoral vestibular techniques—have been introduced to completely avoid a visible cervical scar ( 4 – 6 ). Although these approaches may offer cosmetic advantages, their wider adoption has been limited by the need for specialized equipment, additional training, longer operative times, and increased resource utilization. Mini-incision thyroidectomy (MIT) occupies a distinct position within this evolving spectrum. Rather than relying on endoscopic or robotic platforms, MIT represents a reduced-incision modification of conventional open thyroidectomy, typically performed through a shorter transverse cervical incision. The technique preserves familiar anatomical orientation, capsular dissection principles, and operative sequencing, allowing surgeons experienced in open endocrine surgery to adopt the approach without fundamental changes to their workflow. From a practical perspective, MIT aims to reduce incision length while avoiding the technical complexity and additional resource requirements associated with technology-dependent approaches. Previous reports have described favorable cosmetic outcomes and acceptable perioperative results in selected patients undergoing reduced-incision thyroidectomy ( 7 – 9 ). However, much of the available evidence is derived from relatively small series or narrowly defined patient groups, which may limit generalizability. Accordingly, data reflecting routine clinical practice across a broader spectrum of thyroid pathology remain limited. In this context, we present a five-year single-center experience with mini-incision thyroidectomy performed at a high-volume endocrine surgery unit. By analyzing a consecutive cohort that includes benign disease, functional thyroid disorders, inflammatory conditions, and selected low-risk malignancies, this study describes operative characteristics, perioperative outcomes, and patient-reported cosmetic satisfaction associated with MIT in routine endocrine surgical practice. Study Design and Setting We reviewed consecutive patients who underwent MIT at the Endocrine Surgery Unit of Mansoura University Hospitals between December 2014 and December 2019 in a retrospective cohort design. This represents a single-center retrospective cohort of patients selected for MIT according to predefined clinical and anatomical criteria. As a tertiary referral center, the unit manages a wide range of thyroid pathologies; however, only patients considered suitable for MIT were included in this analysis. During the study period, MIT was increasingly applied in patients meeting selection criteria, while other patients underwent conventional thyroidectomy. The total number of thyroidectomy patients treated during the study period, as well as reasons for exclusion from MIT, are presented in the study flow diagram (Figure 1). All operations were carried out by the same experienced endocrine surgery team following a uniform operative technique, which reduced variability related to surgeon preference and technical approach. Clinical, imaging, and operative information were retrieved from prospectively maintained surgical records and the hospital’s electronic health record system. Collected variables included patient demographics, preoperative ultrasound findings, cytological results, operative details, thyroid and nodule measurements, incision length, postoperative complications, and patient-reported cosmetic satisfaction. Data were reviewed retrospectively and anonymized before analysis. The study was approved by the Institutional Review Board of Mansoura University (approval code: R.26.01.3519.R1). Given the retrospective design and use of anonymized data, the requirement for individual informed consent was waived. As part of routine preoperative assessment, all patients underwent a detailed neck ultrasound examination (Table 1). Thyroid lobe dimensions were measured in three perpendicular planes, and total thyroid volume was calculated using the Brunn formula (0.479 × length × width × depth) (10). Nodule size was defined by the maximum diameter. Relevant ultrasound features, including composition, echogenicity, margin characteristics, and suspicious findings such as microcalcifications or a taller-than-wide shape, were recorded according to standard clinical practice (11). Fine-needle aspiration cytology results were reported using the Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) (12). Decisions regarding surgery were based on a combined evaluation of cytological findings, ultrasound features, and the overall clinical context. In cases with indeterminate (Bethesda III–IV) or suspicious (Bethesda V) cytology, management was individualized, taking into account nodule characteristics, patient preference, and institutional practice. Nodules classified as Bethesda V or VI were generally considered indications for surgical treatment. The study was conducted and reported in accordance with the STROBE guidelines for cohort studies (13). Eligibility Criteria Inclusion Criteria Patients were considered suitable for MIT when all of the following criteria were met: · Dominant thyroid nodule size ≤ 4–5 cm on ultrasound · Estimated thyroid volume generally ≤ 50 mL · Indication for hemithyroidectomy or total thyroidectomy for: o Benign nodular goiter o Indeterminate cytology (Bethesda III–IV) o Toxic nodular goiter with controlled thyroid function o Graves’ disease after metabolic optimization o Low-risk differentiated thyroid carcinoma without radiologic extrathyroidal extension · No clinical or radiologic suspicion of recurrent laryngeal nerve invasion (RLN), tracheal infiltration, or esophageal adherence · No requirement for lateral neck dissection These criteria were applied to ensure that reduced-access exposure would not compromise operative safety or oncologic principles. Exclusion Criteria MIT was avoided when limited exposure could compromise surgical safety or oncologic adequacy, including: · Retrosternal/substernal goiter extending below the thoracic inlet · Thyroid malignancy with gross extrathyroidal extension or fixation to laryngeal cartilage · Previous extensive neck surgery or prior neck irradiation · Severe cervical spine deformity, short muscular neck, or other predictors of inadequate exposure · Morbid obesity (BMI > 40) when soft-tissue thickness exceeded the safe limits of reduced-access exposure These exclusion criteria reflect deliberate case selection and should be considered when interpreting outcomes. Preoperative Assessment All patients underwent a comprehensive preoperative evaluation, including thyroid ultrasound, thyroid function testing, serum calcium assessment, and routine anesthetic work-up. Fine-needle Aspiration was performed when indicated. Selective preoperative vocal fold assessment was obtained for patients with hoarseness, prior contralateral thyroid surgery, or large nodules. Routine preoperative laryngoscopy was not performed in all patients. Hyperthyroid patients were rendered euthyroid or near-euthyroid using antithyroid medications and beta-blockers before surgery. Operative Technique MIT was performed as a reduced-incision, non-endoscopic modification of conventional open thyroidectomy. The procedure adhered to standard anatomic and capsular dissection principles to complete the intended thyroid resection through a limited cervical incision within the constraints of reduced access. All operations were carried out by the same experienced endocrine surgery team, ensuring consistency in operative technique and perioperative decision-making throughout the study period. A largely suture-free surgical method was used. Hemostasis and tissue separation were mainly accomplished with energy-based vessel-sealing tools, such as ultrasonic and advanced bipolar systems. This approach facilitated hemostasis and visualization within the limited operative field. Incision and Initial Exposure A transverse cervical skin incision measuring approximately 2–4 cm was placed along a natural skin crease, most commonly just inferior to the cricoid cartilage. Extension of the incision was avoided whenever feasible and was undertaken only when necessary to ensure safe dissection, improve visualization, or allow controlled extraction of the specimen (Figure 2A–C). After division of the skin and platysma, constrained subplatysmal flaps were developed superiorly toward the thyroid cartilage and inferiorly toward the sternal notch. Flap elevation was intentionally restricted to the least necessary to ensure sufficient exposure while preserving normal tissue planes (Figure 3A). The strap muscles were divided at the midline raphe without being cut. Exposure was maintained using low-profile retractors, and fine instruments—such as small Richardson retractors or pediatric-sized instruments when appropriate—were selected to facilitate precise dissection within the narrow operative field (Figure 3B). Retraction was applied gently and intermittently to minimize tension on the wound edges. Routine use of loupe magnification was not required in the majority of cases. Thyroid lobe mobilization Capsular dissection was initiated medially and continued laterally in a stepwise fashion. Energy-based vessel sealing was used routinely for division of small vessels, enabling controlled dissection with minimal blood loss and efficient progression through the operative planes, which is particularly advantageous in a narrow operative window (Figure 3C). Superior Pole Control The superior pole was approached with close capsular dissection. Individual superior pole vessels were sealed and divided sequentially to protect the external branch of the superior laryngeal nerve. With a bloodless field and focused retraction, this step remained reliably achievable through the mini-incision (Figure 3C). Middle Thyroid Vein and Lateral Dissection When present, the middle thyroid vein was sealed and divided to facilitate lateral mobilization. The avascular capsular plane was then developed using blunt dissection combined with selective energy sealing. Progressive release of lateral attachments allowed medial rotation of the thyroid lobe without incision enlargement. RLN Identification Inferior dissection proceeded until the RLN was identified in the tracheoesophageal groove. In this cohort, the RLN was routinely visualized in all cases. The clear operative field achieved through energy-assisted hemostasis was critical to safe nerve identification in reduced exposure. Once identified, the RLN was traced superiorly to its laryngeal entry point and preserved throughout (Figure 4A–B). Parathyroid Preservation Parathyroid glands were preserved in situ whenever feasible, with vascular supply maintained by keeping dissection close to the thyroid capsule (Figure 4C). If a gland appeared compromised intraoperatively, immediate autotransplantation into the sternocleidomastoid muscle was undertaken based on gross assessment of viability. Management of Large or Cystic Nodules For bulky or cystic nodules limiting delivery through the incision, controlled decompression was used selectively. Aspiration or gentle collapse of the cystic component was performed only after clear identification and protection of the RLN, allowing specimen extraction without extending the incision (Figure 5A–C). Completion, Hemostasis, and Closure Following mobilization, the gland was returned briefly to its anatomical bed when required to optimize exposure for contralateral dissection or to complete isthmus division (Figure 6A–C). Final hemostasis was secured using energy devices and fine bipolar cautery, followed by irrigation and a period of observation to confirm stability. Following completion of the resection, the strap muscles were reapproximated in the midline. The platysma was closed using interrupted absorbable sutures, and the skin was closed with a subcuticular technique to promote favorable cosmetic healing (Figure 7A). Meticulous attention was paid to wound edge alignment to minimize scar tension. Closed suction drains were not used routinely. Drain placement was reserved for selected situations, including extensive bilateral dissection, larger resections, or cases in which intraoperative hemostasis was judged to be borderline (Figure 7B). Postoperative vocal function was assessed clinically based on voice quality and patient-reported symptoms. Laryngoscopic evaluation was performed selectively in patients with voice changes or clinical concern, rather than as a routine postoperative measure. Routine monitoring of drains when present, and serial serum calcium measurements in accordance with the unit’s postoperative protocol. Learning Curve and Technical Adoption MIT closely resembles the anatomical access and operative steps of traditional open thyroidectomy, allowing surgeons experienced in endocrine procedures to implement this technique with minimal disruption to their existing practices. Nonetheless, performing surgery through a smaller cervical incision requires increased attention to meticulous exposure, deliberate instrument selection, and steady decision-making throughout the procedure. Based on our experience, it is advised to slowly implement this technique—beginning with careful patient selection during the early phase of its use—to guarantee patient safety while enjoying the aesthetic benefits linked to an authentic mini-incision approach Cosmetic Assessment Cosmetic outcomes were assessed during routine postoperative follow-up, typically at outpatient visits conducted between 4 and 12 weeks after surgery. Evaluation consisted of structured patient-reported satisfaction combined with direct clinical inspection of the cervical scar by the treating surgical team. Assessment focused on overall scar visibility, contour, pigmentation, and patient-perceived acceptability of the cosmetic result. Patient-reported satisfaction was categorized descriptively (e.g., excellent, good, fair, or poor) based on documentation in follow-up records. No validated scar assessment instrument, such as the Patient and Observer Scar Assessment Scale (POSAS) or Vancouver Scar Scale, was applied in this cohort. Accordingly, cosmetic outcomes should be interpreted as descriptive and may be subject to observer and reporting bias. Statistical Analysis Statistical analysis was primarily descriptive. Continuous variables are presented as mean ± standard deviation (SD) or, when normality assumptions were not met, as median with interquartile range (IQR). Categorical variables are reported as absolute counts and percentages. Given the retrospective single-cohort design and absence of a contemporaneous control group, no comparative hypothesis testing was prespecified. Accordingly, results are presented descriptively and interpreted in the context of previously published literature rather than formal comparative inference. Results Patient Characteristics A total of 209 individuals received MIT. The group was mainly female (79.9%), with an average age of 39.6 ± 12.3 years (range, 14–77). Preoperative ultrasound evaluation confirmed that the thyroid gland and nodule were within the established selection guidelines. Average thyroid volume was 35.1 ± 6.6 mL, and the average maximum nodule size was 2.56 ± 0.84 cm. No nodules exceeded 4.5 cm, and no cases demonstrated retrosternal extension, consistent with the study eligibility criteria (Table 2). Cytology-Based Stratification and Indications for Surgery Fine-needle aspiration cytology classified most nodules as benign (Bethesda II), accounting for 60.8% of cases. Indeterminate cytology (Bethesda III–IV) was present in a smaller subset of patients, although precise distribution within this group is summarized in Table 3. Cytology consistent with malignancy (Bethesda VI) was identified in 18.2% of the cohort (n = 38). Suspicious cytology (Bethesda V) was also present and is reported within the malignant/suspicious group (Table 4). The relationship between preoperative cytology and final histopathology is summarized in Table 5. As expected, most nodules classified as Bethesda II were confirmed as benign on final histopathology, with a small proportion demonstrating malignancy. Increasing Bethesda category was associated with a higher proportion of malignant findings, with the majority of Bethesda V and all Bethesda VI nodules confirmed as malignant. Indeterminate categories (Bethesda III–IV) showed mixed histopathological outcomes. These findings are presented descriptively and reflect the distribution within the studied cohort. Operative Findings Extent of Surgery Total thyroidectomy was performed in 143 patients (68.4%), hemithyroidectomy in 63 patients (30.1%), and near-total thyroidectomy in 3 patients (1.4%). Incision Length The mean incision length was 2.81 ± 0.48 cm, with individual measurements ranging from 1.9 to 3.9 cm. No cases required conversion to a conventional cervical incision within the selected cohort. Operative Time and Blood Loss The mean operative time was 59.4 ± 16.8 minutes (range 32–106 ), and the estimated blood loss was 34.4 ± 12.6 mL (range 10–70 ). Operative time was consistent across procedure extent. Postoperative Outcomes Hypocalcemia Postoperative hypocalcemia was categorized as biochemical (asymptomatic), symptomatic transient, or permanent, based on clinical findings and duration of supplementation. Biochemical hypocalcemia, defined as a low serum calcium level without associated symptoms, was observed in 10.0% of patients. Symptomatic transient hypocalcemia occurred in 9.6% of patients and resolved with medical management within six months. One patient (0.5%) developed permanent hypoparathyroidism requiring ongoing supplementation beyond six months. These categories were recorded descriptively and may partially overlap, as some patients with biochemical hypocalcemia subsequently developed symptoms during follow-up. Accordingly, the reported percentages should not be interpreted as mutually exclusive patient-level rates. RLN Function RLN function was primarily assessed clinically based on voice quality and patient-reported symptoms, with laryngoscopic evaluation performed selectively in symptomatic cases. Routine postoperative laryngoscopy was not performed, which may have underestimated the incidence of transient RLN dysfunction. Transient RLN palsy was defined as vocal dysfunction resolving within six months after surgery. Transient RLN palsy occurred in 7.7% of patients, with recovery documented in all cases within six months . No permanent RLN injury was observed. There were no cases of airway compromise or bilateral vocal fold dysfunction. Wound-Related Events Wound-related complications included: Hematoma: 3.3% Seroma: 2.4% Superficial wound infection: 3.3% Reoperation for postoperative bleeding: 1.0% (n = 2) Re-exploration for bleeding was performed early in both cases, with no subsequent long-term morbidity. Cosmetic Outcomes Cosmetic outcomes were assessed using patient-reported satisfaction combined with clinical scar inspection during follow-up. (Fig. 8). Objective scar abnormalities (hypertrophy or widening) were observed in 3.8% of patients. Overall, cosmetic dissatisfaction was reported in 4.8% of the cohort. No validated scar assessment tool was applied, and results should be interpreted accordingly. Postoperative Analgesia and Recovery Postoperative analgesia followed an opioid-sparing regimen using oral paracetamol with or without NSAIDs after cervical field block and/or local infiltration. Formal pain scores and standardized recovery metrics were not routinely recorded; therefore, no conclusions regarding postoperative pain or recovery can be drawn from this dataset. Final Histopathology Final histopathology findings are summarized in Table 5; benign multinodular goiter was most frequent, differentiated thyroid carcinoma occurred in 18.2% , and thyroiditis-related changes (Hashimoto’s/focal thyroiditis) were observed (Fig. 9). Supplementary Image-Based Findings Figure 10 presents thyroid volume versus incision length. Figure 11 shows the distribution of maximum nodule size (predominantly 2–3.5 cm ). Figure 12 shows cosmetic outcome categories, with most ratings reported as excellent/good and few reported as fair/poor . Subgroup observations: A descriptive comparison of perioperative outcomes according to the extent of surgery (hemithyroidectomy versus total/near-total thyroidectomy) is presented in Tables 6 and 7. Operative time and estimated blood loss were modestly higher in total and near-total thyroidectomy compared with hemithyroidectomy, reflecting the greater extent of dissection. Transient hypocalcemia and permanent hypoparathyroidism occurred exclusively in patients undergoing total or near-total thyroidectomy. Rates of transient recurrent laryngeal nerve (RLN) palsy, hematoma, and reoperation for bleeding were comparable between groups, with no cases of permanent RLN injury observed. Given the descriptive design of the study, no formal statistical comparison was performed, and these findings should be interpreted accordingly. Discussion This study describes a five-year single-center experience with mini-incision thyroidectomy (MIT) across a range of selected thyroid pathologies. In this cohort, MIT was completed through a consistently short cervical incision, with operative time and perioperative outcomes falling within ranges reported in the thyroidectomy literature. Patient-reported scar satisfaction was high, and no conversions to a conventional incision were required within the selected cohort. The technique followed standard open thyroidectomy principles and did not rely on endoscopic or robotic platforms. These findings reflect practice within a high-volume endocrine surgery unit and should be interpreted in the context of deliberate case selection. Given the retrospective single-cohort design and absence of a contemporaneous control group, direct comparative conclusions cannot be drawn. Accordingly, the results are presented descriptively and interpreted relative to ranges reported in published thyroidectomy series. Comparison with Previous Literature Findings from this cohort are consistent with previously published reports describing reduced-incision thyroidectomy in selected patients. Earlier studies have reported acceptable complication profiles and favorable cosmetic outcomes when small-incision approaches are applied within appropriate selection criteria ( 7 – 9 ). Contemporary literature similarly reports favorable cosmetic outcomes and acceptable perioperative results with reduced-incision techniques; however, many of these studies include comparative designs or different patient selection criteria, which should be considered when interpreting cross-study comparisons ( 14 – 20 ). In this context, the present cohort contributes additional descriptive data from a relatively large single-center experience. The inclusion of a range of thyroid pathologies provides insight into how MIT is applied in routine practice within defined selection criteria; however, generalizability remains dependent on similar patient selection and surgical expertise. Safety Profile The observed safety profile falls within ranges reported for conventional thyroidectomy in the literature ( 21 , 22 ). Rates of transient hypocalcemia were within expected ranges, and permanent hypoparathyroidism was rare. These findings suggest that parathyroid preservation is achievable within a reduced-incision approach when standard capsular dissection principles are applied. The incidence of RLN palsy also fell within reported ranges from high-volume endocrine units ( 22 ), although interpretation is limited by the absence of routine postoperative laryngoscopic assessment. The RLN was visually identified in all cases. Wound-related complications were infrequent and within reported ranges ( 22 ). The few postoperative hematomas requiring reoperation occurred early in the series and were treated promptly, with no documented long-term sequelae. The limited extent of flap dissection and use of energy-based hemostasis may have contributed to these findings, although this cannot be directly assessed within the current study design. Postoperative analgesia was delivered using an opioid-sparing regimen that incorporated a cervical field block. Pain scores were not routinely recorded; however, postoperative analgesic requirements were generally low, with opioid escalation required only in a minority. Cervical regional blockade has been reported to reduce postoperative pain and opioid requirements after thyroid surgery ( 23 ). Within-cohort descriptive comparison suggested modest increases in operative time, blood loss, and hypocalcemia rates with total/near-total thyroidectomy compared to hemithyroidectomy, which is expected given the greater extent of dissection. However, no formal comparative analysis was performed, and these observations should be interpreted cautiously. Cosmetic Outcomes Cosmesis remains an important consideration in thyroid surgery, particularly among younger patients. In this cohort, patient-reported satisfaction with scar appearance was high, while objective scar abnormalities were uncommon. These findings are consistent with prior reports suggesting that reduced-incision approaches can achieve favorable cosmetic outcomes in appropriately selected patients ( 9 ). Cosmetic outcomes in the present study were assessed using structured patient-reported feedback combined with clinical inspection of the scar. However, no validated scar assessment tool was applied. This limits direct comparability with studies that use standardized instruments and introduces the potential for observer and reporting bias. Within these limitations, objective scar abnormalities were observed in 3.8% of patients, and overall cosmetic dissatisfaction was reported in 4.8%. Published studies using validated tools such as the Patient and Observer Scar Assessment Scale (POSAS) have reported similarly favorable cosmetic profiles for reduced-incision thyroidectomy. In this context, Table 8 is presented to provide a general comparison with existing literature rather than a direct methodological comparison. The use of a small cervical incision combined with limited soft-tissue dissection may have contributed to the favorable scar appearance observed. From a practical perspective, reduced incision length may be particularly relevant for patients who prioritize minimizing visible scarring when considering surgical options. Efficiency and Practicality In this series, MIT was completed with a mean operative time of less than one hour, and incision extension was not required, including during bilateral resections and malignant cases. As the operative steps follow standard open thyroidectomy principles, the technique can be performed by surgeons experienced in open endocrine surgery. MIT was carried out without the use of robotic or endoscopic platforms or insufflation systems, which may be relevant for centers where access to additional equipment is limited. Operative duration did not show a marked increase across procedure type or underlying pathology in this cohort. Applicability in Thyroid Cancer Selected patients with low-risk differentiated thyroid carcinoma underwent MIT, with perioperative outcomes similar to those observed within the cohort. This study was not designed to assess oncologic adequacy or long-term oncologic outcomes, and no conclusions regarding oncologic equivalence can be drawn. Importantly, malignant pathology represented a meaningful proportion of our cohort, reflecting a typical real-world endocrine surgery population. Among the 38 malignant cases, papillary thyroid carcinoma was the most common subtype (18.4%), followed by micropapillary carcinoma (7.9%), follicular carcinoma (5.3%), Hürthle cell carcinoma (5.3%), follicular-variant papillary thyroid carcinoma (5.3%), and smaller numbers of medullary carcinoma, poorly differentiated carcinoma, and large-cell lymphoma (each 2.6%). Across this spectrum of largely intrathyroidal malignancies, MIT was completed without incision extension and with perioperative outcomes comparable to the overall cohort. Findings from other minimally invasive approaches suggest feasibility in selected low-risk cases; however, differences in technique and study design should be considered when interpreting these comparisons. ( 24 ). Based on our follow-up and published long-term series, MIT appears feasible in selected patients with intrathyroidal tumors and no extrathyroidal extension, when performed by experienced surgeons in high-volume settings. Strengths and Limitations The present findings should be interpreted within the context of a descriptive cohort design. Rather than aiming to demonstrate superiority over conventional thyroidectomy, this study was intended to evaluate the feasibility, safety, and consistency of MIT when applied in routine clinical practice. In this setting, operative performance remained stable across different procedure types, with outcomes falling within accepted ranges reported in the literature. From a practical perspective, these findings suggest that MIT can be adopted as a reduced-incision alternative within standard endocrine surgical workflows, without the need for technology-dependent approaches such as endoscopic or robotic platforms. This may be particularly relevant in settings where resources are limited or where preservation of conventional surgical technique is preferred. In this context, MIT should be viewed as a refinement of established open thyroidectomy rather than a departure from it, offering a balance between surgical familiarity and improved cosmetic outcomes. Several limitations should be acknowledged. The study is limited by its retrospective single-cohort design, the absence of a contemporaneous control group, and potential selection bias related to predefined eligibility criteria, precluding formal comparative analysis. Cosmetic outcomes were not assessed using a validated scar scoring system. Routine postoperative laryngoscopy was not performed, which may have led to underestimation of transient RLN dysfunction. Pain and recovery outcomes were not evaluated using standardized measures, and long-term oncologic outcomes were not assessed. Future Directions Prospective comparative studies using matched cohorts or randomized designs are needed to better define differences in outcomes, including pain, recovery, and cosmetic results. Future studies should incorporate validated patient-reported outcome measures, standardized scar assessment tools, and longer-term follow-up, particularly in patients with malignant disease. Conclusion In this single-center retrospective cohort, mini-incision thyroidectomy (MIT) was applied in carefully selected patients across a range of thyroid indications while maintaining a consistently short cervical incision. Operative time, blood loss, and postoperative morbidity fell within ranges reported for conventional thyroidectomy in the literature. Patient-reported satisfaction with scar appearance was high, and objective scar abnormalities were infrequent. MIT was performed using standard open thyroidectomy principles and conventional instrumentation, without reliance on endoscopic or robotic platforms. These findings support MIT as a reduced-incision variation of open thyroidectomy in appropriately selected patients, rather than as a comparative alternative to conventional approaches. Further prospective comparative studies incorporating validated patient-reported outcomes, standardized scar assessment tools, and longer oncologic follow-up are required to define its role better. Declarations Ethics approval and consent to participate The study was approved by the Institutional Review Board of Mansoura University (approval code: R.26.01.3519.R1). Given the retrospective design and use of anonymized data, the requirement for individual informed consent was waived. Clinical trial number: not applicable Consent for publication Not applicable. Availability of data and materials The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. Competing interests The authors declare that they have no competing interests. Funding The authors received no specific funding for this work. Authors’ contributions Study conception and design: Waleed Gado Data acquisition: Ahmed Taki-Eldin, Mohammed Elghandour, Ahmed Lotfy Data analysis and interpretation: Waleed Gado, Mohammed Tarek Manuscript drafting: Mohammed Tarek Critical revision of the manuscript: All authors All authors read and approved the final manuscript. Acknowledgements Not applicable. References Dordea M, Aspinall SR. Short and long-term cosmesis of cervical thyroidectomy scars. Ann R Coll Surg Engl. 2016;98(1):11–7. https://doi.org/10.1308/rcsann.2016.0022 . Miccoli P, Berti P, Conte M, Bendinelli C, Marcocci C. Minimally invasive surgery for thyroid small nodules: Preliminary report. J Endocrinol Investig. 1999;22(11):849–51. https://doi.org/10.1007/BF03343657 . Lai SY, Walvekar RR, Ferris RL. Minimally invasive video-assisted thyroidectomy: Expanded indications and oncologic completeness. Head Neck. 2008;30(11):1403–7. https://doi.org/10.1002/hed.20883 . Linos D. 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Endocr Pract. 2016;22(Suppl 1):1–60. https://doi.org/10.4158/EP161208.GL . Cibas ES, Ali SZ. (2017).The 2017 Bethesda System for Reporting Thyroid Cytopathology. Thyroid , 27(11), 1341–1346. https://doi.org/10.1089/thy.2017.0500 von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: Guidelines for reporting observational studies. PLoS Med. 2007;4(10):e296. https://doi.org/10.1371/journal.pmed.0040296 . Andrieu G, Amrouni H, Robin E, Carnaille B, Wattier JM, Pattou F, Vallet B, Lebuffe G. Analgesic efficacy of bilateral superficial cervical plexus block administered before thyroid surgery under general anaesthesia. BJA: Br J Anaesth. October 2007;99(4):561–6. https://doi.org/10.1093/bja/aem230 . Kim HY, Kim E, Park JS, Park S, Park MH, Jeon MJ. Small-incision thyroidectomy: Outcomes and long-term cosmetic impact. Head Neck. 2021;43(4):1043–52. https://doi.org/10.1002/hed.26574 . Brunaud L, Zarnegar R, Wada N, Ituarte PHG, Clark OH, Duh Q-Y. Incision length for standard thyroidectomy and parathyroidectomy: When is it minimally invasive? Arch Surg. 2003;138(10):1140–3. https://doi.org/10.1001/archsurg.138.10.1140 . Miccoli P, Minuto MN, Ugolini C, Pisano R, Fosso A, Berti P. Minimally invasive video-assisted thyroidectomy for benign thyroid disease: An evidence-based review. World J Surg. 2008;32(7):1333–40. https://doi.org/10.1007/s00268-008-9479-y . Bakkar S, Miccoli P. Minimally Invasive Video-Assisted Thyroidectomy (MIVAT) in the Era of Minimal Access Thyroid Surgery. J Minim Invasive Surg Sci. 2017;6(1). https://doi.org/10.5812/minsurgery.42470 . Jin XX, Zhang QY, Gao C, Wei WX, Jiao C, Li L, et al. Thyroidectomy using the lateral cervical small incision approach for early thyroid cancer. Clin Cosmet Investig Dermatol. 2022;15:713–20. 10.2147/ccid.S358959 . Kim K, Kang SW, Nam K-H, Lee CR, Lee J, Jeong JJ, Chung WY. Surgical outcomes of minimally invasive thyroidectomy in thyroid cancer: Comparison with conventional open thyroidectomy. Gland Surg. 2020;9(5):1338–48. ԗ https://doi.org/10.21037/gs-20-512 . Fík, Z., Astl, J., Zábrodský, M., Lukeš, P., Merunka, I., Betka, J., … Chovanec, M.(2014). Minimally Invasive Video-Assisted versus Minimally Invasive Nonendoscopic Thyroidectomy. BioMed Research International, 2014, 1–7. https://doi.org/10.1155/2014/450170. Edafe O, Antakia R, Laskar N, Uttley L, Balasubramanian SP. Systematic review and meta-analysis of predictors of post-thyroidectomy hypocalcaemia. Br J Surg. 2014;101(4):307–20. https://doi.org/10.1002/bjs.9384 . 10, Rosato L, Avenia N, Bernante P, De Palma M, Gossetti F, Guida C, Nasi PG, Pelizzo MR, Pezzullo L, Porta A, Curro G. Complications of thyroid surgery: Analysis of a multicentric study on 14,934 patients. World J Surg. 2004;28(3):271–6. https://doi.org/10.1007/s00268-003-6903-1 . Del Rio P, Maestroni U, Sianesi M, Stojadinovic A, Avital I, Vicente D. Minimally invasive video-assisted thyroidectomy for papillary thyroid cancer: A prospective five-year follow-up study. Tumori. 2015;101(2):144–7. https://doi.org/10.5301/tj.5000223 . Sywak MS, Yeh MW, McMullen T, Stalberg P, Low H, Alvarado R, Sidhu SB, Delbridge LW. A randomized controlled trial of minimally invasive thyroidectomy using the lateral direct approach versus conventional hemithyroidectomy. Surgery. 2008;144(6):1016–22. https://doi.org/10.1016/j.surg.2008.07.024 . El Fol HA, Ammar MS, Elbalshy MA, Sobeeh M. Feasibility of using minimal incision in thyroidectomy operation. Int Surg J. 2019;6(12):4266–71. https://doi.org/10.18203/2349-2902.isj20195385 . Tables Table (1) Thyroid ultrasound assessment criteria used for patient selection and preoperative evaluation, based on standardized ultrasound measurement methodology and international clinical practice guidelines (10-11) Parameter Assessment Method Notes / Clinical Relevance Lobe dimensions Measured in 3 orthogonal planes (length × width × depth) Used to calculate thyroid lobe volume Lobe volume formula Volume = 0.479 × (length × width × depth) Using validated Brunn correction factor in Standard Brunn et al. formula(10) Isthmus thickness Linear measurement Helps identify significant gland enlargement Nodule size Maximum transverse or longitudinal diameter Determines surgical eligibility for MIT Nodule characteristics Solid/cystic composition, echogenicity, margins Relevant for malignancy risk assessment Suspicious features Microcalcifications, taller-than-wide shape, irregular borders Directs need for FNA and surgical planning Cervical lymph nodes Size, shape, hilum presence Assesses metastatic disease in DTC Goiter extension Assessment for retrosternal or substernal extension Contraindication for MIT if significant Table (2) Preoperative Thyroid Ultrasound Characteristics of the Cohort Study Ultrasound Parameter Range Mean ± SD Notes / Clinical Interpretation Right/Left Lobe Volume (mL) 21 – 50 35.05 ± 6.61 no massive goiters reported Largest Nodule Size (cm) 0.9 – 4.5 2.56 ± 0.84 All cases within safe MIT nodule size limits Isthmus Thickness Not systematically measured — No cases excluded due to isthmus enlargement Goiter Extension No substernal cases — Matches exclusion criteria for MIT Suspicious US Features Present in malignant group — Consistent with DTC subgroup (18.2%) Focal Thyroiditis (US + histology) — 12.4% Presence confirmed on final pathology Volume calculated using Brunn et al. (1981) formula : Volume = 0.479 × (L × W × D) Table (3) Fine-Needle Aspiration Cytology (FNA) Distribution According to ATA/BSRTC Guidelines (Bethesda classification) Bethesda Category Interpretation No. of Patients % of Cohort II – Benign Colloid, hyperplastic, adenomatous nodules 127 60.8% III – AUS/FLUS Indeterminate / atypical 18 8.6% IV – Follicular Neoplasm / Suspicious FN E.g., follicular adenoma, Hurthle adenoma 12 5.7% V – Suspicious for Malignancy Suspicious cytology 14 6.7% VI – Malignant Confirmed papillary, follicular, medullary 38 18.2% Table (4) Distribution of Malignant FNA Diagnoses (n = 38) Diagnosis n % Papillary thyroid carcinoma 7 18.4% Micropapillary carcinoma 3 7.9% Follicular carcinoma 2 5.3% Hürthle cell carcinoma 2 5.3% Follicular variant PTC 2 5.3% Medullary carcinoma 1 2.6% Poorly differentiated carcinoma 1 2.6% Large-cell lymphoma 1 2.6% Total malignant cases 38 100% Table (5) Relationship between preoperative cytology (Bethesda classification) and final histopathology Bethesda Category n Benign Histopathology (n, %) Malignant Histopathology (n, %) II (Benign) 127 122 (96.1%) 5 (3.9%) III (AUS/FLUS) 18 12 (66.7%) 6 (33.3%) IV (FN/SFN) 12 7 (58.3%) 5 (41.7%) V (Suspicious) 14 3 (21.4%) 11 (78.6%) VI (Malignant) 38 0 (0%) 38 (100%) Total 209 144 (68.9%) 65 (31.1%) Note: Cytology was classified according to the Bethesda System for Reporting Thyroid Cytopathology (TBSRTC). Histopathological diagnosis represents the final postoperative findings. Values are presented descriptively; no diagnostic accuracy analysis was performed within this study. Table (6) Perioperative outcomes according to final pathology (descriptive comparison) Variable Benign Disease (n = 171) Malignant Disease (n = 38) Operative time (min), mean ± SD 58.1 ± 15.9 63.7 ± 18.2 Estimated blood loss (mL), mean ± SD 33.2 ± 12.1 38.6 ± 13.8 Transient hypocalcemia (%) 8.8% 12.1% Permanent hypoparathyroidism (%) 0.6% 0% Transient RLN palsy (%) 7.0% 10.5% Permanent RLN injury (%) 0% 0% Hematoma (%) 2.9% 5.2% Cosmetic dissatisfaction (%) 4.7% 5.3% Note: Findings are presented descriptively. The study was not designed for comparative subgroup analysis, and differences should be interpreted with caution. Table (7) Perioperative outcomes according to extent of surgery (descriptive comparison) Variable Hemithyroidectomy (n = 63) Total/Near-total Thyroidectomy (n = 146) Operative time (min), mean ± SD 54.2 ± 14.1 61.8 ± 17.3 Estimated blood loss (mL), mean ± SD 28.6 ± 10.4 36.9 ± 13.2 Transient hypocalcemia (%) — 9.6% Permanent hypoparathyroidism (%) — 0.5% Transient RLN palsy (%) 6.3% 8.2% Permanent RLN injury (%) 0% 0% Hematoma (%) 1.6% 3.4% Reoperation for bleeding (%) 0% 1.4% Note: Values are presented descriptively. No formal statistical comparison was performed due to the single-cohort study design. Hypocalcemia outcomes are not applicable to hemithyroidectomy. Table (8) Summary of cosmetic outcome assessment methods and reported findings in selected reduced-incision thyroidectomy series Study / Technique Assessment Tool Reported Cosmetic Outcomes How It Compares to Current MIT Study Current MIT Study (n=209) Structured patient-reported satisfaction and clinical scar inspection (non-validated assessment • Hypertrophy / widening: 3.8% • Cosmetic dissatisfaction: 4.8% • Majority with “Excellent/Good” scars (~91%) Provides contextual comparison only; direct comparison is limited by differences in study design and assessment methods Miccoli et al., MIVAT (17) POSAS-like descriptors • Excellent cosmetic satisfaction in >90% of patients • Very low hypertrophic scarring Del Rio et al., 5-year MIVAT follow-up ((24) Patient-reported + clinical exam • Long-term cosmetic results remained excellent • No significant late hypertrophic scars Fík et al., MIVAT vs MINET RCT (21) Vancouver Scar Scale + patient scoring • Both approaches produced superior cosmetic results • MINET (non-endoscopic MIT) showed equally favorable scars Sywak et al., Lateral Mini-incision MIT ((25) Patient scar satisfaction • Significantly better cosmetic results than open surgery • No increase in poor scars El-Fol et al., Minimal-incision thyroidectomy (26) Patient satisfaction scale • Scar dissatisfaction: <5% • Scar complications: ~4% Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviewers agreed at journal 30 Apr, 2026 Reviewers invited by journal 23 Apr, 2026 Editor invited by journal 09 Apr, 2026 Editor assigned by journal 07 Apr, 2026 Submission checks completed at journal 07 Apr, 2026 First submitted to journal 05 Apr, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9328096","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":633533257,"identity":"5f831620-fa55-4fbd-80ff-dd75d0290907","order_by":0,"name":"Waleed Gado","email":"data:image/png;base64,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","orcid":"","institution":"Mansoura University","correspondingAuthor":true,"prefix":"","firstName":"Waleed","middleName":"","lastName":"Gado","suffix":""},{"id":633533260,"identity":"b520bf6d-d2b1-49d2-9c27-6541ee6e9e1b","order_by":1,"name":"Ahmed Taki-Eldin","email":"","orcid":"","institution":"Faculty of Medicine, Horus University","correspondingAuthor":false,"prefix":"","firstName":"Ahmed","middleName":"","lastName":"Taki-Eldin","suffix":""},{"id":633533264,"identity":"d4b50a2b-813b-4d74-bc9b-b9aafacc9c3f","order_by":2,"name":"Mohammed Elghandour","email":"","orcid":"","institution":"Mansoura University","correspondingAuthor":false,"prefix":"","firstName":"Mohammed","middleName":"","lastName":"Elghandour","suffix":""},{"id":633533266,"identity":"37b5371e-78e1-45d8-adbe-b993fa807bfc","order_by":3,"name":"Mohammed Tarek","email":"","orcid":"","institution":"Mansoura University","correspondingAuthor":false,"prefix":"","firstName":"Mohammed","middleName":"","lastName":"Tarek","suffix":""},{"id":633533272,"identity":"a4737c98-a704-4ca6-8016-87763dae3b1f","order_by":4,"name":"Ahmed Lotfy","email":"","orcid":"","institution":"Mansoura University","correspondingAuthor":false,"prefix":"","firstName":"Ahmed","middleName":"","lastName":"Lotfy","suffix":""}],"badges":[],"createdAt":"2026-04-05 18:54:19","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9328096/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9328096/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":108727543,"identity":"42ccc783-3d58-4bfe-9f97-194f8dbba630","added_by":"auto","created_at":"2026-05-07 17:32:58","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":277453,"visible":true,"origin":"","legend":"\u003cp\u003eFlow diagram of patient selection for mini-incision thyroidectomy (MIT).\u003c/p\u003e","description":"","filename":"figure1.png","url":"https://assets-eu.researchsquare.com/files/rs-9328096/v1/af6db7776043b218116ae7d3.png"},{"id":108807200,"identity":"76d07409-389c-4975-8729-32aa4c359cb4","added_by":"auto","created_at":"2026-05-08 15:30:18","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":219265,"visible":true,"origin":"","legend":"\u003cp\u003ePlanned transverse cervical incision for mini-incision thyroidectomy, demonstrating standardized placement and limited length.\u003c/p\u003e","description":"","filename":"figure2.png","url":"https://assets-eu.researchsquare.com/files/rs-9328096/v1/6c56ba5fe6e51fa0d5d901fa.png"},{"id":108807106,"identity":"d78630ed-0ef1-4fb3-83fd-caa17f2a705f","added_by":"auto","created_at":"2026-05-08 15:30:11","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":185397,"visible":true,"origin":"","legend":"\u003cp\u003eKey exposure steps during MIT: (A) limited subplatysmal flap development with confirmation of the correct plane; (B) anterior thyroid surface exposure through gentle retraction; (C) use of an energy-based sealing device during pole dissection.\u003c/p\u003e","description":"","filename":"figure3.png","url":"https://assets-eu.researchsquare.com/files/rs-9328096/v1/ab6f7a6aeef441b61339ecd3.png"},{"id":108727546,"identity":"3037d118-e26e-41e9-954f-6228eed9f58d","added_by":"auto","created_at":"2026-05-07 17:32:58","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":433334,"visible":true,"origin":"","legend":"\u003cp\u003eIntraoperative identification of key anatomic structures following thyroid lobe mobilization. Panels (A) and (B) demonstrate visualization of the left recurrent laryngeal nerve, while panel (C) shows preservation of a parathyroid gland during capsular dissection.\u003c/p\u003e","description":"","filename":"figure4.png","url":"https://assets-eu.researchsquare.com/files/rs-9328096/v1/5def77a613f6e6a46f270a4a.png"},{"id":108807045,"identity":"f83733ae-c82d-4802-8c4f-358e106100d0","added_by":"auto","created_at":"2026-05-08 15:30:00","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":201941,"visible":true,"origin":"","legend":"\u003cp\u003eRepresentative surgical specimens illustrating complete thyroid excision across a range of gland volumes using a standardized mini-incision thyroidectomy approach\u003c/p\u003e","description":"","filename":"figure5.png","url":"https://assets-eu.researchsquare.com/files/rs-9328096/v1/51b382dc52d9175784ea6b67.png"},{"id":108806809,"identity":"71c0b9fc-4d32-46c6-89f7-bd478a76e102","added_by":"auto","created_at":"2026-05-08 15:29:31","extension":"png","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":418087,"visible":true,"origin":"","legend":"\u003cp\u003eSequential intraoperative images demonstrating progressive thyroid lobe mobilization and delivery through the mini-incision. Panel (A) shows controlled traction with capsular dissection, panel (B) illustrates partial exteriorization of the lobe, and panel (C) demonstrates complete delivery of the specimen without extension of the cervical incision.\u003c/p\u003e","description":"","filename":"figure6.png","url":"https://assets-eu.researchsquare.com/files/rs-9328096/v1/94a8187f847244b49176f577.png"},{"id":108807073,"identity":"af4db4c6-4e5f-4012-a947-8e802a38f876","added_by":"auto","created_at":"2026-05-08 15:30:04","extension":"png","order_by":7,"title":"Figure 7","display":"","copyAsset":false,"role":"figure","size":526629,"visible":true,"origin":"","legend":"\u003cp\u003eImmediate postoperative appearance of the cervical incision following mini-incision thyroidectomy. Panel (A) shows the incision without drain placement, while panel (B) demonstrates selective drain placement in a case where it was deemed necessary.\u003c/p\u003e","description":"","filename":"figure7.png","url":"https://assets-eu.researchsquare.com/files/rs-9328096/v1/1497c605d6174c6aceba3c58.png"},{"id":108727548,"identity":"f412dcc1-0e9e-42f0-8b37-23ba3f71c5b0","added_by":"auto","created_at":"2026-05-07 17:32:58","extension":"png","order_by":8,"title":"Figure 8","display":"","copyAsset":false,"role":"figure","size":497227,"visible":true,"origin":"","legend":"\u003cp\u003eAppearance of the cervical scar six months after mini-incision thyroidectomy, showing satisfactory cosmetic healing.\u003c/p\u003e","description":"","filename":"figure8.png","url":"https://assets-eu.researchsquare.com/files/rs-9328096/v1/21025978a5c667cc461921d0.png"},{"id":108806495,"identity":"f5106458-0aae-4355-89c9-470a93ec990b","added_by":"auto","created_at":"2026-05-08 15:28:45","extension":"png","order_by":9,"title":"Figure 9","display":"","copyAsset":false,"role":"figure","size":213421,"visible":true,"origin":"","legend":"\u003cp\u003eVenn diagram showing the overlap between operative indications and final histopathological diagnoses. Percentages exceed 100% because diagnostic categories are not mutually exclusive.\u003c/p\u003e","description":"","filename":"figure9.png","url":"https://assets-eu.researchsquare.com/files/rs-9328096/v1/0743c326a1d2e095523a73cb.png"},{"id":108805852,"identity":"4283b3fb-feea-448c-a305-d5b3726746d7","added_by":"auto","created_at":"2026-05-08 15:27:01","extension":"png","order_by":10,"title":"Figure 10","display":"","copyAsset":false,"role":"figure","size":75076,"visible":true,"origin":"","legend":"\u003cp\u003eRelationship between thyroid size and the length of the cervical incision in patients treated with mini-incision thyroidectomy.\u003c/p\u003e","description":"","filename":"figure10.png","url":"https://assets-eu.researchsquare.com/files/rs-9328096/v1/2c3ce2586b2de0c16b20c541.png"},{"id":108806519,"identity":"0f9e2097-fa43-4e09-9aa7-64cdc297d182","added_by":"auto","created_at":"2026-05-08 15:28:49","extension":"png","order_by":11,"title":"Figure 11","display":"","copyAsset":false,"role":"figure","size":44845,"visible":true,"origin":"","legend":"\u003cp\u003eDistribution of the maximum thyroid nodule diameter within the study cohort.\u003c/p\u003e","description":"","filename":"figure11.png","url":"https://assets-eu.researchsquare.com/files/rs-9328096/v1/0f9a53feb8778e0e7d6c4847.png"},{"id":108727552,"identity":"99569c89-48c2-4895-ac17-1222ad8c9c24","added_by":"auto","created_at":"2026-05-07 17:32:58","extension":"png","order_by":12,"title":"Figure 12","display":"","copyAsset":false,"role":"figure","size":43389,"visible":true,"origin":"","legend":"\u003cp\u003eDistribution of cosmetic outcomes based on patient-reported satisfaction and clinical inspection of the cervical scar. Categories derived from the Patient and Observer Scar Assessment Scale (POSAS) are shown for comparison with published literature and were not formally applied in this cohort\u003c/p\u003e","description":"","filename":"figure12.png","url":"https://assets-eu.researchsquare.com/files/rs-9328096/v1/345b1287516f618a8f80a1df.png"},{"id":108810322,"identity":"a74f03f1-a212-42f8-96db-05c57901a90e","added_by":"auto","created_at":"2026-05-08 15:58:09","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":4358982,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9328096/v1/bebfb750-1adb-4d5a-9706-77bb5efd226d.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eMini-incision Thyroidectomy in Contemporary Practice: Safety, Efficiency, and Cosmetic Outcomes from a Large Consecutive Cohort\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eOne of the most common endocrine surgery procedures is thyroidectomy. Conventional open thyroidectomy remains the standard approach for both benign and malignant thyroid diseases, providing dependable exposure and established oncologic safety. However, the visible neck scar associated with the conventional transverse cervical incision\u0026mdash;which typically measures 6 to 10 cm\u0026mdash;may be undesirable for some patients. Concerns about scar appearance and postoperative neck pain are frequently voiced in routine clinical practice, especially by younger patients and women, who make up a significant portion of patients having thyroid surgery (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIncreasing emphasis on patient-reported outcomes and quality-of-life measures has led to growing interest in surgical approaches that aim to reduce the external impact of thyroid surgery while maintaining established safety standards.In this setting, several limited-access techniques have been developed. Minimally invasive video-assisted thyroidectomy (MIVAT) demonstrated that a shorter midline incision combined with endoscopic visualization could replicate the essential steps of open thyroidectomy in carefully selected patients (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). More recently, remote-access approaches\u0026mdash;including transaxillary, bilateral axillo-breast, and transoral vestibular techniques\u0026mdash;have been introduced to completely avoid a visible cervical scar (\u003cspan additionalcitationids=\"CR5\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). Although these approaches may offer cosmetic advantages, their wider adoption has been limited by the need for specialized equipment, additional training, longer operative times, and increased resource utilization.\u003c/p\u003e \u003cp\u003eMini-incision thyroidectomy (MIT) occupies a distinct position within this evolving spectrum. Rather than relying on endoscopic or robotic platforms, MIT represents a reduced-incision modification of conventional open thyroidectomy, typically performed through a shorter transverse cervical incision. The technique preserves familiar anatomical orientation, capsular dissection principles, and operative sequencing, allowing surgeons experienced in open endocrine surgery to adopt the approach without fundamental changes to their workflow. From a practical perspective, MIT aims to reduce incision length while avoiding the technical complexity and additional resource requirements associated with technology-dependent approaches. Previous reports have described favorable cosmetic outcomes and acceptable perioperative results in selected patients undergoing reduced-incision thyroidectomy (\u003cspan additionalcitationids=\"CR8\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). However, much of the available evidence is derived from relatively small series or narrowly defined patient groups, which may limit generalizability. Accordingly, data reflecting routine clinical practice across a broader spectrum of thyroid pathology remain limited.\u003c/p\u003e \u003cp\u003eIn this context, we present a five-year single-center experience with mini-incision thyroidectomy performed at a high-volume endocrine surgery unit. By analyzing a consecutive cohort that includes benign disease, functional thyroid disorders, inflammatory conditions, and selected low-risk malignancies, this study describes operative characteristics, perioperative outcomes, and patient-reported cosmetic satisfaction associated with MIT in routine endocrine surgical practice.\u003c/p\u003e"},{"header":"Study Design and Setting","content":"\u003cp\u003eWe reviewed consecutive patients who underwent MIT at the Endocrine Surgery Unit of Mansoura University Hospitals between December 2014 and December 2019 in a retrospective cohort design. This represents a single-center retrospective cohort of patients selected for MIT according to predefined clinical and anatomical criteria. As a tertiary referral center, the unit manages a wide range of thyroid pathologies; however, only patients considered suitable for MIT were included in this analysis.\u003c/p\u003e\n\u003cp\u003eDuring the study period, MIT was increasingly applied in patients meeting selection criteria, while other patients underwent conventional thyroidectomy. The total number of thyroidectomy patients treated during the study period, as well as reasons for exclusion from MIT, are presented in the study flow diagram (Figure 1).\u0026nbsp;All operations were carried out by the same experienced endocrine surgery team following a uniform operative technique, which reduced variability related to surgeon preference and technical approach.\u003c/p\u003e\n\u003cp\u003eClinical, imaging, and operative information were retrieved from prospectively maintained surgical records and the hospital\u0026rsquo;s electronic health record system. Collected variables included patient demographics, preoperative ultrasound findings, cytological results, operative details, thyroid and nodule measurements, incision length, postoperative complications, and patient-reported cosmetic satisfaction. Data were reviewed retrospectively and anonymized before analysis.\u003c/p\u003e\n\u003cp\u003eThe study was approved by the Institutional Review Board of Mansoura University (approval code: R.26.01.3519.R1). Given the retrospective design and use of anonymized data, the requirement for individual informed consent was waived.\u003c/p\u003e\n\u003cp\u003eAs part of routine preoperative assessment, all patients underwent a detailed neck ultrasound examination (Table 1). Thyroid lobe dimensions were measured in three perpendicular planes, and total thyroid volume was calculated using the Brunn formula (0.479 \u0026times; length \u0026times; width \u0026times; depth) (10). Nodule size was defined by the maximum diameter. Relevant ultrasound features, including composition, echogenicity, margin characteristics, and suspicious findings such as microcalcifications or a taller-than-wide shape, were recorded according to standard clinical practice (11).\u003c/p\u003e\n\u003cp\u003eFine-needle aspiration cytology results were reported using the Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) (12). Decisions regarding surgery were based on a combined evaluation of cytological findings, ultrasound features, and the overall clinical context. In cases with indeterminate (Bethesda III\u0026ndash;IV) or suspicious (Bethesda V) cytology, management was individualized, taking into account nodule characteristics, patient preference, and institutional practice. Nodules classified as Bethesda V or VI were generally considered indications for surgical treatment.\u003c/p\u003e\n\u003cp\u003eThe study was conducted and reported in accordance with the STROBE guidelines for cohort studies (13).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEligibility Criteria\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInclusion Criteria\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePatients were considered suitable for MIT when all of the following criteria were met:\u003c/p\u003e\n\u003cp\u003e\u0026middot;\u0026nbsp;Dominant thyroid nodule size \u0026le; 4\u0026ndash;5 cm on ultrasound\u003c/p\u003e\n\u003cp\u003e\u0026middot;\u0026nbsp;Estimated thyroid volume generally \u0026le; 50 mL\u003c/p\u003e\n\u003cp\u003e\u0026middot;\u0026nbsp;Indication for hemithyroidectomy or total thyroidectomy for:\u003c/p\u003e\n\u003cp\u003eo Benign nodular goiter\u003c/p\u003e\n\u003cp\u003eo Indeterminate cytology (Bethesda III\u0026ndash;IV)\u003c/p\u003e\n\u003cp\u003eo Toxic nodular goiter with controlled thyroid function\u003c/p\u003e\n\u003cp\u003eo Graves\u0026rsquo; disease after metabolic optimization\u003c/p\u003e\n\u003cp\u003eo Low-risk differentiated thyroid carcinoma without radiologic extrathyroidal extension\u003c/p\u003e\n\u003cp\u003e\u0026middot; No clinical or radiologic suspicion of recurrent laryngeal nerve invasion (RLN), tracheal infiltration, or esophageal adherence\u003c/p\u003e\n\u003cp\u003e\u0026middot;\u0026nbsp;No requirement for lateral neck dissection\u003c/p\u003e\n\u003cp\u003eThese criteria were applied to ensure that reduced-access exposure would not compromise operative safety or oncologic principles.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eExclusion Criteria\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMIT was avoided when limited exposure could compromise surgical safety or oncologic adequacy, including:\u003c/p\u003e\n\u003cp\u003e\u0026middot;\u0026nbsp;Retrosternal/substernal goiter extending below the thoracic inlet\u003c/p\u003e\n\u003cp\u003e\u0026middot;\u0026nbsp;Thyroid malignancy with gross extrathyroidal extension or fixation to laryngeal cartilage\u003c/p\u003e\n\u003cp\u003e\u0026middot;\u0026nbsp;Previous extensive neck surgery or prior neck irradiation\u003c/p\u003e\n\u003cp\u003e\u0026middot; Severe cervical spine deformity, short muscular neck, or other predictors of inadequate exposure\u003c/p\u003e\n\u003cp\u003e\u0026middot;\u0026nbsp;Morbid obesity (BMI \u0026gt; 40) when soft-tissue thickness exceeded the safe limits of\u003c/p\u003e\n\u003cp\u003ereduced-access exposure\u003c/p\u003e\n\u003cp\u003eThese exclusion criteria reflect deliberate case selection and should be considered when interpreting outcomes.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePreoperative Assessment\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll patients underwent a comprehensive preoperative evaluation, including thyroid ultrasound, thyroid function testing, serum calcium assessment, and routine anesthetic work-up. Fine-needle Aspiration was performed when indicated. Selective preoperative vocal fold assessment was obtained for patients with hoarseness, prior contralateral thyroid surgery, or large nodules. Routine preoperative laryngoscopy was not performed in all patients.\u003c/p\u003e\n\u003cp\u003eHyperthyroid patients were rendered euthyroid or near-euthyroid using antithyroid medications and beta-blockers before surgery.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eOperative Technique\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMIT was performed as a reduced-incision, non-endoscopic modification of conventional open thyroidectomy. The procedure adhered to standard anatomic and capsular dissection principles to complete the intended thyroid resection through a limited cervical incision within the constraints of reduced access. All operations were carried out by the same experienced endocrine surgery team, ensuring consistency in operative technique and perioperative decision-making throughout the study period.\u003c/p\u003e\n\u003cp\u003eA largely suture-free surgical method was used. Hemostasis and tissue separation were mainly accomplished with energy-based vessel-sealing tools, such as ultrasonic and advanced bipolar systems. This approach facilitated hemostasis and visualization within the limited operative field.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eIncision and Initial Exposure\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA transverse cervical skin incision measuring approximately 2\u0026ndash;4 cm was placed along a natural skin crease, most commonly just inferior to the cricoid cartilage. Extension of the incision was avoided whenever feasible and was undertaken only when necessary to ensure safe dissection, improve visualization, or allow controlled extraction of the specimen (Figure 2A\u0026ndash;C). After division of the skin and platysma, constrained subplatysmal flaps were developed superiorly toward the thyroid cartilage and inferiorly toward the sternal notch. Flap elevation was intentionally restricted to the\u0026nbsp;least\u0026nbsp;necessary\u0026nbsp;to\u0026nbsp;ensure\u0026nbsp;sufficient\u0026nbsp;exposure while preserving normal tissue planes (Figure 3A).\u0026nbsp;The strap muscles were divided\u0026nbsp;at the midline raphe without being\u0026nbsp;cut. Exposure was maintained using low-profile retractors, and fine instruments\u0026mdash;such as small Richardson retractors or pediatric-sized instruments when appropriate\u0026mdash;were selected to facilitate precise dissection within the narrow operative field (Figure 3B). Retraction was applied gently and intermittently to minimize tension on the wound edges. Routine use of loupe magnification was not required in the majority of cases.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eThyroid lobe mobilization\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCapsular dissection was initiated medially and continued laterally in a stepwise fashion. Energy-based vessel sealing was used routinely for division of small vessels, enabling controlled dissection with minimal blood loss and efficient progression through the operative planes, which is particularly advantageous in a narrow operative window (Figure 3C).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSuperior Pole Control\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe superior pole was approached with close capsular dissection. Individual superior pole vessels were sealed and divided sequentially to protect the external branch of the superior laryngeal nerve. With a bloodless field and focused retraction, this step remained reliably achievable through the mini-incision (Figure 3C).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMiddle Thyroid Vein and Lateral Dissection\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWhen present, the middle thyroid vein was sealed and divided to facilitate lateral mobilization. The avascular capsular plane was then developed using blunt dissection combined with selective energy sealing. Progressive release of lateral attachments allowed medial rotation of the thyroid lobe without incision enlargement.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRLN Identification\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eInferior dissection proceeded until the RLN was identified in the tracheoesophageal groove. In this cohort, the RLN was routinely visualized in all cases. The clear operative field achieved through energy-assisted hemostasis was critical to safe nerve identification in reduced exposure. Once identified, the RLN was traced superiorly to its laryngeal entry point and preserved throughout (Figure 4A\u0026ndash;B).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eParathyroid Preservation\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eParathyroid glands were preserved in situ whenever feasible, with vascular supply maintained by keeping dissection close to the thyroid capsule (Figure 4C). If a gland appeared compromised intraoperatively, immediate autotransplantation into the sternocleidomastoid muscle was undertaken based on gross assessment of viability.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eManagement of Large or Cystic Nodules\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFor bulky or cystic nodules limiting delivery through the incision, controlled decompression was used selectively. Aspiration or gentle collapse of the cystic component was performed only after clear identification and protection of the RLN, allowing specimen extraction without extending the incision (Figure 5A\u0026ndash;C).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompletion, Hemostasis, and Closure\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFollowing mobilization, the gland was returned briefly to its anatomical bed when required to optimize exposure for contralateral dissection or to complete isthmus division (Figure 6A\u0026ndash;C). Final hemostasis was secured using energy devices and fine bipolar cautery, followed by irrigation and a period of observation to confirm stability.\u0026nbsp;Following completion of the resection, the strap muscles were reapproximated in the midline. The platysma was closed using interrupted absorbable sutures, and the skin was closed with a subcuticular technique to promote favorable cosmetic healing (Figure 7A). Meticulous attention was paid to wound edge alignment to minimize scar tension.\u003c/p\u003e\n\u003cp\u003eClosed suction drains were not used routinely. Drain placement was reserved for selected situations, including extensive bilateral dissection, larger resections, or cases in which intraoperative hemostasis was judged to be borderline (Figure 7B). Postoperative vocal function was assessed clinically based on voice quality and patient-reported symptoms. Laryngoscopic evaluation was performed selectively in patients with voice changes or clinical concern, rather than as a routine postoperative measure. Routine monitoring of drains when present, and serial serum calcium measurements in accordance with the unit\u0026rsquo;s postoperative protocol.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLearning Curve and Technical Adoption\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMIT closely resembles the anatomical access and operative steps of traditional open thyroidectomy, allowing surgeons experienced in endocrine procedures to implement this technique with minimal disruption to their existing practices. Nonetheless, performing surgery through a smaller cervical incision requires increased attention to meticulous exposure, deliberate instrument selection, and steady decision-making throughout the procedure. Based on our experience, it is advised to slowly implement this technique\u0026mdash;beginning with careful patient selection during the early phase of its use\u0026mdash;to guarantee patient safety while enjoying the aesthetic benefits linked to an authentic mini-incision approach\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCosmetic Assessment\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCosmetic outcomes were assessed during routine postoperative follow-up, typically at outpatient visits conducted between 4 and 12 weeks after surgery. Evaluation consisted of structured patient-reported satisfaction combined with direct clinical inspection of the cervical scar by the treating surgical team. Assessment focused on overall scar visibility, contour, pigmentation, and patient-perceived acceptability of the cosmetic result.\u003c/p\u003e\n\u003cp\u003ePatient-reported satisfaction was categorized descriptively (e.g., excellent, good, fair, or poor) based on documentation in follow-up records. No validated scar assessment instrument, such as the Patient and Observer Scar Assessment Scale (POSAS) or Vancouver Scar Scale, was applied in this cohort. Accordingly, cosmetic outcomes should be interpreted as descriptive and may be subject to observer and reporting bias.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical Analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eStatistical analysis was primarily descriptive. Continuous variables are presented as mean \u0026plusmn; standard deviation (SD) or, when normality assumptions were not met, as median with interquartile range (IQR). Categorical variables are reported as absolute counts and percentages. Given the retrospective single-cohort design and absence of a contemporaneous control group, no comparative hypothesis testing was prespecified. Accordingly, results are presented descriptively and interpreted in the context of previously published literature rather than formal comparative inference.\u003c/p\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003ePatient Characteristics\u003c/h2\u003e \u003cp\u003eA total of 209 individuals received MIT. The group was mainly female (79.9%), with an average age of 39.6\u0026thinsp;\u0026plusmn;\u0026thinsp;12.3 years (range, 14\u0026ndash;77).\u003c/p\u003e \u003cp\u003e Preoperative ultrasound evaluation confirmed that the thyroid gland and nodule were within the established selection guidelines. Average thyroid volume was 35.1\u0026thinsp;\u0026plusmn;\u0026thinsp;6.6 mL, and the average maximum nodule size was 2.56\u0026thinsp;\u0026plusmn;\u0026thinsp;0.84 cm. No nodules exceeded 4.5 cm, and no cases demonstrated retrosternal extension, consistent with the study eligibility criteria (Table\u0026nbsp;2).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec21\" class=\"Section2\"\u003e \u003ch2\u003eCytology-Based Stratification and Indications for Surgery\u003c/h2\u003e \u003cp\u003eFine-needle aspiration cytology classified most nodules as benign (Bethesda II), accounting for 60.8% of cases. Indeterminate cytology (Bethesda III\u0026ndash;IV) was present in a smaller subset of patients, although precise distribution within this group is summarized in Table\u0026nbsp;3. Cytology consistent with malignancy (Bethesda VI) was identified in 18.2% of the cohort (n\u0026thinsp;=\u0026thinsp;38). Suspicious cytology (Bethesda V) was also present and is reported within the malignant/suspicious group (Table\u0026nbsp;4).\u003c/p\u003e \u003cp\u003eThe relationship between preoperative cytology and final histopathology is summarized in Table\u0026nbsp;5. As expected, most nodules classified as Bethesda II were confirmed as benign on final histopathology, with a small proportion demonstrating malignancy. Increasing Bethesda category was associated with a higher proportion of malignant findings, with the majority of Bethesda V and all Bethesda VI nodules confirmed as malignant. Indeterminate categories (Bethesda III\u0026ndash;IV) showed mixed histopathological outcomes. These findings are presented descriptively and reflect the distribution within the studied cohort.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec22\" class=\"Section2\"\u003e \u003ch2\u003eOperative Findings\u003c/h2\u003e \u003cdiv id=\"Sec23\" class=\"Section3\"\u003e \u003ch2\u003eExtent of Surgery\u003c/h2\u003e \u003cp\u003eTotal thyroidectomy was performed in 143 patients (68.4%), hemithyroidectomy in 63 patients (30.1%), and near-total thyroidectomy in 3 patients (1.4%).\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec24\" class=\"Section2\"\u003e \u003ch2\u003eIncision Length\u003c/h2\u003e \u003cp\u003eThe mean incision length was 2.81\u0026thinsp;\u0026plusmn;\u0026thinsp;0.48 cm, with individual measurements ranging from 1.9 to 3.9 cm. No cases required conversion to a conventional cervical incision within the selected cohort.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cdiv id=\"Sec25\" class=\"Section3\"\u003e \u003ch2\u003eOperative Time and Blood Loss\u003c/h2\u003e \u003cp\u003eThe mean operative time was \u003cb\u003e59.4\u0026thinsp;\u0026plusmn;\u0026thinsp;16.8 minutes\u003c/b\u003e (range \u003cb\u003e32\u0026ndash;106\u003c/b\u003e), and the estimated blood loss was \u003cb\u003e34.4\u0026thinsp;\u0026plusmn;\u0026thinsp;12.6 mL\u003c/b\u003e (range \u003cb\u003e10\u0026ndash;70\u003c/b\u003e). Operative time was consistent across procedure extent.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec26\" class=\"Section3\"\u003e \u003ch2\u003ePostoperative Outcomes\u003c/h2\u003e \u003cdiv id=\"Sec27\" class=\"Section4\"\u003e \u003ch2\u003eHypocalcemia\u003c/h2\u003e \u003cp\u003ePostoperative hypocalcemia was categorized as biochemical (asymptomatic), symptomatic transient, or permanent, based on clinical findings and duration of supplementation.\u003c/p\u003e \u003cp\u003eBiochemical hypocalcemia, defined as a low serum calcium level without associated symptoms, was observed in 10.0% of patients. Symptomatic transient hypocalcemia occurred in 9.6% of patients and resolved with medical management within six months. One patient (0.5%) developed permanent hypoparathyroidism requiring ongoing supplementation beyond six months.\u003c/p\u003e \u003cp\u003eThese categories were recorded descriptively and may partially overlap, as some patients with biochemical hypocalcemia subsequently developed symptoms during follow-up. Accordingly, the reported percentages should not be interpreted as mutually exclusive patient-level rates.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec28\" class=\"Section2\"\u003e \u003ch2\u003eRLN Function\u003c/h2\u003e \u003cp\u003eRLN function was primarily assessed clinically based on voice quality and patient-reported symptoms, with laryngoscopic evaluation performed selectively in symptomatic cases. Routine postoperative laryngoscopy was not performed, which may have underestimated the incidence of transient RLN dysfunction. Transient RLN palsy was defined as vocal dysfunction resolving within six months after surgery. Transient RLN palsy occurred in \u003cb\u003e7.7%\u003c/b\u003e of patients, with recovery documented in all cases within \u003cb\u003esix months\u003c/b\u003e. \u003cb\u003eNo permanent RLN injury\u003c/b\u003e was observed. There were no cases of airway compromise or bilateral vocal fold dysfunction.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec29\" class=\"Section2\"\u003e \u003ch2\u003eWound-Related Events\u003c/h2\u003e \u003cp\u003eWound-related complications included:\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eHematoma: \u003cb\u003e3.3%\u003c/b\u003e\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eSeroma: \u003cb\u003e2.4%\u003c/b\u003e\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eSuperficial wound infection: \u003cb\u003e3.3%\u003c/b\u003e\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eReoperation for postoperative bleeding: \u003cb\u003e1.0% (n\u0026thinsp;=\u0026thinsp;2)\u003c/b\u003e\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003eRe-exploration for bleeding was performed early in both cases, with no subsequent long-term morbidity.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eCosmetic Outcomes\u003c/h3\u003e\n\u003cp\u003eCosmetic outcomes were assessed using patient-reported satisfaction combined with clinical scar inspection during follow-up. (Fig.\u0026nbsp;8). Objective scar abnormalities (hypertrophy or widening) were observed in \u003cb\u003e3.8%\u003c/b\u003e of patients. Overall, cosmetic dissatisfaction was reported in \u003cb\u003e4.8%\u003c/b\u003e of the cohort. No validated scar assessment tool was applied, and results should be interpreted accordingly.\u003c/p\u003e \u003cdiv id=\"Sec31\" class=\"Section2\"\u003e \u003ch2\u003ePostoperative Analgesia and Recovery\u003c/h2\u003e \u003cp\u003ePostoperative analgesia followed an opioid-sparing regimen using oral paracetamol with or without NSAIDs after cervical field block and/or local infiltration. Formal pain scores and standardized recovery metrics were not routinely recorded; therefore, no conclusions regarding postoperative pain or recovery can be drawn from this dataset.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec32\" class=\"Section2\"\u003e \u003ch2\u003eFinal Histopathology\u003c/h2\u003e \u003cp\u003eFinal histopathology findings are summarized in Table\u0026nbsp;5; benign multinodular goiter was most frequent, differentiated thyroid carcinoma occurred in \u003cb\u003e18.2%\u003c/b\u003e, and thyroiditis-related changes (Hashimoto\u0026rsquo;s/focal thyroiditis) were observed (Fig.\u0026nbsp;9).\u003c/p\u003e \u003cdiv id=\"Sec33\" class=\"Section3\"\u003e \u003ch2\u003eSupplementary Image-Based Findings\u003c/h2\u003e \u003cp\u003eFigure 10 presents thyroid volume versus incision length. Figure\u0026nbsp;11 shows the distribution of maximum nodule size (predominantly \u003cb\u003e2\u0026ndash;3.5 cm\u003c/b\u003e). Figure\u0026nbsp;12 shows cosmetic outcome categories, with most ratings reported as \u003cb\u003eexcellent/good\u003c/b\u003e and few reported as \u003cb\u003efair/poor\u003c/b\u003e.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec34\" class=\"Section3\"\u003e \u003ch2\u003eSubgroup observations:\u003c/h2\u003e \u003cp\u003eA descriptive comparison of perioperative outcomes according to the extent of surgery (hemithyroidectomy versus total/near-total thyroidectomy) is presented in Tables\u0026nbsp;6 and 7.\u003c/p\u003e \u003cp\u003eOperative time and estimated blood loss were modestly higher in total and near-total thyroidectomy compared with hemithyroidectomy, reflecting the greater extent of dissection. Transient hypocalcemia and permanent hypoparathyroidism occurred exclusively in patients undergoing total or near-total thyroidectomy.\u003c/p\u003e \u003cp\u003eRates of transient recurrent laryngeal nerve (RLN) palsy, hematoma, and reoperation for bleeding were comparable between groups, with no cases of permanent RLN injury observed. Given the descriptive design of the study, no formal statistical comparison was performed, and these findings should be interpreted accordingly.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study describes a five-year single-center experience with mini-incision thyroidectomy (MIT) across a range of selected thyroid pathologies. In this cohort, MIT was completed through a consistently short cervical incision, with operative time and perioperative outcomes falling within ranges reported in the thyroidectomy literature. Patient-reported scar satisfaction was high, and no conversions to a conventional incision were required within the selected cohort. The technique followed standard open thyroidectomy principles and did not rely on endoscopic or robotic platforms. These findings reflect practice within a high-volume endocrine surgery unit and should be interpreted in the context of deliberate case selection.\u003c/p\u003e \u003cp\u003eGiven the retrospective single-cohort design and absence of a contemporaneous control group, direct comparative conclusions cannot be drawn. Accordingly, the results are presented descriptively and interpreted relative to ranges reported in published thyroidectomy series.\u003c/p\u003e\n\u003ch3\u003eComparison with Previous Literature\u003c/h3\u003e\n\u003cp\u003eFindings from this cohort are consistent with previously published reports describing reduced-incision thyroidectomy in selected patients. Earlier studies have reported acceptable complication profiles and favorable cosmetic outcomes when small-incision approaches are applied within appropriate selection criteria (\u003cspan additionalcitationids=\"CR8\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eContemporary literature similarly reports favorable cosmetic outcomes and acceptable perioperative results with reduced-incision techniques; however, many of these studies include comparative designs or different patient selection criteria, which should be considered when interpreting cross-study comparisons (\u003cspan additionalcitationids=\"CR15 CR16 CR17 CR18 CR19\" citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn this context, the present cohort contributes additional descriptive data from a relatively large single-center experience. The inclusion of a range of thyroid pathologies provides insight into how MIT is applied in routine practice within defined selection criteria; however, generalizability remains dependent on similar patient selection and surgical expertise.\u003c/p\u003e \u003cdiv id=\"Sec37\" class=\"Section2\"\u003e \u003ch2\u003eSafety Profile\u003c/h2\u003e \u003cp\u003eThe observed safety profile falls within ranges reported for conventional thyroidectomy in the literature (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). Rates of transient hypocalcemia were within expected ranges, and permanent hypoparathyroidism was rare. These findings suggest that parathyroid preservation is achievable within a reduced-incision approach when standard capsular dissection principles are applied.\u003c/p\u003e \u003cp\u003eThe incidence of RLN palsy also fell within reported ranges from high-volume endocrine units (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e), although interpretation is limited by the absence of routine postoperative laryngoscopic assessment. The RLN was visually identified in all cases.\u003c/p\u003e \u003cp\u003eWound-related complications were infrequent and within reported ranges (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). The few postoperative hematomas requiring reoperation occurred early in the series and were treated promptly, with no documented long-term sequelae. The limited extent of flap dissection and use of energy-based hemostasis may have contributed to these findings, although this cannot be directly assessed within the current study design.\u003c/p\u003e \u003cp\u003ePostoperative analgesia was delivered using an opioid-sparing regimen that incorporated a cervical field block. Pain scores were not routinely recorded; however, postoperative analgesic requirements were generally low, with opioid escalation required only in a minority. Cervical regional blockade has been reported to reduce postoperative pain and opioid requirements after thyroid surgery (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eWithin-cohort descriptive comparison suggested modest increases in operative time, blood loss, and hypocalcemia rates with total/near-total thyroidectomy compared to hemithyroidectomy, which is expected given the greater extent of dissection. However, no formal comparative analysis was performed, and these observations should be interpreted cautiously.\u003c/p\u003e \u003cdiv id=\"Sec38\" class=\"Section3\"\u003e \u003ch2\u003eCosmetic Outcomes\u003c/h2\u003e \u003cp\u003eCosmesis remains an important consideration in thyroid surgery, particularly among younger patients. In this cohort, patient-reported satisfaction with scar appearance was high, while objective scar abnormalities were uncommon. These findings are consistent with prior reports suggesting that reduced-incision approaches can achieve favorable cosmetic outcomes in appropriately selected patients (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eCosmetic outcomes in the present study were assessed using structured patient-reported feedback combined with clinical inspection of the scar. However, no validated scar assessment tool was applied. This limits direct comparability with studies that use standardized instruments and introduces the potential for observer and reporting bias.\u003c/p\u003e \u003cp\u003eWithin these limitations, objective scar abnormalities were observed in 3.8% of patients, and overall cosmetic dissatisfaction was reported in 4.8%. Published studies using validated tools such as the Patient and Observer Scar Assessment Scale (POSAS) have reported similarly favorable cosmetic profiles for reduced-incision thyroidectomy. In this context, Table\u0026nbsp;8 is presented to provide a general comparison with existing literature rather than a direct methodological comparison.\u003c/p\u003e \u003cp\u003eThe use of a small cervical incision combined with limited soft-tissue dissection may have contributed to the favorable scar appearance observed. From a practical perspective, reduced incision length may be particularly relevant for patients who prioritize minimizing visible scarring when considering surgical options.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec39\" class=\"Section2\"\u003e \u003ch2\u003eEfficiency and Practicality\u003c/h2\u003e \u003cp\u003eIn this series, MIT was completed with a mean operative time of less than one hour, and incision extension was not required, including during bilateral resections and malignant cases. As the operative steps follow standard open thyroidectomy principles, the technique can be performed by surgeons experienced in open endocrine surgery. MIT was carried out without the use of robotic or endoscopic platforms or insufflation systems, which may be relevant for centers where access to additional equipment is limited.\u003c/p\u003e \u003cp\u003eOperative duration did not show a marked increase across procedure type or underlying pathology in this cohort.\u003c/p\u003e \u003cdiv id=\"Sec40\" class=\"Section3\"\u003e \u003ch2\u003eApplicability in Thyroid Cancer\u003c/h2\u003e \u003cp\u003eSelected patients with low-risk differentiated thyroid carcinoma underwent MIT, with perioperative outcomes similar to those observed within the cohort.\u003c/p\u003e \u003cp\u003eThis study was not designed to assess oncologic adequacy or long-term oncologic outcomes, and no conclusions regarding oncologic equivalence can be drawn.\u003c/p\u003e \u003cp\u003eImportantly, malignant pathology represented a meaningful proportion of our cohort, reflecting a typical real-world endocrine surgery population. Among the 38 malignant cases, papillary thyroid carcinoma was the most common subtype (18.4%), followed by micropapillary carcinoma (7.9%), follicular carcinoma (5.3%), H\u0026uuml;rthle cell carcinoma (5.3%), follicular-variant papillary thyroid carcinoma (5.3%), and smaller numbers of medullary carcinoma, poorly differentiated carcinoma, and large-cell lymphoma (each 2.6%). Across this spectrum of largely intrathyroidal malignancies, MIT was completed without incision extension and with perioperative outcomes comparable to the overall cohort.\u003c/p\u003e \u003cp\u003eFindings from other minimally invasive approaches suggest feasibility in selected low-risk cases; however, differences in technique and study design should be considered when interpreting these comparisons. (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). Based on our follow-up and published long-term series, MIT appears feasible in selected patients with intrathyroidal tumors and no extrathyroidal extension, when performed by experienced surgeons in high-volume settings.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e\n\u003ch3\u003eStrengths and Limitations\u003c/h3\u003e\n\u003cp\u003eThe present findings should be interpreted within the context of a descriptive cohort design. Rather than aiming to demonstrate superiority over conventional thyroidectomy, this study was intended to evaluate the feasibility, safety, and consistency of MIT when applied in routine clinical practice. In this setting, operative performance remained stable across different procedure types, with outcomes falling within accepted ranges reported in the literature.\u003c/p\u003e \u003cp\u003eFrom a practical perspective, these findings suggest that MIT can be adopted as a reduced-incision alternative within standard endocrine surgical workflows, without the need for technology-dependent approaches such as endoscopic or robotic platforms. This may be particularly relevant in settings where resources are limited or where preservation of conventional surgical technique is preferred.\u003c/p\u003e \u003cp\u003eIn this context, MIT should be viewed as a refinement of established open thyroidectomy rather than a departure from it, offering a balance between surgical familiarity and improved cosmetic outcomes.\u003c/p\u003e \u003cp\u003e \u003cb\u003eSeveral limitations should be acknowledged.\u003c/b\u003e The study is limited by its retrospective single-cohort design, the absence of a contemporaneous control group, and potential selection bias related to predefined eligibility criteria, precluding formal comparative analysis. Cosmetic outcomes were not assessed using a validated scar scoring system. Routine postoperative laryngoscopy was not performed, which may have led to underestimation of transient RLN dysfunction. Pain and recovery outcomes were not evaluated using standardized measures, and long-term oncologic outcomes were not assessed.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e\n\u003ch3\u003eFuture Directions\u003c/h3\u003e\n\u003cp\u003eProspective comparative studies using matched cohorts or randomized designs are needed to better define differences in outcomes, including pain, recovery, and cosmetic results.\u003c/p\u003e \u003cp\u003eFuture studies should incorporate validated patient-reported outcome measures, standardized scar assessment tools, and longer-term follow-up, particularly in patients with malignant disease.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn this single-center retrospective cohort, mini-incision thyroidectomy (MIT) was applied in carefully selected patients across a range of thyroid indications while maintaining a consistently short cervical incision. Operative time, blood loss, and postoperative morbidity fell within ranges reported for conventional thyroidectomy in the literature.\u003c/p\u003e \u003cp\u003ePatient-reported satisfaction with scar appearance was high, and objective scar abnormalities were infrequent. MIT was performed using standard open thyroidectomy principles and conventional instrumentation, without reliance on endoscopic or robotic platforms.\u003c/p\u003e \u003cp\u003eThese findings support MIT as a reduced-incision variation of open thyroidectomy in appropriately selected patients, rather than as a comparative alternative to conventional approaches.\u003c/p\u003e \u003cp\u003eFurther prospective comparative studies incorporating validated patient-reported outcomes, standardized scar assessment tools, and longer oncologic follow-up are required to define its role better.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eEthics approval and consent to participate\u003c/p\u003e\n\u003cp\u003eThe study was approved by the Institutional Review Board of Mansoura University (approval code: R.26.01.3519.R1). Given the retrospective design and use of anonymized data, the requirement for individual informed consent was waived.\u003c/p\u003e\n\u003cp\u003eClinical trial number: not applicable\u003c/p\u003e\n\u003cp\u003eConsent for publication\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003eAvailability of data and materials\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003eCompeting interests\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003eFunding\u003c/p\u003e\n\u003cp\u003eThe authors received no specific funding for this work.\u003c/p\u003e\n\u003cp\u003eAuthors\u0026rsquo; contributions\u003c/p\u003e\n\u003cp\u003eStudy conception and design: Waleed Gado\u003c/p\u003e\n\u003cp\u003eData acquisition: Ahmed Taki-Eldin, Mohammed Elghandour, Ahmed Lotfy\u003c/p\u003e\n\u003cp\u003eData analysis and interpretation: Waleed Gado, Mohammed Tarek\u003c/p\u003e\n\u003cp\u003eManuscript drafting: Mohammed Tarek\u003c/p\u003e\n\u003cp\u003eCritical revision of the manuscript: All authors\u003c/p\u003e\n\u003cp\u003eAll authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003eAcknowledgements\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eDordea M, Aspinall SR. 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Surgery. 2008;144(6):1016\u0026ndash;22. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.surg.2008.07.024\u003c/span\u003e\u003cspan address=\"10.1016/j.surg.2008.07.024\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEl Fol HA, Ammar MS, Elbalshy MA, Sobeeh M. Feasibility of using minimal incision in thyroidectomy operation. Int Surg J. 2019;6(12):4266\u0026ndash;71. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.18203/2349-2902.isj20195385\u003c/span\u003e\u003cspan address=\"10.18203/2349-2902.isj20195385\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable (1)\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eThyroid ultrasound assessment criteria used for patient selection and preoperative evaluation, based on standardized ultrasound measurement methodology and international clinical practice guidelines (10-11)\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"633\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eParameter\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAssessment Method\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eNotes / Clinical Relevance\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eLobe dimensions\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMeasured in 3 orthogonal planes (length \u0026times; width \u0026times; depth)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eUsed to calculate thyroid lobe volume\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eLobe volume formula\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eVolume = 0.479 \u0026times; (length \u0026times; width \u0026times; depth)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eUsing validated Brunn correction factor in Standard Brunn et al. formula(10)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eIsthmus thickness\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eLinear measurement\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eHelps identify significant gland enlargement\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eNodule size\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMaximum transverse or longitudinal diameter\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eDetermines surgical eligibility for MIT\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eNodule characteristics\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSolid/cystic composition, echogenicity, margins\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eRelevant for malignancy risk assessment\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eSuspicious features\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMicrocalcifications, taller-than-wide shape, irregular borders\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eDirects need for FNA and surgical planning\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eCervical lymph nodes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSize, shape, hilum presence\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eAssesses metastatic disease in DTC\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eGoiter extension\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eAssessment for retrosternal or substernal extension\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eContraindication for MIT if significant\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable (2) Preoperative Thyroid Ultrasound Characteristics of the Cohort Study\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eUltrasound Parameter\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eRange\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean \u0026plusmn; SD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eNotes / Clinical Interpretation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eRight/Left Lobe Volume (mL)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e21 \u0026ndash; 50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e35.05 \u0026plusmn; 6.61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eno massive goiters reported\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eLargest Nodule Size (cm)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.9 \u0026ndash; 4.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2.56 \u0026plusmn; 0.84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eAll cases within safe MIT nodule size limits\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eIsthmus Thickness\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003eNot systematically measured\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNo cases excluded due to isthmus enlargement\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eGoiter Extension\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNo substernal cases\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMatches exclusion criteria for MIT\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eSuspicious US Features\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePresent in malignant group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eConsistent with DTC subgroup (18.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eFocal Thyroiditis (US + histology)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e12.4%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePresence confirmed on final pathology\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eVolume calculated using Brunn et al. (1981) formula\u003c/strong\u003e:\u003cbr\u003e\u003cstrong\u003eVolume = 0.479 \u0026times; (L \u0026times; W \u0026times; D)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable (3) Fine-Needle Aspiration Cytology (FNA) Distribution According to ATA/BSRTC Guidelines\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;(Bethesda classification)\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eBethesda Category\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eInterpretation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo. of Patients\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e% of Cohort\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eII \u0026ndash; Benign\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eColloid, hyperplastic, adenomatous nodules\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e127\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e60.8%\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eIII \u0026ndash; AUS/FLUS\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eIndeterminate / atypical\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e8.6%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eIV \u0026ndash; Follicular Neoplasm / Suspicious FN\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eE.g., follicular adenoma, Hurthle adenoma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eV \u0026ndash; Suspicious for Malignancy\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSuspicious cytology\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e6.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eVI \u0026ndash; Malignant\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eConfirmed papillary, follicular, medullary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e18.2%\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u003c/strong\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable (4)\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eDistribution of Malignant FNA Diagnoses (n = 38)\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eDiagnosis\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003en\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePapillary thyroid carcinoma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e18.4%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMicropapillary carcinoma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e7.9%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eFollicular carcinoma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eH\u0026uuml;rthle cell carcinoma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eFollicular variant PTC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMedullary carcinoma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2.6%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePoorly differentiated carcinoma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2.6%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eLarge-cell lymphoma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2.6%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eTotal malignant cases\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e100%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u003c/strong\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable (5)\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eRelationship between preoperative cytology (Bethesda classification) and final histopathology\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eBethesda Category\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003en\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eBenign Histopathology (n, %)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eMalignant Histopathology (n, %)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eII (Benign)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e127\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e122 (96.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5 (3.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eIII (AUS/FLUS)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e12 (66.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e6 (33.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eIV (FN/SFN)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e7 (58.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5 (41.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eV (Suspicious)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3 (21.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e11 (78.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eVI (Malignant)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e38 (100%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e209\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e144 (68.9%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e65 (31.1%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eNote:\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;Cytology was classified according to the Bethesda System for Reporting Thyroid Cytopathology (TBSRTC).\u003cbr\u003e\u0026nbsp;Histopathological diagnosis represents the final postoperative findings.\u003cbr\u003e\u0026nbsp;Values are presented descriptively; no diagnostic accuracy analysis was performed within this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable (6)\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/strong\u003e\u003cstrong\u003ePerioperative outcomes according to final pathology (descriptive comparison)\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eBenign Disease (n = 171)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eMalignant Disease (n = 38)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eOperative time (min), mean \u0026plusmn; SD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e58.1 \u0026plusmn; 15.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e63.7 \u0026plusmn; 18.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eEstimated blood loss (mL), mean \u0026plusmn; SD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e33.2 \u0026plusmn; 12.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e38.6 \u0026plusmn; 13.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eTransient hypocalcemia (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e8.8%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e12.1%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePermanent hypoparathyroidism (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.6%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eTransient RLN palsy (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e7.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e10.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePermanent RLN injury (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eHematoma (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2.9%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5.2%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eCosmetic dissatisfaction (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eNote:\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;Findings are presented descriptively. The study was not designed for comparative subgroup analysis, and differences should be interpreted with caution.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable (7)\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003ePerioperative outcomes according to extent of surgery (descriptive comparison)\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eHemithyroidectomy (n = 63)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal/Near-total Thyroidectomy (n = 146)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eOperative time (min), mean \u0026plusmn; SD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e54.2 \u0026plusmn; 14.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e61.8 \u0026plusmn; 17.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eEstimated blood loss (mL), mean \u0026plusmn; SD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e28.6 \u0026plusmn; 10.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e36.9 \u0026plusmn; 13.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eTransient hypocalcemia (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e9.6%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePermanent hypoparathyroidism (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eTransient RLN palsy (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e6.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e8.2%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePermanent RLN injury (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eHematoma (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.6%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3.4%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eReoperation for bleeding (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.4%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eNote:\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;Values are presented descriptively. No formal statistical comparison was performed due to the single-cohort study design. Hypocalcemia outcomes are not applicable to hemithyroidectomy.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable (8)\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eSummary of cosmetic outcome assessment methods and reported findings in selected reduced-incision thyroidectomy series\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" class=\"fr-table-selection-hover\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eStudy / Technique\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAssessment Tool\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eReported Cosmetic Outcomes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eHow It Compares to Current MIT Study\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eCurrent MIT Study (n=209)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eStructured patient-reported satisfaction and clinical scar inspection (non-validated assessment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026bull; Hypertrophy / widening: \u003cstrong\u003e3.8%\u003c/strong\u003e \u0026bull; Cosmetic dissatisfaction: \u003cstrong\u003e4.8%\u003c/strong\u003e \u0026bull; Majority with \u0026ldquo;Excellent/Good\u0026rdquo; scars (~91%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"6\" valign=\"top\"\u003e\n \u003cp\u003eProvides contextual comparison only; direct comparison is limited by differences in study design and assessment methods\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eMiccoli et al., MIVAT (17)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePOSAS-like descriptors\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026bull; Excellent cosmetic satisfaction in \u003cstrong\u003e\u0026gt;90%\u003c/strong\u003e of patients \u0026bull; Very low hypertrophic scarring\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eDel Rio et al., 5-year MIVAT follow-up ((24)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePatient-reported + clinical exam\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026bull; Long-term cosmetic results remained \u003cstrong\u003eexcellent\u003c/strong\u003e \u0026bull; No significant late hypertrophic scars\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eF\u0026iacute;k et al., MIVAT vs MINET RCT (21)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eVancouver Scar Scale + patient scoring\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026bull; Both approaches produced \u003cstrong\u003esuperior cosmetic results\u003c/strong\u003e \u0026bull; MINET (non-endoscopic MIT) showed \u003cstrong\u003eequally favorable scars\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eSywak et al., Lateral Mini-incision MIT ((25)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePatient scar satisfaction\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026bull; Significantly better cosmetic results than open surgery \u0026bull; No increase in poor scars\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eEl-Fol et al., Minimal-incision thyroidectomy (26)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePatient satisfaction scale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026bull; Scar dissatisfaction: \u003cstrong\u003e\u0026lt;5%\u003c/strong\u003e \u0026bull; Scar complications: \u003cstrong\u003e~4%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bsur","sideBox":"Learn more about [BMC Surgery](http://bmcsurg.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bsur/default.aspx","title":"BMC Surgery","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Mini-incision thyroidectomy, Thyroidectomy, Thyroid neoplasms, Postoperative complications, Cosmetic outcomes","lastPublishedDoi":"10.21203/rs.3.rs-9328096/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9328096/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eConventional open thyroidectomy remains the standard approach for most thyroid diseases but may result in a visible cervical scar that affects patient satisfaction. Mini-incision thyroidectomy (MIT) is a reduced-access modification of open surgery designed to limit incision length while preserving established operative principles. Evidence describing its performance in routine clinical practice remains limited.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eWe conducted a retrospective cohort study of consecutive patients who underwent MIT at a high-volume endocrine surgery unit between December 2014 and December 2019. Demographic, clinical, and operative data were analyzed, including incision length, perioperative outcomes, and patient-reported cosmetic satisfaction. All procedures were performed using a standardized non-endoscopic technique. Given the single-cohort design without a contemporaneous control group, outcomes were analyzed descriptively.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eA total of 209 patients were included (79.9% female; mean age 39.6 years). Mean incision length was 2.81 cm, and MIT was completed in all cases without conversion. Mean operative time was 59.4 minutes, with minimal blood loss. Transient hypocalcemia occurred in 9.6% of patients, and transient recurrent laryngeal nerve palsy in 7.7%, with no permanent nerve injury. Permanent hypoparathyroidism occurred in one patient (0.5%). Reoperation for bleeding was required in 1.0% of cases. Cosmetic dissatisfaction was reported by 4.8% of patients.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eIn this single-center retrospective cohort, MIT was safely performed in carefully selected patients, with perioperative outcomes within ranges reported for conventional thyroidectomy. These findings support MIT as a reduced-incision variation of open thyroidectomy rather than a comparative alternative. Interpretation is limited by the retrospective design, absence of a control group, and non-validated cosmetic assessment. Prospective comparative studies are required to further define its role.\u003c/p\u003e","manuscriptTitle":"Mini-incision Thyroidectomy in Contemporary Practice: Safety, Efficiency, and Cosmetic Outcomes from a Large Consecutive Cohort","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-05-07 17:32:52","doi":"10.21203/rs.3.rs-9328096/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewerAgreed","content":"244190589256106557539181544507650609596","date":"2026-04-30T20:58:25+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-04-23T06:39:37+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-04-09T12:28:34+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-04-07T07:23:24+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-04-07T07:22:47+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Surgery","date":"2026-04-05T18:40:51+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bsur","sideBox":"Learn more about [BMC Surgery](http://bmcsurg.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bsur/default.aspx","title":"BMC Surgery","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"cb3800de-4511-496f-91a1-f81bc23bf847","owner":[],"postedDate":"May 7th, 2026","published":true,"recentEditorialEvents":[{"type":"reviewerAgreed","content":"244190589256106557539181544507650609596","date":"2026-04-30T20:58:25+00:00","index":39,"fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-07T17:32:53+00:00","versionOfRecord":[],"versionCreatedAt":"2026-05-07 17:32:52","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9328096","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9328096","identity":"rs-9328096","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}