Postoperative pain outcomes following thyroidectomy: a systematic review and network meta-analysis of various surgical approaches.

Summary

Across 61 studies (n=9,780), MIVAT and the transoral approach consistently yielded lower postoperative pain than conventional open and several remote-access techniques, particularly on day 1 and sustained to one month. Robotic platforms did not universally outperform endoscopic ones, though robotic retroauricular and transoral approaches showed lower pain in some comparisons.

Key Findings

• Network meta-analysis of 61 studies (n=9,780) compared MIVAT and five remote-access approaches versus conventional open surgery.
• MIVAT and transoral approach had the lowest postoperative pain at day 1 and maintained benefits at 1 week and 1 month.
• Retroauricular and bilateral axillo-breast approaches had higher early pain; robotic vs endoscopic differences were not significant overall.

Clinical Implications

When prioritizing reduced pain and improved cosmesis, MIVAT or transoral approaches can be considered, balancing surgeon expertise, resource availability, and oncologic/safety considerations.

Limitations

• Likely heterogeneity and inclusion of nonrandomized studies may introduce bias
• Pain measures and follow-up time points varied across studies

Future Directions

Prospective, standardized patient-reported outcomes across approaches and stratified analyses (e.g., benign vs malignant, extent of surgery) will refine guidance.