🦋 Thyroid Surgery
Thyroid Surgery: Open, Endoscopic & Robotic — Which One Is Right for You?
July 22, 2026
10 min read
If you have been told you need thyroid surgery, you may feel overwhelmed by the different terms your doctor uses — open surgery, endoscopic surgery, TOETVA, robotic surgery. What do they all mean? Which one is better? Which one is right for you?
I am Dr. Prabhakaran U, a Surgical Oncologist at KG Hospital, Coimbatore. I perform all three types of thyroid surgery. In this article, I will explain each approach in plain language — what it involves, who it suits, and what to expect — so that when you sit down with your surgeon, you can have an informed conversation.
All three approaches — open, endoscopic, and robotic — can achieve the same surgical goal: safe, complete removal of the thyroid with protection of the voice nerve (recurrent laryngeal nerve) and calcium glands (parathyroid glands). The differences lie in where the incision is made, what scar is left, and the recovery experience.
Choosing the right approach is not about which is the most "advanced" — it is about which is the most appropriate for your specific condition, anatomy, and personal priorities.
Open thyroidectomy is the traditional surgical approach that has been performed for over a century. It remains the most widely used and most extensively validated method for thyroid surgery worldwide.
A horizontal incision of approximately 4–8 cm is made in the lower part of the front of the neck — usually along a natural skin crease to minimise scar visibility. Through this incision, the surgeon directly accesses and removes the thyroid gland, clips any bleeding vessels, and carefully identifies and preserves the recurrent laryngeal nerve and parathyroid glands. The incision is then closed with fine sutures or surgical glue.
Endoscopic thyroid surgery was developed to avoid a visible scar on the neck. Instead of opening the neck directly, the surgeon reaches the thyroid through small incisions made away from the neck — in the mouth, the armpit, or behind the ear — and uses a camera and long instruments to operate.
TOETVA is the most popular and most elegant endoscopic thyroid technique. The entire operation is performed through three tiny incisions inside the lower lip — completely hidden inside the mouth. There is no external incision at all.
Three small cuts (5–10 mm each) are made in the vestibule of the lower lip — the space between the gum and the lip. A small amount of carbon dioxide gas is used to create a working space under the skin of the chin and neck. The camera and instruments are passed through these hidden openings to reach and remove the thyroid gland. The incisions are closed with dissolvable stitches inside the mouth — there is nothing to dress at home and no external scar to worry about.
I trained directly under Dr. Angkoon Anuwong at Police General Hospital, Bangkok, Thailand — the surgeon who invented TOETVA and has performed the most of these operations worldwide. I now perform TOETVA at KG Hospital, Coimbatore.
In the transaxillary approach, a single incision of approximately 5–6 cm is made in the armpit (axilla). A tunnel is created under the skin of the chest and up to the neck, through which the camera and instruments reach the thyroid. The neck remains completely scar-free.
Comparison of thyroid surgery approaches — showing open, transaxillary endoscopic, TOETVA oral, and robotic methods
Robotic thyroid surgery uses the Da Vinci robotic system — the same platform used for robotic lung, pancreatic, and pelvic cancer surgeries. The surgeon controls robotic arms from a console, with 3D magnified vision up to 10× and instruments that articulate with 7 degrees of freedom — far beyond the range of the human hand or conventional laparoscopic tools.
Importantly: the robot does not operate on its own. Every single movement of the robotic instruments is directly controlled by the surgeon in real time. The robot simply makes the surgeon's movements more precise, tremor-free, and ergonomic.
Both robotic and endoscopic thyroid surgeries avoid a neck scar. The key differences are the tools used and the level of precision achievable:
Robotic thyroid surgery offers particular advantages when extensive lymph node dissection is needed alongside thyroidectomy — where the robot's fine dissection capabilities around critical neck structures (vessels, nerves) are invaluable.
I hold the Certificate of Training Equivalency as a Console Surgeon — Da Vinci X Surgical System, issued by Intuitive Surgical on 22 June 2026 at KG Hospital, Coimbatore, under Chief of Surgery Dr. Kalyanasundarabharathi VC.
| Feature | Open Surgery | TOETVA (Oral) | Transaxillary | Robotic |
|---|---|---|---|---|
| Neck scar | Yes (4–8 cm) | None | None | None |
| External incision | Neck | Inside lip (hidden) | Armpit | Armpit or oral |
| Hospital stay | 1–2 days | 1–2 days | 1–2 days | 1–2 days |
| Return to desk work | 1–2 weeks | 1 week | 1–2 weeks | 1–2 weeks |
| Suitable for large goitres | Yes | Selected | Selected | Selected |
| Suitable for thyroid cancer | All stages | Early stage | Selected | Including lymph nodes |
| 3D magnified vision | No | HD 2D camera | HD 2D camera | Yes — up to 10× |
| Instrument articulation | Full manual | Standard | Standard | Superior (7 DoF) |
| Operative time | Shortest | Moderate | Moderate–long | Moderate–long |
| Cost | Lowest | Moderate | Moderate | Highest |
| Available in Coimbatore | Yes | Yes — KG Hospital | Yes — KG Hospital | Yes — KG Hospital |
The recurrent laryngeal nerve — the nerve that controls the voice box (larynx) — runs very close to the thyroid gland on both sides. Injury to this nerve can cause hoarseness or voice weakness. This risk applies to all three approaches.
In experienced hands, the risk of permanent voice change after thyroid surgery is less than 1%. In all approaches I perform, I use intraoperative nerve monitoring (IONM) — a real-time system that electrically confirms the nerve is functioning normally throughout the operation.
The parathyroid glands — four tiny glands that sit behind the thyroid and control blood calcium levels — can be temporarily disturbed during total thyroidectomy. This causes a temporary drop in calcium, leading to tingling in the fingertips, toes, or around the mouth for a few weeks.
This is managed with calcium and Vitamin D supplements after surgery. Permanent hypoparathyroidism (long-term calcium problems) occurs in less than 2% of cases in experienced centres. The risk is the same regardless of which surgical approach is used.
Thyroid cancer surgery requires complete removal of the thyroid and — in many cases — removal of lymph nodes in the central neck (central compartment dissection). The surgical approach is chosen based on cancer stage, lymph node involvement, and tumour size:
Important: Cure rates for differentiated thyroid cancer (papillary and follicular) are excellent regardless of whether open or minimally invasive surgery is used — provided the surgery is complete and performed in an experienced centre. The choice of approach does NOT compromise cancer control when done correctly.
When a patient comes to me with thyroid disease, I assess several factors before recommending an approach:
I always discuss all available options with each patient — including their pros, cons, costs, and suitability — so that we make the decision together. There is no single right answer that suits everyone.
Yes. Multiple published studies comparing TOETVA and robotic thyroid surgery to conventional open surgery show equivalent rates of complete thyroid removal, nerve preservation, and long-term cancer control. The safety and outcomes depend primarily on the surgeon's experience and training, not the approach itself.
If the entire thyroid is removed (total thyroidectomy), you will take a daily thyroxine (thyroid hormone) tablet for life. This is a simple, well-tolerated medication. If only half the thyroid is removed (hemithyroidectomy), many patients do not need medication — though about 20–30% will eventually require thyroxine supplementation as the remaining half may not produce enough hormone.
Permanent voice change is rare (<1%) in experienced hands. Temporary mild voice changes or fatigue are more common and usually resolve within weeks. I use nerve monitoring in all thyroid operations to reduce this risk.
The neck scar from open thyroidectomy is placed along a natural skin crease. In most patients, it fades significantly over 6–12 months and becomes barely noticeable. Scar gels and sun protection help it heal well. For patients who are particularly concerned about neck visibility, TOETVA or robotic surgery are excellent alternatives.
Open total thyroidectomy: 1.5–2 hours. TOETVA: 2–3 hours. Robotic thyroidectomy: 2.5–3.5 hours. Times vary based on complexity and whether lymph node dissection is included.
Yes. I perform TOETVA, transaxillary endoscopic, and robotic thyroid surgery at KG Hospital, Coimbatore — making all three scarless approaches available to patients in Tamil Nadu and across South India without needing to travel to Chennai or abroad.
Modern thyroid surgery — regardless of the approach chosen — achieves excellent outcomes. The thyroid can be safely removed, the voice nerve can be identified and preserved, the calcium glands can be protected, and cancer can be completely eradicated.
What has changed dramatically in recent years is the experience of surgery — the scar, the recovery, the return to normal life. For patients who do not want a neck scar, we now have safe, proven alternatives that were not available a decade ago.
If you have been advised to have your thyroid removed, I invite you to come and discuss all the options with me at KG Hospital, Coimbatore. Together, we will find the approach that is right for you — for your disease, your body, your life, and your priorities.
MBBS · MS · MCh (Surgical Oncology) | Consultant Surgical Oncologist & Lung Cancer Specialist | KG Hospital, Coimbatore
Dr. Prabhakaran U is a Consultant Surgical Oncologist performing all three approaches to thyroid surgery — including scarless TOETVA (trained under pioneer Dr. Angkoon Anuwong in Bangkok), robotic thyroid surgery (Da Vinci X Certified Console Surgeon), and conventional open thyroidectomy. He has performed over 1,000 cancer surgeries at KG Hospital, Coimbatore.
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