Topographic and Anatomical Justification of the Choice of Surgical Approach in Thyroid Surgery

Background/Aims: Safe thyroidectomy depends on an approach that provides stable exposure of the poles, reliable hemostasis and protection of the external and recurrent laryngeal nerves. This review synthesizes topographic–anatomical determinants that justify the choice among open Kocher incision, minimally invasive video-assisted, endoscopic/remote-access and robotic approaches.

Materials and Methods: Narrative review of peer-reviewed anatomical, surgical and outcome studies (2000–2025; PubMed/Scopus/eLibrary). Key variables: relation of upper/lower thyroid poles to laryngeal framework and trachea, course of external branch of superior laryngeal nerve (EBSLN), recurrent laryngeal nerve (RLN), and vascular pedicles; exposure and complexity profiles across approaches.

Results: Optimal access aligns incision and working corridors with the expected positions of EBSLN at the superior pole, RLN in the tracheoesophageal groove, and parathyroid glands with their end-arterial supply. The Kocher approach remains the reference for bilateral disease or large goiter; minimally invasive/endoscopic routes yield superior cosmesis in selected nodular disease; remote and robotic approaches avoid a cervical scar but demand longer operative time and resources.

Conclusion: An anatomy-first algorithm—lesion extent, pole orientation, cervical habitus, need for bilateral exploration—should guide approach selection to reduce RLN injury and hypoparathyroidism while preserving oncologic and functional goals.