title: American Thyroid Association Statement on Remote-Access Thyroid Surgery.
abstract: BACKGROUND
  Remote-access techniques have been described over the recent years as a method of removing the thyroid gland without an incision in the neck. However, there is confusion related to the number of techniques available and the ideal patient selection criteria for a given technique. The aims of this review were to develop a simple classification of these approaches, describe the optimal patient selection criteria, evaluate the outcomes objectively, and define the barriers to adoption.
  
  
  METHODS
  A review of the literature was performed to identify the described techniques. A simple classification was developed. Technical details, outcomes, and the learning curve were described. Expert opinion consensus was formulated regarding recommendations for patient selection and performance of remote-access thyroid surgery.
  
  
  RESULTS
  Remote-access thyroid procedures can be categorized into endoscopic or robotic breast, bilateral axillo-breast, axillary, and facelift approaches. The experience in the United States involves the latter two techniques. The limited data in the literature suggest long operative times, a steep learning curve, and higher costs with remote-access thyroid surgery compared with conventional thyroidectomy. Nevertheless, a consensus was reached that, in appropriate hands, it can be a viable option for patients with unilateral small nodules who wish to avoid a neck incision.
  
  
  CONCLUSIONS
  Remote-access thyroidectomy has a role in a small group of patients who fit strict selection criteria. These approaches require an additional level of expertise, and therefore should be done by surgeons performing a high volume of thyroid and robotic surgery.
authors: 1 Department of Endocrine Surgery, Cleveland Clinic , Cleveland, Ohio.
authors: Eren
authors: E
authors: Berber
authors: 2 Division of Endocrinology, Mayo Clinic , Jacksonville, Florida.
authors: Victor
authors: V
authors: Bernet
authors: 3 Department of Endocrine Surgery, Weill Cornell Medical College/New York Presbyterian Hospital , New York, New York.
authors: Thomas J
authors: TJ
authors: Fahey
authors: 4 Endocrine Oncology Branch, National Cancer Institutes of Health , Bethesda, Maryland.
authors: Electron
authors: E
authors: Kebebew
authors: 5 Department of Head and Neck Surgery, Memorial Sloan-Kettering Cancer Center , New York, New York.
authors: Ashok
authors: A
authors: Shaha
authors: 6 Department of Otolaryngology-Head and Neck Surgery, University of Arkansas for Medical Sciences , Little Rock, Arkansas.
authors: Brendan C
authors: BC
authors: Stack
authors: 7 Division of Endocrine Surgery, University of Pittsburgh Medical Center , Pittsburgh, Pennsylvania.
authors: Michael
authors: M
authors: Stang
authors: 8 Department of Otolaryngology-Head and Neck Surgery, University Hospital , Cincinnati, Ohio.
authors: David L
authors: DL
authors: Steward
authors: 9 Department of Otolaryngology, Augusta University , Augusta, Georgia .
authors: David J
authors: DJ
authors: Terris
mesh_terms: D001365:Axilla / Q000601:surgery*; D001940:Breast / Q000601:surgery*; D002983:Clinical Competence; D032921:Consensus; D003362:Cost-Benefit Analysis; D004724:Endoscopy / Q000009:adverse effects / Q000191:economics; D005260:Female; D017048:Health Care Costs; D006801:Humans; D059032:Learning Curve; D008297:Male; D018579:Patient Selection; D012307:Risk Factors; D065287:Robotic Surgical Procedures / Q000009:adverse effects / Q000191:economics; D012955:Societies, Medical; D016606:Thyroid Nodule / Q000175:diagnosis / Q000191:economics / Q000601:surgery*; D013965:Thyroidectomy / Q000009:adverse effects / Q000191:economics / Q000379:methods*; D016896:Treatment Outcome