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

Abstract

Purpose: Remote-access thyroidectomy techniques and minimally invasive video-assisted thyroidectomy (MIVAT) have been developed to optimize cosmetic outcomes and potentially improve recovery, particularly in the case of MIVAT, compared with the conventional transcervical approach (CTA). However, comparative evidence regarding postoperative pain outcomes remains limited. This study aims to evaluate postoperative pain outcomes among MIVAT and five remote-access approaches-breast approach (BA), bilateral axillo-breast approach (BABA), gasless transaxillary approach (GTAA), retroauricular approach (RA), and transoral approach (TOA)-in comparison with CTA. Methods: A systematic review and network meta-analysis were conducted. PUBMED, EMBASE, and the Cochrane Library were searched through March 2025. Pain outcomes across surgical approaches were compared using a frequentist random-effects network meta-analysis. Results: Sixty-one studies involving 9,780 patients were included. On postoperative day one, MIVAT was associated with the lowest pain scores, followed by the BA and TOA. At one-week and one-month follow-ups, MIVAT and TOA consistently exhibited the most favorable pain outcomes. Conversely, the RA and BABA were linked to the highest pain scores on day one and at one week. Differences in postoperative pain between robotic and endoscopic techniques within the same approach were not significant, although robotic RA and robotic TOA showed lower pain scores than those of their endoscopic counterparts. Conclusion: MIVAT and TOA provide superior postoperative pain outcomes than those of CTA and other remote-access approaches. Robotic techniques may offer additional benefits over endoscopic methods in selected cases. These findings may support more patient-centered surgical decision-making.