MIRA is feasible and safe for thyroid cancer but requires longer operative times than COARobotic and Endoscopic Surgery Show Safety for Thyroid Cancer

Head & neck Published October 8, 2026 Study authors: Valenziano Claudia, Costantino Andrea, Sebastiani Martina, Russell Marika D, Abdelhamid Ahmed Amr H,… PubMed ↗ DOI ↗ Editorial oversight: Dr. Lars van Dijk, PhD · Surgical, Procedural & Diagnostic

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Key Takeaway

Note that MIRA is a feasible and safe alternative to COA but involves significantly longer operative times.

This meta-analysis evaluates the safety and efficacy of minimally invasive remote approaches (MIRA), including robotic and endoscopic techniques, compared to the conventional open approach (COA) for patients undergoing total thyroidectomy and central neck dissection. The analysis included 1626 patients to assess operative time, complications, and lymph node retrieval.

Key findings indicate that MIRA is associated with significantly longer operative times compared to COA (SMD 1.75; 95% CI 1.39-2.11). However, there were no significant differences between MIRA and COA regarding transient vocal fold paralysis (OR 1.38; 95% CI 0.93-2.04) or transient hypoparathyroidism (OR 0.83; 95% CI 0.46-1.49). Intraoperative blood loss, postoperative drainage volume, and length of hospital stay were comparable between groups. The MIRA group had a slightly lower number of retrieved lymph nodes (SMD -0.12; 95% CI -0.26 to -0.003).

Limitations include inconsistent reporting of permanent vocal fold paralysis and permanent hypoparathyroidism, as well as a lack of long-term oncologic data. While MIRA is feasible and shows comparable complication rates to COA, COA remains the reference standard due to the longer operative times required for MIRA and the lack of established long-term oncologic outcomes.

How this fits prior evidence

This meta-analysis addresses a gap in surgical technique comparison for thyroid cancer. While previous evidence notes that high-frequency ultrasound serves as a complementary tool for recurrent laryngeal nerve management, this study specifically compares MIRA to COA. It confirms that MIRA is a feasible alternative with comparable complication rates to COA, though it notes the trade-off of longer operative times.

Researchers analyzed data from over 1,600 patients to compare minimally invasive remote approaches (MIRA) with conventional open surgery for thyroid cancer. MIRA includes both robotic and endoscopic techniques. The study looked at several factors, including how long the surgery took and the risk of complications like vocal fold paralysis or issues with the parathyroid glands.

The results showed that MIRA is a feasible and safe option. Patients who underwent minimally invasive procedures had similar rates of temporary vocal fold paralysis and temporary hypoparathyroidism compared to those who had traditional surgery. Other factors, such as blood loss and the length of hospital stays, were also similar between the two groups.

However, the study did find that MIRA procedures took significantly longer to perform than the standard open approach. Because of these longer times and a lack of long-term data on cancer outcomes, the traditional open approach remains the standard of care. Patients should discuss these surgical options and the specific trade-offs with their surgical team.

What this means for you:

Minimally invasive thyroid surgery is safe and has similar complication rates to traditional surgery, but takes longer.

Common questions

Is minimally invasive surgery safe for thyroid cancer?

Yes, the study of 1,626 patients found that minimally invasive remote approaches (MIRA) are feasible and safe. The rates of complications, such as transient vocal fold paralysis and transient hypoparathyroidism, were not significantly different compared to the conventional open approach.

How does the surgery time differ between methods?

The study found that the minimally invasive approach (MIRA) was associated with significantly longer operative times compared to the conventional open approach. Because of these longer times and limited long-term data, the open approach is still the standard of care.

Are there different risks for vocal fold paralysis?

The study found no significant difference in the rates of transient vocal fold paralysis between the minimally invasive and conventional open approaches. However, the study noted that reporting on permanent vocal fold paralysis was limited and inconsistent.

Study Details

Study typeMeta analysis

Sample sizen = 1,626

EvidenceLevel 1

PublishedOct 2026

PMID42481402

View Original Abstract ↓

BACKGROUND: Total thyroidectomy (TT) with central neck dissection (CND) is the standard surgical approach in selected thyroid cancer patients. Minimally invasive remote approaches (MIRA), either robotic or endoscopic, have been developed to improve cosmetic outcomes, but their oncological safety and efficacy remain debated. OBJECTIVE: To compare MIRA and the conventional open approach (COA) for CND during TT in terms of surgical outcomes, postoperative complications, and oncologic adequacy. METHODS: Following PRISMA 2020 guidelines, a systematic review and meta-analysis was conducted. PubMed/MEDLINE, Cochrane Library, and Scopus databases were searched up to November 24, 2025. Only comparative studies including TT and CND (either ipsilateral or bilateral) in thyroid carcinoma patients were included. Primary outcomes of interest were differences in operative time, rates of transient and permanent vocal fold paralysis, and incidence of transient and permanent hypoparathyroidism. RESULTS: Eleven comparative studies including 1626 patients were analyzed. MIRA was associated with a significantly longer operative time compared with COA (standardized mean difference (SMD) 1.75; 95% CI 1.39-2.11). No significant differences were observed between the two techniques in terms of transient vocal fold paralysis (OR 1.38; 95% CI 0.93-2.04) or transient hypoparathyroidism (OR 0.83; 95% CI 0.46-1.49). Intraoperative blood loss, postoperative drainage volume, and length of hospital stay were comparable between groups. The number of retrieved lymph nodes was slightly lower in the MIRA group, although the effect size was small (SMD -0.12; 95% CI -0.26 to -0.003). Due to limited and inconsistent reporting, permanent vocal fold paralysis and permanent hypoparathyroidism could not be quantitatively analyzed. CONCLUSION: MIRA for CND during TT appears to be feasible and safe in carefully selected thyroid cancer patients, with postoperative complication rates comparable to those of the COA. However, given the longer operative times and the limited evidence on long-term oncologic outcomes, the COA should remain the reference standard, while MIRA may be considered in selected patients at specialized high-volume centers.

MIRA is feasible and safe for thyroid cancer but requires longer operative times than COARobotic and Endoscopic Surgery Show Safety for Thyroid Cancer

How this fits prior evidence

Common questions

Study Details

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MIRA is feasible and safe for thyroid cancer but requires longer operative times than COARobotic and Endoscopic Surgery Show Safety for Thyroid Cancer

How this fits prior evidence

Common questions

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