From technical feasibility to patient-centered selection in remote-access thyroidectomy: the AGES framework in the single-port robotic era
- 1Department of Surgery, Jen-Ai Hospital, Dali, Taichung, Taiwan
- 2Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
- 3Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
Abstract
Remote-access thyroidectomy now includes established endoscopic and multi-port robotic operations alongside emerging single-port (SP) techniques. Selection requires consideration of disease requirements, access burden, patient priorities, and the treating center’s capabilities. This narrative review synthesizes literature through 31 August 2026 on access routes, robotic platforms, recovery, patient-reported outcomes, and resource use. Comparative evidence is more developed for TOETVA and multi-port robotic approaches than for newer GOSTA, SPRA, and SAM techniques; evidence from these newer routes remains concentrated in selected institutional cohorts. Lateral neck dissection and reoperative SP reports demonstrate technical capability and short-term outcomes, without establishing long-term oncologic equivalence. Inflammatory biomarkers are surrogate biological endpoints and should be interpreted alongside patient-reported and functional outcomes. We propose AGES as a provisional, non-numeric conceptual heuristic: Age and physiologic reserve; Gland disease; Extension and Economics; and prior Surgery, Shape/anatomy, Scar priorities, Surgeon, and System capability. Its proposed sequence documents the operation required by disease, assesses access and platform feasibility within the available evidence, and then considers patient preference and local value. AGES supplements existing guidance by organizing these discussions and candidate research variables; it does not supply indications, validated thresholds, risk predictions, or treatment recommendations. Psychosocial readiness, equitable access, multidisciplinary capability, and longitudinal functional and hormonal outcomes require explicit consideration. Multidisciplinary Delphi refinement, prospective registration, external assessment, and clinical utility testing are needed before any decision-support role can be claimed.
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BibTeX
@article{wu2026from,
title = {{From technical feasibility to patient-centered selection in remote-access thyroidectomy: the AGES framework in the single-port robotic era}},
author = {Yi-Ju Wu and Yi-Chia Chan and Shun-Yu Chi and Fong-Fu Chou and Wei-Che Lin},
journal = {Frontiers in Endocrinology},
year = {2026},
month = nov,
doi = {10.3389/fendo.2026.1983957},
url = {https://doi.org/10.3389/fendo.2026.1983957},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - From technical feasibility to patient-centered selection in remote-access thyroidectomy: the AGES framework in the single-port robotic era
AU - Yi-Ju Wu
AU - Yi-Chia Chan
AU - Shun-Yu Chi
AU - Fong-Fu Chou
AU - Wei-Che Lin
PY - 2026
DA - 2026/11/11
JO - Frontiers in Endocrinology
DO - 10.3389/fendo.2026.1983957
UR - https://doi.org/10.3389/fendo.2026.1983957
AB - Remote-access thyroidectomy now includes established endoscopic and multi-port robotic operations alongside emerging single-port (SP) techniques. Selection requires consideration of disease requirements, access burden, patient priorities, and the treating center’s capabilities. This narrative review synthesizes literature through 31 August 2026 on access routes, robotic platforms, recovery, patient-reported outcomes, and resource use. Comparative evidence is more developed for TOETVA and multi-port robotic approaches than for newer GOSTA, SPRA, and SAM techniques; evidence from these newer routes remains concentrated in selected institutional cohorts. Lateral neck dissection and reoperative SP reports demonstrate technical capability and short-term outcomes, without establishing long-term oncologic equivalence. Inflammatory biomarkers are surrogate biological endpoints and should be interpreted alongside patient-reported and functional outcomes. We propose AGES as a provisional, non-numeric conceptual heuristic: Age and physiologic reserve; Gland disease; Extension and Economics; and prior Surgery, Shape/anatomy, Scar priorities, Surgeon, and System capability. Its proposed sequence documents the operation required by disease, assesses access and platform feasibility within the available evidence, and then considers patient preference and local value. AGES supplements existing guidance by organizing these discussions and candidate research variables; it does not supply indications, validated thresholds, risk predictions, or treatment recommendations. Psychosocial readiness, equitable access, multidisciplinary capability, and longitudinal functional and hormonal outcomes require explicit consideration. Multidisciplinary Delphi refinement, prospective registration, external assessment, and clinical utility testing are needed before any decision-support role can be claimed.
SN - 1664-2392
ER -