Remote-Access Thyroidectomy and Parathyroidectomy: A 2025 Consensus Statement from the Asia-Pacific Society of Thyroid Surgery, American Head and Neck Society, American Association of Endocrine Surgeons, American Thyroid Association, European Society of Endocrine Surgeons, and Latin American Thyroid Society

Abstract

Background: Remote-access thyroid and parathyroid surgery has emerged as a safe and effective alternative to conventional transcervical approaches, particularly valued for its superior cosmetic outcomes. However, global adoption remains inconsistent, hindered by variability in clinical indications, geographic and economic factors, learning curves, and training infrastructure. This international consensus statement aims to provide comprehensive, evidence-based guidance on patient selection, surgeon training, surgical approaches, and expected outcomes. An expert panel was convened with representatives nominated by six leading international societies The Asia-Pacific Society of Thyroid Surgery, American Head and Neck Society, American Association of Endocrine Surgeons, American Thyroid Association, European Society of Endocrine Surgeons, and Latin American Thyroid Society. A modified Delphi process, consistent with Conducting and Reporting of Delphi Studies guidelines, was used. Expert subgroups performed targeted literature reviews and formulated recommendations, which were refined through multiple rounds of anonymous electronic voting. Consensus was defined a priori as >= 80% agreement on a 5-point Likert scale.Summary: A total of 23 consensus statements were established. These include recommendations on minimum surgeon volume requirements, structured training pathways (including cadaveric dissection and proctoring), and patient eligibility based on disease characteristics. The four most commonly utilized remote-access approaches-transoral, gasless transaxillary, bilateral axillo-breast, and retroauricular-each offer distinct advantages and limitations. With an experienced surgeon, these techniques demonstrate oncologic and surgical outcomes comparable with open surgery, with notable improvements in cosmetic satisfaction. Approach-specific complications and extended operative times were acknowledged. The importance of informed consent and the development of high-volume centers of excellence was emphasized.Conclusions: This international consensus statement provides structured, evidence-informed recommendations to support the safe and effective implementation of remote-access thyroid and parathyroid surgery. Widespread dissemination and adoption of these recommendations may improve patient outcomes and promote global standardization of care.