Surgery for thyroid disease requires skin incisions that can result in postsurgical problems. Therefore, several approaches in thyroid surgery have been developed to avoid large scars on the anterior neck. Since the first report of endoscopic subtotal parathyroidectomy, various endoscopic approaches have been reported. However, to be able to perform these procedures using endoscopic instruments in a skillful manner, sufficient training time and effort is required. We assessed the feasibility and cosmetic benefit of the far lateral neck approach using natural skin fold thyroidectomy.

From July 2011 to February 2014, 123 patients underwent thyroidectomy via far lateral neck approach by one surgeon. An approximately 5 to 6 cm incision was created on the natural skin fold at the far lateral neck, so that the scar can be completely hidden by a V-shaped collar shirt. Thyroidectomy was performed using a Harmonic scalpel® and conventional tie technique.

The mean operation time was 89.6±18.4 min for benign tumors and 79.1±30.1 min for malignant tumors. The number of retrieved lymph nodes (mean) was 5.4±3.5 in the central neck compartment dissection group, and 26.9±13.1 in the lateral neck lymph node dissection group. The 3, 6, and 12 month cosmetic satisfaction score (mean) after the operation was 7.47, 7.68, and 8.81. There were no hypertrophic scars or keloid on the neck.

Far lateral approach using natural skin fold for thyroidectomy is safe and patients expressed high cosmetic satisfaction. In addition, the technique is suitable for inexperienced surgeons in endoscopic thyroidectomy. It can be a feasible alternative to conventional or endoscopic thyroidectomy.