The most obvious benefit of minimally invasive head and neck surgery is the avoidance of a disfiguring, medical-condition-revealing scar. Cosmesis, the improvement of aesthetic appearance, must be distinguished from the avoidance of morbidity.
The importance of this issue depends on many factors, which may include age, gender, physical appearance and others. Experience has demonstrated that young women and children are more likely to be concerned with this outcome. Formal quality of life studies have not been performed, and this concept has not been addressed scientifically.
Endoscopic sinus surgery for fronto-ethmoid disease was developed in part to avoid visible incision. Additional benefits include a shortened period of recovery, less post-operative pain and quicker return to normal function. While early in the development, some prospective randomized controlled clinical trials have been performed, and these demonstrate advantage to these approaches.
The potential impact of a disease-specific incision may become more important as the awareness of this procedure and its incision inevitably becomes more widespread. Concerns for a unique incision revealing a private and potentially stigmatizing health problem may ultimately serve as a barrier to care.
Critics of minimally invasive approaches are quick to dismiss the impact of a visible incision of the neck, citing this as a cosmetic issue. Cosmesis is the act of improving aesthetics from baseline. Avoiding operative morbidity should be the goal of any surgeon.
It is clear from the existing experience that postoperative pain and return to function are decisively improved with both video-assisted and particularly totally endoscopic approaches. Based on these benefits alone, a minimally invasive approach should be considered for any patient requiring thyroidectomy, regardless of aesthetic concerns. It must be kept in mind that some patients' underlying thyroid conditions may mandate a conventional open approach.
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