Contenido principal del artículo

José GRANELL
Servicio de Otorrinolaringología. Hospital Universitario Rey Juan Carlos. Móstoles. Madrid
España
https://orcid.org/0000-0002-8025-3336
Vol. 13 Núm. 2 (2022), Artículo de revisión, Páginas e27167
DOI: https://doi.org/10.14201/orl.27167
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Resumen

Introducción y objetivo: El desarrollo de las técnicas de acceso remoto para cirugía de tiroides y paratiroides en los últimos años ha llevado a la consolidación de las cuatro configuraciones que actualmente se utilizan de manera estándar. El objetivo de esta revisión es describir la experiencia acumulada en tiroidectomía y paratiroidectomía por abordaje axilar, axilo-pectoral bilateral, retroauricular y transoral, así como exponer los resultados publicados por los diferentes grupos.
Síntesis: El abordaje transaxilar fue el primero que se describió y tiene las series más antiguas y algunas de las más numerosas, cuyos resultados reproducen los estándares de la cirugía abierta para las mismas indicaciones. Sin embargo en los últimos años se ha ido abandonando a favor de abordajes alternativos. El abordaje retroauricular se describió inicialmente para la cirugía de tiroides, pero sus indicaciones han migrado hacia otra patología cervical. El abordaje axilopectoral bilateral ha sido extensamente utilizado en cirugía de tiroides y reproduce no solo los exigentes estándares respecto a las lesiones recurrenciales y el hipopartiroidismo postoperatorio, sino también los estándares oncológicos en el manejo quirúrgico del carcinoma diferenciado de tiroides. El abordaje transoral / transvestibular, el último en llegar, se encuentra en franca expansión y es potencialmente  aplicable a la mayoría de los casos quirúrgicos de tiroides y paratiroides.
Conclusiones: Las técnicas de acceso remoto han demostrado ser seguras y eficaces. El volumen de actividad publicado y los resultados las convertirían ya en procedimientos estándar, aunque sigue siendo necesario comprobar en series multicéntricas prospectivas la reproductibilidad de los resultados.

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