Scar Assessment Between Lateral Approach and Conventional Thyroidectomy

Objectives To compare postoperative scar outcomes between the lateral cervical approach and the conventional midline approach in thyroid surgery using the Patient and Observer Scar Assessment Scale (POSAS). Design Retrospective comparative cohort study. Setting Single tertiary referral centre (Ramathibodi Hospital, Faculty of Medicine, Mahidol University, Bangkok, Thailand). Participants Adult patients who underwent thyroid surgery between 2019 and 2023 were included. Patients ( n = 192) were classified into two equal‐sized groups: one undergoing the lateral cervical approach and the other treated with the conventional midline approach. Main Outcome Measures Overall and individual POSAS scores, operative outcomes (operative time and blood loss), postoperative complications and age subgroup analyses. Results Baseline characteristics were comparable between the two surgical groups. The lateral approach significantly reduced operative time and blood loss. The patient‐rated overall opinion score on the POSAS was significantly lower in the lateral group than in the conventional group (1.51 ± 1.16 vs. 1.94 ± 1.61, p = 0.032). The observer‐rated overall opinion score was also significantly lower (1.85 ± 1.26 vs. 2.32 ± 1.30, p = 0.012). Exploratory analyses demonstrated more favourable scar thickness and surface relief with the lateral approach. Cosmetic benefits were more pronounced in patients younger than 60 years. Rates of recurrent laryngeal nerve palsy and permanent hypoparathyroidism were comparable between groups. Conclusion The lateral cervical approach to thyroid surgery offers better cosmetic results whilst maintaining safety and improving surgical efficiency, especially for younger patients.