There is no “minimally invasive surgery” for malignant thyroid tumors, thank you for stopping by to share my personal opinion. Minimally invasive treatment for thyroid cancer has been widely disseminated in various media including the internet or in some academic settings, thus many friends with thyroid nodules are concerned or consulted whether they are suitable for such treatment. First of all, the science of minimally invasive treatment, and here only refers to lumpectomy, that is, an endoscope with fiber optics enters into the natural body cavity through or natural mouth on the body surface or one or more small incisions, and surgically removes certain lesions with the help of special surgical instruments, replacing the traditional large incision surgery, reducing the surgical trauma and allowing patients to recover quickly. This method of treating patients with relatively minor trauma is called minimally invasive surgery, which has obvious advantages in the field of surgical treatment, and its application has been rapidly developed in China. There are two types of “minimally invasive thyroid treatment” that we know about, one is radiofrequency ablation, which I will discuss separately. The other is minimally invasive surgery, or lumpectomy of the thyroid. Traditional thyroid surgery requires a surgical incision in the front of the neck, which inevitably leaves surgical scars on the often exposed parts of the body and becomes a lingering psychological shadow for some patients, especially young women. Therefore, many scholars have transplanted the lumpectomy technique to thyroid surgery, and “minimally invasive treatment” was born. The lumpectomy application itself is not a new technology, but it is indeed a new idea or approach compared to the traditional thyroid surgery approach. Since the emphasis is on minimally invasive, it should be called “minimally invasive” only if it is significantly less invasive than traditional surgical approaches. Whether lumpectomy thyroid surgery is minimally invasive or not has been controversial. The procedure is performed by making small incisions in the chest wall and areolas of both breasts, followed by two to three subcutaneous tunnels into the thyroid area (or from the armpits, or the front of the mouth), creating an artificial surgical space, and using some special surgical instruments to remove the thyroid and the lump with the aid of video. The surgical damage cannot be measured by the size of the surgical incision alone, but for the same condition, the entire procedure is no less invasive than traditional surgery in terms of anesthesia, operative time, and tissue damage. It is also an “invasive” procedure that may increase certain side effects. The only advantage is that the scar that would otherwise appear in the neck is replaced in a relatively undetectable area of the body, which satisfies the cosmetic needs of some patients, especially female patients, to a greater extent. Therefore, lumpectomy in thyroid surgery is not essentially a “minimally invasive” procedure, but is objectively a procedure with aesthetic advantages, or more appropriately called “invasive” or “hidden scar” surgery. It is more appropriate to call it “invasive” or “invisible” surgery! After a period of debate, such an understanding has gradually been unified, but there are still a small number of scholars who insist on the term “minimally invasive psychological”. However, we have learned that some thyroid cancer patients who have undergone lumpectomy are more aware of the increased chance of recurrence, which adds a new psychological burden to them and makes the “psychological minimally invasive” theory untenable. Therefore, the concept of aesthetic minimally invasive treatment is too much of an eye-catcher. In breaking the traditional or conventional way of malignant tumor surgical treatment, the first concern is the safety and effectiveness of treatment. Safety includes two aspects: safety of surgical procedure and tumor safety. The safety as well as the advantages of endoscopic surgery have actually been agreed without much discussion, while the tumor safety effectiveness is still lacking clinical evidence-based data to prove this point, which is often ignored when recommending this modality of treatment. The scholars who are enthusiastic about lumpectomy thyroid surgery believe that compared with the traditional open approach, endoscopic thyroid surgery has “clear vision, exact hemostasis by ultrasonic knife, less bleeding, and easier observation of fine structures”, etc. This should be a different feeling formed by the different surgical operations and visual habits of the surgeons, and there is no substantial advantage mentioned, because The use of the same advanced and excellent microelectronic surgical equipment in traditional surgery nowadays is more secure for the safe, precise and complete removal of thyroid malignant tumors. There have also been reviews of “randomized groups” comparing surgical conditions, adverse events, pain scores and incisional satisfaction between the two groups, but none of these reports have compared patient recurrence rates and survival outcomes in parallel. All clinical studies, to date, have focused on surgical outcomes, postoperative recovery time, length of hospital stay, amount of blood transfusion, and overall functional recovery and daily rehabilitation of patients, among others. When accumulating data for clinical studies, the selection of many cases is also not objectively randomized, such as when two patients sit in front of the surgeon and the surgeon chooses one to undergo a lumpectomy while the other undergoes a conventional procedure, usually for a reason. The surgeon thinks the case is more suitable for endoscopic surgery, so it is selected; the patient hears that the results are the same as conventional treatment and that there is no scarring of the neck, so he accepts the choice. Some of the problems that have been revealed from some of the patients who have received lumpectomy for thyroid cancer who have come for review include having increased side injuries, incomplete treatment of the tumor for the first time, and in a very small number of cases, tunnel implantation in the operative field of the tumor. Therefore, for malignant thyroid tumors, the use of lumpectomy is still considered by most to be prudent. Traditional treatment methods, are not set in stone. In the field of tumor treatment, we (National Cancer Center) never reject the use of advanced treatment methods and new technologies, and dozens of hundreds of basic or clinical researches are being conducted every year. If there is a new treatment method, we encourage to actively try and explore it, but first of all, we need to have well-designed protocols that can be validly based on evidence-based medicine in the future, and then conduct scientific exploration and research; at the same time, we also need to meet ethical requirements, and before accepting a new treatment modality patients should not only understand the benefits obtained, but also be fully aware of the possible risks, especially the unknown and potential oncological risks. After all, “oncologic safety is more important than cosmetic requirements”. Those patients who opt for lumpectomy or robotic resection, either for clinical trials or standard treatment options, should have an informed conversation with your physician about the treatment modality. It is necessary for patients to know the following two pieces of information and then choose to undergo the surgical modality based on their knowledge of thyroid cancer as an oncological disease and their own situation and needs: 1. The main advantage of this surgery is the aesthetic appearance and no scar in front of the neck. 2. This treatment is still in the exploratory stage, and it remains to be confirmed whether the treatment effect is the same for malignant tumors. Patients with benign thyroid nodules generally only need to consider #1. For the surgical treatment of benign thyroid tumors, nodular goiter, and some benign diseases such as hyperthyroidism, lumpectomy is indeed a good choice for patients who have a strong desire for cosmetic neck surgery. Patients with thyroid cancer should consider and balance these two options. Patients who have a strong desire to maintain aesthetics due to work or professional needs, and who understand that most thyroid cancers have a good prognosis despite the risks of oncologic treatment, may also be amenable to lumpectomy by an experienced surgical oncologist. After treatment and close oncologic surveillance.