There is no “minimally invasive surgery” for the treatment of thyroid malignancy, so thank you for stopping by here 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, so many friends with thyroid nodules are concerned about 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 one or more small incisions on the natural or body surface, 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 borrowed the real concept of minimally invasive treatment and transplanted the lumpectomy technology to thyroid surgery, and “minimally invasive surgery” was born. The application of lumpectomy itself is not a “new technology”, but is indeed a new way of thinking 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 less invasive than the traditional surgical approach. 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 areola of both breasts, followed by two to three subcutaneous tunnels into the thyroid area (or from the front of the armpit, or the front of the mouth), creating a surgical space artificially, and using some special surgical instruments to remove the thyroid and the mass with the aid of video. The size of the surgical injury is not measured by the size of the incision on the body alone, but for the same condition, the whole process of lumpectomy is no less traumatic than traditional surgery, as any real surgeon knows, in terms of anesthesia, time spent on surgery, and the extent and degree of tissue damage, and is actually an “invasive” process. The procedure is actually an “invasive” one, and may also 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, it should be clear by now that lumpectomy in thyroid surgery is not essentially a “minimally invasive” treatment, but objectively a procedure with aesthetic advantages, or more appropriately called “invisible” or “hidden scar” surgery. It is a procedure with aesthetic advantages, or more appropriately called “invasive” or “hidden scar” 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 “psychological minimally invasive”. However, it has been learned that some patients with thyroid cancer 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: surgical procedure safety and tumor safety. The safety as well as advantages of endoscopic surgery in other surgical fields are obvious and have not needed much literature to discuss, while oncologic safety and efficacy are still lacking clinical evidence-based data to prove, which is often selectively ignored when recommending this modality of treatment. The scholars who are enthusiastic about lumpectomy thyroid surgery believe that compared with traditional open approach, endoscopic thyroid surgery is “clearer and clearer after endoscopic magnification; easier to observe fine structures; exact hemostasis effect and less damage by ultrasonic knife; more complete tumor removal”, which is only based on “perception”. This is only a statement based on “feeling”, in fact, it should be a different experience and feeling difference formed by different operation and visual habits of doctors, and there is no substantial advantage mentioned. Moreover, the same advanced and excellent microelectronic surgical equipment is now applied to traditional surgery, which is more secure for safe, precise and complete removal of thyroid malignant tumors. This is also a subjective conclusion based on perception, because most thyroid cancers have long natural survival and good prognosis, and many patients do get “the same results” by chance. There have been reviews of “randomized groups” comparing surgery, adverse events, pain scores, and incisional satisfaction between the two groups, but none of these reports have compared patients’ 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. During the clinical study process of accumulating data, the selection of many cases was also not objectively randomized, such as when two patients sat in front of the surgeon and the surgeon chose one to undergo a lumpectomy while the other underwent a conventional procedure, usually for a reason. The surgeon thinks the case is more suitable for endoscopic surgery, so it is chosen; the patient hears that the results are the same as conventional treatment and that there is no scarring of the neck, so he gladly accepts the choice. Some of the problems that have been revealed from some of the patients who have been received to come for review after lumpectomy for thyroid cancer include having increased side injuries, incomplete treatment of the tumor for the first time, and very few tumor tunnel implants in the operative field. 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 advanced treatment concepts and technological innovations, and dozens of hundreds of basic or clinical researches are being conducted every year. If there are new treatment methods, we encourage to actively try and explore them, 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 new treatment modalities 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 choose lumpectomy or robotic resection, either for clinical trials or standard treatment protocols, should have an informed communication with your physician about the treatment modality. It is necessary for patients to know both of the following, and then choose which surgical modality to undergo based on their knowledge of thyroid cancer as an oncologic disease and their own situation and needs: 1. The main advantages of this surgical modality are aesthetics There is no scar in front of the neck. 2. This treatment method 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 specific work or professional needs, and who understand that most thyroid cancers have a good prognosis despite the risks of oncologic treatment, may also undergo lumpectomy with an experienced oncologic surgeon. After treatment and close oncologic follow-up.