1. Size first: 4 cm is the cut-off Benign nodules or papillary cancers ≤4 cm, intact capsule, no airway/nerve/vessel invasion→ An endoscopic approach (trans-oral TOETVA, axillary, areolar, etc.) gives the same quality of lobectomy plus central-compartment dissection; six-month recurrence rates are identical to open surgery. Tumours >4 cm, multifocal lesions kissing the recurrent laryngeal nerve, gross extrathyroidal extension or bulky lateral-neck nodes→ Open operation gives a wider view, safer handling and a lower chance of “leaving disease behind”. 2. Patient second: can you tolerate CO₂ insufflation and a sub-cutaneous tunnel? Green light Age 18–60, BMI <30, no significant cardiopulmonary disease... Learn more