From technical feasibility to patient-centered selection in remote-access thyroidectomy: the AGES framework in the single-port robotic era

Remote-access thyroidectomy now includes established endoscopic and multi-port robotic operations alongside emerging single-port (SP) techniques. Selection requires consideration of disease requirements, access burden, patient priorities, and the treating center’s capabilities. This narrative review synthesizes literature through 31 August 2026 on access routes, robotic platforms, recovery, patient-reported outcomes, and resource use. Comparative evidence is more developed for TOETVA and multi-port robotic approaches than for newer GOSTA, SPRA, and SAM techniques; evidence from these newer routes remains concentrated in selected institutional cohorts. Lateral neck dissection and reoperative SP reports demonstrate technical capability and short-term outcomes, without establishing long-term oncologic equivalence. Inflammatory biomarkers are surrogate biological endpoints and should be interpreted alongside patient-reported and functional outcomes. We propose AGES as a provisional, non-numeric conceptual heuristic: Age and physiologic reserve; Gland disease; Extension and Economics; and prior Surgery, Shape/anatomy, Scar priorities, Surgeon, and System capability. Its proposed sequence documents the operation required by disease, assesses access and platform feasibility within the available evidence, and then considers patient preference and local value. AGES supplements existing guidance by organizing these discussions and candidate research variables; it does not supply indications, validated thresholds, risk predictions, or treatment recommendations. Psychosocial readiness, equitable access, multidisciplinary capability, and longitudinal functional and hormonal outcomes require explicit consideration. Multidisciplinary Delphi refinement, prospective registration, external assessment, and clinical utility testing are needed before any decision-support role can be claimed.