Minimally invasive procedures in thyroid surgery

Abstract

Purpose: Since T. Kocher (1841-1917) bilateral/unilateral lobar resection is the golden standard of thyroid surgery. Nevertheless there are attempts to introduce minimal invasive surgery into endocrine surgical procedures. Regarding surgical procedures, minimal access thyroidectomy (MAT) or videoassisted thyroidectomy (MIVAT) can be performed if there is a solitary nodule, smaller than 35 mm, low risk papillary cancer smaller than 1.5 cm and thyroid volume is 20 ml or less.Relative contraindications are history of irradiation, previous thyroid surgery, thyroiditis and a short neck.

Material and Method: Between January 2005-June 2007 154 patients were operated using minimal access technique and videoassisted techniques. Between January 2006 and June 2007 52 thyroidectomies using videoassisted technique were performed. These were 15 % of the whole series of thyroidectomized patients during the same period (52 MIVAT, 102 MAT).

Result: There were 132 female-22 male patients with a mean age of 35 (21-52) years. The mean operative duration was for lobectomy 37 min (22-53) p<0.001, for bilateral thyroidectomy 48 min (40-62) . The mean nodule diameter was 3.1cm (0,5-3,9). The pathology of the resected specimen were 41 colloid nodules, 73 follicular adenoma, 11 Hürthle cell adenoma, 1 Follicular thyroid cancer, 4 Basedow-Graves, 23 papillary thyroid cancer. Patients with history of previous thyroid operation, with thyroid cancer larger than 1.5 cm, with benign thyroid nodule larger than 3,5 cm were excluded.Completion thyroidectomy was performed in one patient after two months. A pretracheal hematoma occurred in one patient, transient nerve injury occured in 1,3% ( 3 months ), transient hypoparathyroidism occurred in 8,4 %, no persistent hypoparathyroidism and no persistent paralysis was observed. Thyroid volume (>25cc) was found to be the most important limitation and contraindication for the technique.

Conclusion: As for today, MAT or MIVAT is significantly superior regarding operative duration to standard surgery based on the technology used for vascular occlusion.It is an important advantage of the technique to reduce the incision up to 75 %.Regarding complications, hospitalization and pain medication there is no significant difference between minimal access, videoassisted and standard techniques.