Video-assisted surgery of the thyroid diseases

M. Ruggieri, A. Straniero, F.M. Pacini, A. Maiuolo, A. Mascaro, M. Genderini

Department of Surgical Sciences and Applied Medical Technologies “Francesco Durante”, University of Rome “La Sapienza”, Rome (Italy)

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• Surgery

Background: After first endoscopic parathyroidectomy, performed and described by Gagner in 1996, several surgeons reported their experiences with minimally invasive and video-assisted (MIVA) surgery of the neck. The patients were considered eligible for MIVA hemithyroidectomy and thyroidectomy on the basis of some criteria.

Methods: Completely gasless procedure, is carried out through a 15-30 mm central incision above the sternal notch. Dissection is performed mainly under endoscopic vision using conventional endoscopic instruments. Video assisted group in our experience included 5 patients. All patients were women with mean age of 56 years. Results: We performed in three cases a total thyroidectomy and in two an hemithyroidectomy. Operative mean time was 189 minutes. No complications are happened. No conversion have been necessary.

Discussion: Traditionally, open thyroidectomy require a 6 to 8 cm, or bigger, transverse wound on the lower neck. The minimally invasive approach wound is very small in length (1.5 cm for small nodules, maximum 2-3 cm for the biggest, in respect of the exclusion criteria) upon the suprasternal notch. Wound pain following the MIVA surgery is much less when compared with the conventional thyroidectomy, because there is less dissection and destruction of tissues. The treated pathologies are prevalently nodular goiter; the only kind of thyroid cancer what it may be attacked with endoscopic surgery is a small papillary carcinoma without lymph node involvement. The complications, there are the same complications of the traditional thyroidectomy. Conversion to the traditional approach sometimes may it be required.

Conclusions: At the present this kind of surgery, in selected patients, clearly demonstrate excellent results regarding patient cure rate and comfort, with short hospital stay, few postoperative pain and attractive cosmetic results.

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