Minimally invasive video-assisted thyroidectomy

Abstract

The first endoscopic procedures proposed to reduce the invasiveness of surgery in the neck were the endoscopic and video-assisted parathyroidectomies because it was quite evident that parathyroid adenomas were ideal candidates for a minimal access surgery, being these tumors mostly benign and characterized by their limited size. Later on, the same accesses proved to be suitable also for removing small thyroid nodules, and new approaches were soon proposed, in some cases, also modifying the old ones. At present, some controversies still exist about what should be considered a real minimally invasive operation for thyroid. Although the concern raised by some about the possible adverse effect of CO2 insufflation in the neck was probably over evaluated, the procedure we set up in 1998, minimally invasive video-assisted thyroidectomy (MIVAT), was characterized by the use of an external retraction avoiding any gas inflation which is not necessary to create an adequate operative space in the neck. This approach to the thyroid has been used in our Department of Surgery for the last 8 years on more than 2,500 patients with results that can successfully rival those of standard open surgery also in terms of operative time. Of course, this is not an operation which might be proposed for any patient: its main limit is represented by the necessity of a severe selection of the patients undergoing surgery. Only 10–30% of the cases, according to different authors, fulfill the inclusion criteria for a MIVAT.