ABSTRACT
Minimal access surgery in the thyroid compartment has evolved considerably over the past 10 years and now takes many forms. This study examined the feasibility and reliability of minimally invasive thyroid surgery in the management of small benign thyroid lesions. Sixty eight patients with small thyroid nodules admitted in Oncology Center, Mansoura University, Egypt, were enrolled in this prospective randomized trial. Patients were allotted in one of these procedures, minimally invasive video assisted thyroidectomy [MIVAT], or minimally invasive open thyroidectomy using the Sofferman technique of strap muscle transection. Exclusion criteria were nodules greater than 4 cm, presence of thyroiditis, and thyroid gland volume greater than 20 ml Preoperative diagnosis, operative time, blood loss, postoperative pain, complications and cosmetic outcome were all evaluated. MIVAT group included 35 patients and the Sofferman group included 33 patients. The main preoperative pathology was benign follicular lesion [70.5%] and the main postoperative final pathology was follicular adenoma [54.4]. Both groups were comparable regarding age, sex and extent of thyroid surgery. Operative time was significantly longer in MIVAT group [115.4 +/- 33.5 min] compared to the Sofferman group [65.6 +/- 23.7 min]. Postoperative course was significantly less painful in MIVAT group [P< 0.05]. Although patients in MIVAT group had smaller incisions [P <0.05], the cosmetic outcome in both groups was comparable. No long term complication was encountered in both groups. Two distinct approaches of minimally invasive thyroidectomy are now available and can be performed safely in selected patients. Despite some MIVAT advantages of less postoperative pain and slightly better cosmesis, minimally invasive open thyroidectomy offers an advantage of less operative time with comparable cosmetic results