Minimal access thyroid surgery: technique and report of the first 25 cases.

BACKGROUND: Minimal access thyroid surgery, using various techniques, is increasingly being reported. The present study reviews our experience with thyroid surgery using a lateral focused mini-incision approach, and assesses its safety and feasibility. METHODS: The study group comprised all patients undergoing minimal access thyroid surgery (MATS) during the period May 2002-May 2003. Data were prospectively gathered, including patient demographics, indication for surgery, operation performed, nodule size, final pathology, and complications. Exclusion criteria for this procedure included: family history of thyroid cancer, previous neck irradiation or surgery, carcinoma on fine needle aspiration, presence of significant thyroiditis, multinodular goitre, and nodule size >3 cm. The operation was carried out through a 2.5-cm lateral incision placed directly over the nodule, with exposure gained by dissecting the plane between the sternomastoid muscle and the lateral edge of the strap muscles. RESULTS: Twenty-five patients underwent MATS, 22 women and three men. Nineteen patients underwent hemithyroidectomy, five underwent isthmectomy, and one underwent local nodule excision. The average measured incision size was 2.63 cm at the end of the procedure. The average nodule size was 2.2 cm, and the average thyroid lobe resected measured 4.7 cm in maximal length. Final pathology revealed benign nodules in 21 patients and four thyroid cancers (two follicular and two papillary). There was one wound infection and two patients had temporary recurrent laryngeal nerve neuropraxia. CONCLUSION: Minimal access thyroid surgery is a safe and feasible alternative to open thyroid surgery in selected cases.

Minimal access thyroid surgery: is it feasible, is it appropriate?

BACKGROUND: Reports of minimal access thyroid surgery (MATS) using various techniques have recently appeared. This study examined the feasibility of MATS using either a lateral 'focused' or endoscopically assisted approach. METHODS: The study group comprised all patients undergoing minimally invasive parathyroidectomy (MIP) during the period May 1998 to April 2002 in whom a concomitant thyroid procedure was undertaken. All procedures were performed either through a 2-cm lateral cervical incision (n = 19) or endoscopically (n = 7). RESULTS: Twenty-six patients underwent thyroid surgery, consisting of either local excision of a thyroid nodule (n = 25) or hemi-thyroidectomy (n = 1). In 13 patients the nodule was incidentally discovered, in four patients removal of the parathyroid necessitated partial thyroidectomy, and in nine patients the lesion identified by preoperative parathyroid localization proved to be a thyroid nodule. There were no permanent complications in the study group. Two patients required drainage of a haematoma. The final pathology of all 26 cases revealed benign nodular thyroid disease. CONCLUSION: Thyroid surgery can safely be performed as a minimally invasive procedure. Minimal access thyroid surgery is therefore a feasible option for selected patients. The question remains to be answered as to whether this surgical approach is appropriate treatment for nodular thyroid disease.

Worldwide trends in the surgical treatment of primary hyperparathyroidism in the era of minimally invasive parathyroidectomy.

HYPOTHESIS: Minimally invasive surgery for primary hyperparathyroidism has become an accepted part of endocrine surgical practice worldwide. DESIGN: Survey of members of the International Association of Endocrine Surgeons. SETTING: Clinical practice of endocrine surgeons worldwide. MAIN OUTCOME MEASURES: Numbers of parathyroid procedures performed, types of minimally invasive procedures undertaken, and techniques used to ensure completeness of removal of hyperfunctioning parathyroid tissue as reported by the survey respondents. RESULTS: Of 160 surveys completed, 95 (59%) indicate that the surgeons currently perform minimally invasive parathyroidectomy and use this technique on average for 44% of patients with primary hyperparathyroidism. The most common approach is the focused technique with a small incision, either central or lateral (92% [87 respondents]), followed by a video-assisted technique (22% [21 respondents]), and a true endoscopic technique with gas insufflation (12% [11 respondents]). Techniques used to ensure completeness of resection include the quick intraoperative intact parathyroid hormone assay (68% [65 respondents]), a same-day intact parathyroid hormone assay (17% [16 respondents]), and the nuclear probe (14% [13 respondents]). The number of parathyroidectomies performed worldwide increased from 1727 in 1980 to 6977 in 2000 with the average number per surgeon increasing from 23 in 1980 to 45 in 2000. Geographically, 20 (59%) of 34 surveys from the Americas report the use of minimally invasive parathyroidectomy, 23 (56%) of 41 from the Australasian region, and 34 (49%) of 69 from Europe or the Middle East. CONCLUSIONS: The number of parathyroidectomies performed for primary hyperparathyroidism has increased worldwide over the past 20 years. More than half of the surgeons responding to the survey perform minimally invasive parathyroidectomy, with the most using the focused small-incision technique.