Minimally invasive video-assisted thyroidectomy: The initial experience

Abstract

Problem: For many patients undergoing thyroidectomy, the most significant long-term issue is the length of their thyroidectomy scar. The purpose of this ongoing study is to analyze the safety and efficacy of thyroidectomy using a minimally invasive approach under video-assisted guidance. Methods: This report comprises the first 8 patients who underwent video-assisted thyroidectomy. The initial phase of the study took place in the fresh tissue laboratory where we performed 8 thyroid lobectomies through a 1.5–2.0 cm central incision. Clinical studies were carried out under an IRB-approved protocol. Patients were required to have either small goiters or nodules smaller than 2.5 cm. Thyroidectomy was performed without insufflation under general endotracheal anesthesia using an incision less than 2.0 cm. Video-assistance was obtained using a 30-degree endoscope with dissection performed using small atraumatic instruments. Procedures were documented extensively using digital photography and videography. Operative time, postoperative pain, complications, and cosmetic result were evaluated in addition to surgical technique. Results: Seven patients underwent video-assisted lobectomy for solitary nodules, and 1 patient underwent video-assisted total thyroidectomy due to bilateral disease. Mean operative times were 122 minutes for lobectomy and 175 minutes for total. Postoperative pain was minimal. No recurrent laryngeal nerve palsies were encountered and transient hypoparathyroidism (2 days) occurred only in the patient who underwent total thyroidectomy. The cosmetic result was considered excellent by all patients. Conclusion: Initial results of video-assisted thyroidectomy suggest it is both safe and technically feasible. Mean operative time was considered acceptable and cosmetic results were considered superior. Our initial experience suggests a larger study is needed to more fully examine this technique. Significance: Minimally invasive surgery has become increasingly popular owing to decreased postoperative pain and recovery time, as well as improved cosmetic result. This study demonstrates that video-assisted thyroidectomy may potentially provide these advantages to select patients without sacrificing safety and efficacy. Support: None reported.