Section 2. Thyroid: Video-assisted minimally invasive endoscopic thyroid surgery using a gasless neck skin lifting method—153 cases of benign thyroid tumors and applicability for large tumors

Abstract

Endoscopic surgery is often considered to be ‘minimally invasive surgery’ in the light of recent developments. In particular, endoscopic endocrine neck surgery is desirable from a cosmetic viewpoint. Here we compared the usefulness of our original endoscopic method of video-assisted neck surgery (the VANS method) with conventional surgery when challenged with the removal of thyroid tumors measuring more than 5 cm in diameter, based on our experience with 167 cases (162 thyroid tumors, five parathyroid tumors). The percentage of patients who underwent the VANS method of the total number of patients who underwent neck surgery was determined and the operative procedures used in the different surgeries were analyzed. The operating time and blood loss for 153 benign thyroid tumors were statistically compared between the small-tumor group ( n = 130, <5 cm) and the large-tumor group ( n = 23, ≥5 cm). More than 60% of the benign and 5.3% of the malignant thyroid tumors were operated on by the VANS method. Near- or subtotal lobectomy was the most common procedure (64.1%) for benign tumors. Malignancy was defined as papillary carcinoma less than 1 cm in diameter. Total lobectomy with lymph node clearance was performed for all malignant tumors. Although the operating time and the blood loss were statistically greater in the large-tumor group than the small-tumor group, with increased experience it was possible to remove tumors of up to 7.4 cm safely. Our findings support the idea that the VANS method is feasible, practical, and safe, and has great cosmetic benefits, even for the removal of large benign tumors.