Minimal Invasive Video-Assisted Partial And Total Thyroidectomy: Feasibility And Current Indications

The authors report their initial experience with partial and total thyroidectomy by video-assisted approach. Feasibility, safety and benefits are examined as well as current indications and exclusion criteria. Patients and methods: Between January and July 2000, 38 patients were operated on for thyroid lobectomy (n=22) or total thyroidectomy (n=16) by a video-assisted cervical approach. Surgical procedures were conducted under general anesthesia. Frozen section was performed peroperatively in all cases. Patient selection was based on the preoperative ultrasonography and clinical examination. Results: Initial diagnosis was solitary nodule in 24 patients, multinodular goiter in 11 patients. Three patients were treated for hyperthyroidism. The mean cranio-caudal and transversal axis were respectively 4.83 and 2.78 cm, and mean total lobar weight was 11.56 grams. Five conversions to conventional surgery occurred (13.15%). Mean operative time was 143.3+/-21.7 and 96.9+/-20.4 minutes respectively for total and partial thyroidectomies. Laryngeal nerve was identified in 95% of cases. The mean length of skin incision was 24.7+/-1.9 mm. There was one case of postoperative hypocalcemia, and one case of postoperative hoarseness. One patient presented a transient vocal corde palsy. The postoperative hospital stay was one day for 72% of patients. The pain intensity evaluation, based on the VAS methodology and measured at day one was 2.21+/-1.3. Conclusion: Video-assisted thyroidectomy is feasible, safe and effective for small thyroid nodular disease. It provides benefits for the patients in term of postoperative pain, hospital stay and cosmetic satisfaction.