Video-assisted thyroidectomy: indications and results.
OBJECTIVE
Minimally invasive video-assisted thyroidectomy (MIVAT) was set up and introduced in our department in 1998. Its results, after an acceptable relapse, can now be evaluated, also speculating on new possible indications.


METHODS
The procedure is based on a unique incision in the central neck, 2 cm above the sternal notch, using small conventional retractors and needlescopic (2 mm) reusable instruments. Haemostasis is achieved by a harmonic scalpel. Patients, 833, underwent MIVAT since June 1998. There were 715 females and 118 males (ratio 4:1). Lobectomy was carried out in 323 (38.7%) patients, total thyroidectomy in 510 (61.2%) patients.


RESULTS
Mean operative time of lobectomy was 36.2 min (range: 20-120); for total thyroidectomy, 46.1 min (30-130). Conversion to standard cervicotomy was required in 16 cases (1.9%); Operative complications were represented by transient monolateral recurrent nerve palsy in eight cases (0.9%), definitive monolateral recurrent nerve palsy in seven cases (0.8%). Twenty patients exhibited a hypoparathyroidism, which corresponds to 3.9% of total thyroidectomies performed, but only two showed permanent hypoparathyroidism (0.3%).


CONCLUSIONS
MIVAT can be considered a safe operation offering significant cosmetic advantages with possible new promising indications such as prophylactic thyroidectomy in rearranged during transfection (RET) gene mutation carriers. It is still limited to a minority of patients, in particular, in endemic goitre countries.
Miccoli
Paolo
P
Dipartimento di Chirurgia, Università di Pisa, Ospedale Santa Chiara, Via Roma, 67, 56126, Pisa, Italy. p.miccoli@dc.med.unipi.it
Berti
Piero
P
Frustaci
Gian Luca
GL
Ambrosini
Carlo Enrico
CE
Materazzi
Gabriele
G
D005260:Female; D006801:Humans; D008297:Male; D009154:Mutation; D051096:Proto-Oncogene Proteins c-ret / Q000235:genetics; D013959:Thyroid Diseases / Q000235:genetics / Q000601:surgery*; D013965:Thyroidectomy / Q000379:methods*; D020535:Video-Assisted Surgery
D051096:Proto-Oncogene Proteins c-ret; C099282:RET protein, human