title: A randomized controlled trial of minimally invasive thyroidectomy using the lateral direct approach versus conventional hemithyroidectomy.
abstract: BACKGROUND
  The role of minimally invasive thyroid surgery (MITS) is currently in evolution. The aim of this study is to compare the outcomes of MITS using the direct approach through a lateral incision with conventional hemithyroidectomy (CHT) for the management of atypical thyroid nodules.
  
  
  METHODS
  A prospective, single-blinded, randomized controlled trial involving patients presenting with atypical thyroid nodules of 3-cm diameter or less was performed. Patients were randomized to MITS through a lateral 2.5-cm incision or CHT through a traditional 5- to 6-cm cervicotomy. Pain was measured using a 7-point visual analog scale on the 1st and 10th postoperative days. Serum C-reactive protein was measured on postoperative days 1 and 10. Satisfaction with cosmetic outcome was measured at 3 months.
  
  
  RESULTS
  One-hundred patients were randomized to undergo MITS or CHT. The 2 groups were equivalent in terms of age and thyroid nodule size. Mean operative times were longer for the MITS group (56 vs 46 min, P < .001). Mean pain scores were less in the MITS group on the 1st postoperative day (2.67 vs 3.43, P = .032). Pain scores at 10 days were equivalent (1.5 vs 1.8, P = .36). Serum C-reactive protein levels were equivalent postoperatively. At 3 months, patients undergoing MITS reported a greater mean cosmetic satisfaction score (6.3 vs 5.0, P = .002). Incision lengths measured at 3 months were 2.6 cm for MITS and 5.4 cm for CHT group, P < .001.
  
  
  CONCLUSIONS
  In the management of small, atypical thyroid nodules, MITS through a direct lateral approach results in less early postoperative pain and superior cosmetic results when compared with conventional thyroidectomy.
authors.affiliation: University of Sydney Endocrine Surgical Unit, Royal North Shore Hospital, St Leonards, Australia. marksywak@nebsc.com.au
authors.forename: Mark S
authors.initials: MS
authors.lastname: Sywak
authors.forename: Michael W
authors.initials: MW
authors.lastname: Yeh
authors.forename: Todd
authors.initials: T
authors.lastname: McMullen
authors.forename: Peter
authors.initials: P
authors.lastname: Stalberg
authors.forename: Hubert
authors.initials: H
authors.lastname: Low
authors.forename: Raul
authors.initials: R
authors.lastname: Alvarado
authors.forename: Stan B
authors.initials: SB
authors.lastname: Sidhu
authors.forename: Leigh W
authors.initials: LW
authors.lastname: Delbridge
mesh_terms: D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D010147:Pain Measurement; D010149:Postoperative Pain / Q000175:diagnosis; D017060:Patient Satisfaction; D016037:Single-Blind Method; D016606:Thyroid Nodule / Q000473:pathology / Q000601:surgery*; D013965:Thyroidectomy / Q000379:methods*
chemical_list: D015415:Biomarkers; D002097:C-Reactive Protein