title: Minimally invasive video-assisted thyroidectomy: Ascending the learning curve.
abstract: BACKGROUND
  Minimally invasive video-assisted thyroidectomy (MIVAT) is a technically demanding procedure and requires a surgical team skilled in both endocrine and endoscopic surgery. The aim of this report is to point out some aspects of the learning curve of the video-assisted thyroid surgery, through the analysis of our preliminary series of procedures.
  
  
  METHODS
  Over a period of 8 months, we selected 36 patients for minimally invasive video-assisted surgery of the thyroid. The patients were considered eligible if they presented with a nodule not exceeding 35 mm and total thyroid volume <20 ml; presence of biochemical and ultrasound signs of thyroiditis and pre-operative diagnosis of cancer were exclusion criteria. We analysed surgical results, conversion rate, operating time, post-operative complications, hospital stay and cosmetic outcomes of the series.
  
  
  RESULTS
  We performed 36 total thyroidectomy and in one case we performed a consensual parathyroidectomy. The procedure was successfully carried out in 33 out of 36 cases (conversion rate 8.3%). The mean operating time was 109 min (range: 80-241 min) and reached a plateau after 29 MIVAT. Post-operative complications included three transient recurrent nerve palsies and two transient hypocalcemias; no definitive hypoparathyroidism was registered. The cosmetic result was considered excellent by most patients.
  
  
  CONCLUSIONS
  Advances in skills and technology allow surgeons to easily reproduce the standard open total thyroidectomy with video-assistance. Although the learning curve represents a time-consuming step, training remains a crucial point in gaining a reasonable confidence with video-assisted surgical technique.
authors.affiliation: General Surgery 1 Unit, Emergency Department, Papa Giovanni XXIII Hospital, Bergamo, Italy.
authors.forename: Michela Giulii
authors.initials: MG
authors.lastname: Capponi
authors.affiliation: Thyroid and Parathyroid Surgery Unit, Surgeal Department, Sant' Andrea Hospital, La Sapienza University, Rome, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Bellotti
authors.affiliation: General Surgery 1 Unit, Emergency Department, Papa Giovanni XXIII Hospital, Bergamo, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Lotti
authors.affiliation: General Surgery 1 Unit, Emergency Department, Papa Giovanni XXIII Hospital, Bergamo, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Ansaloni
keywords: Minimally invasive video-assisted thyroidectomy; minimally invasive thyroidectomy; thyroid surgery