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Mini-thyroidectomy
Minimally invasive thyroid
surgery
Endoscopic thyroid surgery
 Video-assisted thyroid surgery
 Mini-thyroidectomy
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I- Endoscopic thyroid surgery
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Creation of a
subplatysmal space
Maintenance of the space
using CO2 insufflation
[1,2] or neck lift device [3]
Placement of the trocars:
anterior, lateral neck or
Neck lift device
subareolar
1 Husher Eur J Coelio 1997
2 Gagner et al 2000
3 Shimizu et al J Surg Oncol 1998
4 Ohgami et al
Advantages
Precise anatomical detail due to the
greatly magnified view
 Decreased pain ?
 Smaller scar ?
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Limitation
Limited to a small (<3cm) nodule
 Contraindicated in :
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Suspicion of malignancy
Multinodular goiter
Grave’s disease
Prior surgery
Obese patient
Disadvantages
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Lack of direct palpation and manipulation
Small working space
Respiratory acidosis and diffuse
subcutaneous emphysema from CO2
insufflation
Minimal bleeding can obscure operative field
Long operative time
Multiple scars in case of conversion or
reoperation for completion thyroidectomy
II- Video-assisted thyroid
surgery
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1.5 cm anterior incision
A 12 mm trocar is placed. Gas insufflation is used
to help developing the space.
The trocar is then removed and the rest of the
procedure is performed with the space maintained
using external retractors.
A 5mm endoscope is placed through the incision
Laparoscopic and conventional instruments are
used for the dissection.
Miccoli et al
Video-assisted thyroid
surgery
Main Access
Advantages
Shorter operative time
 Small incision
 Prevents subcutaneous emphysema
 Good lighting and magnification
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Disadvantages
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Small working space
Minimal bleeding can obscure operative field
Placement of the endoscope in addition to the
instruments can be cumbersome
Requires a second assistant
III-Mini-thyroidectomy
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A 2.5 to 3cm
incision is
performed
approximately 3 to
4 cm above the
sternal notch
Superior and
inferior
subplatysmal flaps
are created
Mini-thyroidectomy
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The superior pole
vessels are
approached first
Mini-thyroidectomy
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The thyroid gland is
delivered through the
incision
The recurrent
laryngeal nerve is
identified
The inferior pole
vessels are divided
Patients
March 1997 to December 1999
 89 thyroid surgeries on 84 patients
 13 men and 71 women
 Age 18 to 95
 61 thyroid masses and 23 goiters
 Procedures: 4 nodulectomies, 54
thyroidectomies, 3 near total and 28
total thyroidectomies
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Results
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Pathology: 33 follicular adenomas, 17 papillary
carcinomas, 15 multinodular goiters, 7 colloid
nodules, 7 Hashimotos, 4 nodular hyperplasia, 2
mixed papillary-follicular carcinomas, 1 follicular
carcinoma and 1 lymphoma
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Completion thyroidectomy: 5 patients (all
through the same incision)
Specimen weight: 14 to 421 gm (44.2gm)
Results
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OR time: 35 to 164 min (mean 76 min)
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Hospital stay: Few hours to 2 days
(mean 1 day)
– few hours post op: 5 patients
– < 23 hours post op: 79 patients
– second day post op: 5 patients
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Complications: 1 cardiac arrhythmia
and 1 transient hypocalcemia
Results
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Incision length: 2.5 to 10 cm (4.2)
– 2-3 cm: 25 patients (28%)
– 3-4 cm: 56 patients (63%)
– >4cm: 8 patients (9%)
Advantages
Short operative time
 It can be done on an out patient basis
 Excellent postoperative pain control
 It can be attempted on any thyroid
pathology
 In the case of “conversion” the incision
can be extended as needed
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Advantages
Completion thyroidectomy, when
required, can be performed through the
same incision
 The procedure can be performed under
local anesthesia
 It has no complications related to neck
insufflation
 It has an excellent cosmetic result
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45 year old patient after right thyroid lobectomy
Conclusions
Mini-thyroidectomy is feasible and safe
 It has excellent cosmetic results
 It can be applied to all patients
regardless of thyroid pathology or size
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Conclusions
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Mini-thyroidectomy (along with video
assisted thyroidectomy) compared to
totally endoscopic thyroid surgery,
have shorter operative times, shorter
hospital stays, comparable cosmetic
results without complications related to
neck insufflation
Conclusions
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The greatest advantage to minithyroidectomy is that it requires no
additional technical expertise, and is
therefore easier to teach and reproduce