Minimally invasive surgery for thyroid small nodules: Preliminary report

Abstract

Cytological assessment of cold thyroid nodules cannot exclude malignancy in case of follicular tumors. Many follicular nodules undergo surgery although most of them later on prove to be benign. We report a new minimally invasive video-assisted approach (MIVA) for the treatment of thyroid lesions with a diameter minor than 3 cm. Ten females and 2 males (mean age: 37 yr) with a cold thyroid nodule and a cytological diagnosis of microfollicular tumor were selected for MIVA hemythyroidectomy. The procedure was carried out through a 15 mm incision with needlescopic instruments and a 30 infinity 5-mm endoscope. Mean operative time was 87 min (range 60-120). No complications were registered. Cosmetical result was excellent in all patients. MIVA hemythyroidectomy is safe and effective; indications and limits of this new procedure require further studies.

Comparative study of endoscopic thyroidectomy versus conventional open thyroidectomy in papillary thyroid microcarcinoma (PTMC) patients

“…We have developed our own novel methods of gasless endoscopic thyroidectomy using the trans-axillary approach and have reported our initial experience and surgical outcomes [11]. Endoscopic thyroid operations can be classified based on the method of making the working space, the continuous CO 2 gas insufflation method, and the gasless method [3,5,7]. According to the insertion site of surgical instruments, endoscopic surgery can be sorted as cervical [3,6], anterior chest wall [7], breast [8], axillary [4,5,11], and axillarybreast approaches [14].…”

“…With the widespread adoption of endoscopic thyroidectomies, the application criteria for endoscopic techniques have been altered extensively. At an early time, many surgeons regarded benign thyroid disease as an indication for endoscopic surgery [3][4][5][6][7][8]. In 2002, Miccoli et al [9] attempted to perform endoscopic surgery on patients with papillary thyroid carcinoma [9].…”

Operative Technique of Endoscopic Thyroidectomy: A Narration of General Principles

“…The ET techniques can be broadly divided into mini-incision minimally invasive, video-assisted gasless, and purely endoscopic with gas-insufflation methods [4]. According to anatomical access, ET can be performed through cervical, extracervical (chest wall, transaxillary), or combined approaches [7][8][9]. The obvious advantage of the extracervical approach is absence of visible scar in the neck and upper chest.…”

Tireoidectomia vídeo assistida: experiência de 120 casos

“…Procede-se a abertura da linha média com eletrocautério e até esse ponto não são utilizadas ópticas. Na técnica descrita por Miccoli 5 , não se realiza elevação de retalho de pele e programa-se a incisão algo mais alta. O primeiro auxiliar se encarrega da câmera (Figura 1) e o segundo auxiliar procede a exposição do pólo superior com afastadores diferenciados, mais longos, desenvolvidos no serviço de Pisa para permitir a manipulação em campo mais estreito (Figura 2).…”

“…Em 1999 surgia a tireoidectomia vídeo-assistida. A técnica foi descrita quase simultaneamente por Miccoli 5 na Universidade de Pisa, Itália e por Bellantone 6 na Universidade de Roma. Ressalte-se que esses grupos são serviços de cirurgia geral, especializados em cirurgias laparoscópicas, o que os estimulou a desenvolverem a técnica vídeo-assistida para a cirurgia de tireóide.…”