Over recent years, the development of ultrasonic shears for hemostasis and small size endoscopes has allowed surgeons to perform thyroidectomies and parathyroidectomies through much smaller incisions than using traditional techniques.
The minimally-invasive video assisted thyroidectomy technique developed by Dr. Paolo Miccoli which is widely utilized in Europe and has recently gained momemntum in the United States, utilizes a smaller incision than usual.
In general, a 2.5cm (1 inch) incision is made in the sternal notch at the base of the neck and after the strap muscles are retracted from the thyroid gland, a 5 mm 30 degree endoscope is introduced into the incision. The scope is utilized to visualize the tissue along the lateral aspect of the thyroid gland and especially for the superior pole vessels. Usually after the superior and lateral aspects of the thyroid gland have been dissected free, the parathyroid glands and recurrent nerve are visualized and then the thyroid lobe is delivered through the neck incision and the remainder of the operation is performed in the conventional manner through the small cervical incision. Several authors in the United States have reported good results with this video-assisted approach.
A significant benefit of this approach is that the incision is in the usual location so that if any bleeding results in difficulty with visualization during the procedure, the incision can be enlarged and a conventional thyroidectomy can readily be completed. Most authors have found this approach to be shorter than conventional thyroidectomy in operative time, although the small neck incision does limit the size of the thyroid gland that could be resected utilizing this technique. The cosmetic advantages are self-evident.
MINIMALLY INVASIVE VIDEO ASSISTED THYROIDECTOMY & PARATHYROIDECTOMY
Picture of the right recurrent laryngeal nerve as seen in minimally invasive video assisted thyroidectomy. A drop of ink has been placed on the nerve for easier visualization.