BackgroundThe targets of minimally invasive surgery (MIVA) could be summarised by: achievement of the same results as those obtained with traditional surgery, less trauma, better post-operative course, early discharge from hospital and improved cosmetic results. The minimally invasive techniques in thyroid surgery can be described as either endoscopic "pure" approach (completely closed approach with or without CO2 insufflation), or "open approach" with central neck mini-incision or "open video-assisted approach". Traditionally, open thyroidectomy requires a 6 to 8 cm, or bigger, transverse wound on the lower neck. The minimally invasive approach wound is much shorter (1.5 cm for small nodules, up to 2–3 cm for the largest ones, in respect of the exclusion criteria) upon the suprasternal notch.Patients also experience much less pain after MIVA surgery than after conventional thyroidectomy. This is due to less dissection and destruction of tissues.Pathologies treated are mainly nodular goiter; the only kind of thyroid cancer which may be approached with endoscopic surgery is a small differentiated carcinoma without lymph node involvement.The patients were considered eligible for MIVA hemithyroidectomy and thyroidectomy on the basis of some criteria, such as gland volume and the kind of disease. In our experience we have chosen the minimally invasive open video-assisted approach of Miccoli et al. (2002). The aim of this work was to verify the suitability of the technique and the applicability in clinical practice.MethodsA completely gasless procedure was carried out through a 15–30 mm central incision about 20 mm above the sternal notch. Dissection was mainly performed under endoscopic vision using conventional endoscopic instruments. The video aided group included 11 patients. All patients were women with a average age of 54.ResultsWe performed thyroidectomy in 8 cases and hemithyroidectomy in 3 cases. The operative average time has been 170 minutes.ConclusionNowadays this minimally invasive surgery, in selected patients, clearly demonstrates excellent results regarding patient cure rate and comfort, with shorter hospital stay, reduced postoperative pain and most attractive cosmetic results.

BackgroundThyroid size is a very important criteria of MIVAT exclusion because the working space provided by the technique is limited.The aim of this work has been to verify the suitability of MIVAT and its applicability in clinical practice, not only in patients with a thyroid volume up to 25 ml but also in patients with a thyroid volume included from 25 to 50 ml.MethodsFrom January 2003 to February 2006, 33 patients have been selected for MIVAT. A completely gasless procedure was carried out through a central 20 to 35 mm skin incision performed "high" between the cricoid and jugular notch.ResultsThe patients were separated in 2 groups. The first group (less than 25 ml) included 23 patients, the second group (from 25 to 50 ml) included 10 patients. The skin incision performed was from 20 to 25 mm (mean 23.61 mm ± 1.83) long in the first group and from 25 to 35 mm (mean 27.8 mm ± 2.20) long in the second one; this difference is significant (t test p < 0.001).ConclusionOur study suggest that the MIVAT using for thyroids bigger than 25 ml and up to 50 ml in volume is feasible and safe. This way allows more patients, excluded before, to take the advantages of minimally invasive approach.

We demonstrated that using a linear model, it is possible to predict from US the PS-TV with high accuracy. In fact, the mean predicted TV perfectly matched the mean PS-TV in all cases. In particular, the percentage of cases in which the predicted TV perfectly matched the PS-TV increases from 23%, estimated by US, to 43%. Moreover, the percentage of TV underestimation was reduced from 77% to 19%, as well as the range of the disagreement from up to 200% to 80%. This study shows that two-dimensional US can provide the accurate estimation of thyroid volume but that it can be improved by a mathematical model. This may contribute to a more appropriate surgical management of thyroid diseases.

This study shows that 2D-US does not provide an accurate estimation of TV and suggests that it can be improved by a mathematical model different from the ellipsoid model. If confirmed in prospective studies, this may contribute to a more appropriate management of thyroid diseases.

In this study, we demonstrated that the MIVAT, for thyroids up to 50 ml in volume, is feasible and safe. This procedure allows more patients, who would have been excluded before, to take advantage of this minimally invasive approach with good cosmetic results, highly regarded by young female patients, and reduced paresthetic consequences.