Minimally Invasive Hemithyroidectomy Using a Mini Incision over the Upper Pole of Thyroid Swelling

Abstract

Minimally invasive thyroid surgery, using various techniques including endoscopic and video-assisted have been reported. Thyroid surgery using a mini-incision over the upper pole of the thyroid, as a new technique is presented here. Methods: The study group comprised of 52 patients undergoing minimally invasive thyroid surgery (MITS) by open method during the period May 2005-May 2013. Data regarding patient demographics, indication for surgery, operation performed, nodule size, final pathology, and complications were recorded. The operation was carried out through a 1.5-2-cm incision placed directly over the upper pole of the swelling, and deepening the incision to visualize the superior pedicle. After ligating the superior pedicle, the finger is passed over the gland and separated from all sides. Then the thyroid is pulled up and the inferior pedicle accessed and ligated. Any bleeding points were taken care of and the wound was closed without drain. Results: Fifty two patients underwent MITS, 38 women and fourteen men. All the patients underwent hemi-thyroidectomy. The average measured incision size was 2. cm at the end of the procedure. The average nodule size was 3.2 cm, and the average thyroid lobe resected measured 4.5 cm in maximal length. Final pathology revealed follicular adenoma in51 patients and one thyroid cancer (follicular). There was one wound infection and one patient had temporary recurrent laryngeal nerve neurapraxia. Conclusion: Minimally invasive thyroid surgery with a minimal incision over the upper pole of thyroid swelling as an alternative to open thyroid surgery, using a standard cervical collar incision, is safe and feasible.

Mini-incision Hemithyroidectomy—Incision Closure with Subcuticular Suture Versus No Suture of Subcutaneous Tissue and Skin

“…It is attractive because patients are concerned not only about the results of treating their thyroid disease, but also outcomes such as better cosmesis, reduced hospital stay and decreased pain. The three most commonly utilized approaches for thyroid surgery are minimally invasive video-assisted thyroidectomy (MIVAT), minimal invasive thyroid surgery through a direct lateral mini-incision approach (MITS) or a central mini incision approach or an incision at the upper pole of the swelling [2]. If skin suturing techniques are improved, the results will be more encouraging.…”

“…Development of minimally invasive approaches for thyroid surgery and parathyroid surgery over the last decade have been motivated by the cosmetic concern about the final appearance of the scar. [1][2][3]. Minimally invasive thyroid surgery techniques (MIT) are different but all share the same goals: reduction of tissue trauma, early hospital discharge, and better neck wound cosmetic appearance, while maintaining the same surgical outcome as traditional thyroidectomy [4].…”

“…The aesthetic outcome is particularly relevant in thyroid surgery since patients are mostly women and young adults and since the incision is in a highly sensitive and in visible anatomic location. Cosmetic concern about the final scar appearance contributed to motivate the development of minimally invasive approaches for thyroid surgery and parathyroid surgery over the last decade [2][3][4][5][6][7][8][9][10][11][12][13]. In addition to MIT, methods of skin closure play a role in the cosmetic outcome of surgery.…”

“…The exclusion criteria were previous surgery of thyroid. The operation was performed through a minimal open cervical incision, as described earlier [2]. Surgery was performed by the same surgeon (MS).…”

“…After the operation, patients received a standard postoperative protocol and analgesic regime. Post-operative pain assessment was done using visual analogue scale ranging from 1-10 as described earlier [2]. The assessment of the scar was done after 6 weeks in both the groups.…”