1. Mini-thyroidectomy

2. Minimally invasive thyroid surgery
Endoscopic thyroid surgery
Video-assisted thyroid surgery
Mini-thyroidectomy

3. I- Endoscopic thyroid surgery
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 subareolar
Neck lift device
1 Husher Eur J Coelio 1997
2 Gagner et al 2000
3 Shimizu et al J Surg Oncol 1998
4 Ohgami et al

4. Advantages Precise anatomical detail due to the greatly magnified view
Decreased pain ?
Smaller scar ?

5. Limitation Limited to a small (<3cm) nodule Contraindicated in :
Suspicion of malignancy
Multinodular goiter
Grave’s disease
Prior surgery
Obese patient

6. Disadvantages 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

7. II- Video-assisted thyroid surgery
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

8. Video-assisted thyroid surgery
Main Access

9. Advantages Shorter operative time Small incision
Prevents subcutaneous emphysema
Good lighting and magnification

10. Disadvantages 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

11. III-Mini-thyroidectomy
A 2.5 to 3cm incision is performed approximately 3 to 4 cm above the sternal notch
Superior and inferior subplatysmal flaps are created

12. Mini-thyroidectomy
The superior pole vessels are approached first

13. Mini-thyroidectomy The thyroid gland is delivered through the incision
The recurrent laryngeal nerve is identified
The inferior pole vessels are divided

14. 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

15. Results
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
Completion thyroidectomy: 5 patients (all through the same incision)
Specimen weight: 14 to 421 gm (44.2gm)

16. Results Hospital stay: Few hours to 2 days (mean 1 day)
OR time: 35 to 164 min (mean 76 min)
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
Complications: 1 cardiac arrhythmia and 1 transient hypocalcemia

17. Results Incision length: 2.5 to 10 cm (4.2) 2-3 cm: 25 patients (28%)

18. 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

19. 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

20. 45 year old patient after right thyroid lobectomy

21. 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

22. Conclusions
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

23. Conclusions
The greatest advantage to mini-thyroidectomy is that it requires no additional technical expertise, and is therefore easier to teach and reproduce