Minimally invasive video-assisted thyroidectomy: seven-year experience with 240 cases

Introduction: Minimally invasive video-assisted thyroidectomy (MIVAT) has gained acceptance in recent years as an alternative to conventional thyroid surgery. Aim: Assessment of our 7-year experience with MIVAT. Material and methods: A retrospective study of 240 consecutive patients who underwent MIVAT at our institution between 01/2004 and 05/2011 was conducted. The inclusion criterion was a single thyroid nodule below 30 mm in diameter within the thyroid of 25 ml or less in volume. The exclusion criteria were previous thyroid or parathyroid surgery; T2 or higher thyroid cancer, N1 stage, and thyroiditis. The Miccoli technique was used. The analysis included indications, eligibility rate, operative time, morbidity and cosmetic effects. Results: Of 6,574 patients referred for thyroid surgery, 240 (3.6%) were eligible for MIVAT. In the final pathology report, there were 206 follicular adenomas, 21 papillary thyroid cancers, 9 cases of Graves' disease and 4 follicular cancers. Reasons for exclusion were as follows: thyroid volume above 25 ml in 5401 (85.3%), thyroid cancer larger than stage T1 in 392 (6.2%), thyroiditis in 358 (5.6%), and previous neck surgery in 183 patients (2.9%). Minimally invasive video-assisted thyroidectomy operations consisted of 210 lobectomies and 30 total thyroidectomies, including 15 one-stage parathyroidectomies. Mean operative time was 38.6 +/- 15.1 min. Transient versus permanent recurrent laryngeal nerve injury was found in 8 (3.0%) vs. 2 (0.7%) nerves at risk, respectively. Cosmetic effects were assessed after 1 and 6 months of follow-up as very good or excellent by 89.6% and 95.8% of patients, respectively. Conclusions: Minimally invasive video-assisted thyroidectomy is suitable for surgeons experienced in thyroid and video-assisted surgery. It is feasible for well-selected patients including cases of T1 thyroid cancer, Graves' disease and concomitant parathyroid adenoma