Clinical implementation of endoscopic thyroidectomy in selected patients

Objectives: Systematic investigation of minimal access thyroid compartment surgery combined with the advent of several key new technologies has culminated in the implementation of endoscopic thyroidectomy in specific clinical situations. Study Design: The authors conducted a prospective, nonrandomized analysis of a consecutive cohort of surgical patients from the Medical College of Georgia Thyroid Center. Methods and Materials: A series of patients meeting specific criteria underwent thyroid surgery with the intention of performing endoscopic thyroidectomy. Demographic and clinical data were prospectively collected and included age, gender, indications for surgery, length of incision, need for conversion, and pathology. Results. Thirty-five patients successfully underwent 36 endoscopic thyroidectomies between February 2005 and March 2006 (representing 28.8% of the 125 thyroidectomies done during that period of time). There were 32 females and three males with a mean age of 45.3 +/- 13.9 years. There were five total thyroidectomies and 31 hemithyroidectomies. The mean incision length was 24.2 +/- 0.5 mm. There were no cases of permanent hypocalcemia or recurrent laryngeal nerve paralysis. Factors that increased the difficulty of endoscopic surgery included obesity, the presence of thyroiditis, and nodules >2.5 cm. Conclusions: The combination of new technology and careful experimental investigation has spawned a new era of thyroidectomy in which definitive management of thyroid pathology may be accomplished through an incision of <1 inch. This approach is feasible in the hands of surgeons with high-volume thyroidectomy practices who are comfortable with endoscopic principles. The cosmetic advantages are self-evident.