[Indications for and limitations of endoscopic thyroid surgery]

Endoscopic thyroid surgery has become a common procedure in recent years, mainly because of its cosmetic advantages. Generally two methods are used to obtain a working space: CO2 insufflation and anterior neck skin lifting. The incision sites for approaching the thyroid are the chest wall, mammary areolar area, axillary and submandibular area, in addition to the neck. Among the new operative devices, the ultrasonically activated scalpel has contributed to the development of endoscopic thyroid surgery. Based on our experience of more than 180 cases using our original endoscopic method, video-assisted neck surgery(the VANS method), we here report the clinical outcome and usefulness of the method. The operating time and blood loss in patients with 161 benign thyroid tumors were statistically compared between the small-tumor group (n = 138, < 5 cm) and the large-tumor group (n = 23, > or = 5 cm). More than 60% of the benign and 7.1% of the malignant thyroid tumors were operated on using the VANS method. Near or subtotal lobectomy was the most common procedure (64.4%) for benign tumors. Malignancy was defined as a papillary carcinoma < 1 cm in diameter. Total lobectomy with lymph node clearance was performed for all malignant cases. Although the operating time and blood loss were statistically greater in the large-tumor group than the small-tumor group, with increased experience it was possible to remove tumors of up to 7.4 cm safely. Our findings show that the VANS method is feasible, practical, and safe, and has great cosmetic benefits. However, it must be remembered that the intrinsic surgical goal of treatment should not be compromised in the pursuit of less-invasive surgery. Care must be taken to select appropriate patients carefully and to train surgeons sufficiently in the techniques required.