Related Experiment Video
Updated: Aug 19, 2026
Transoral Robotic Total Thyroidectomy and Bilateral Central Regional Lymph Node Dissection for Papillary Thyroid Carcinoma
Published on: September 15, 2023
Video assisted prophylactic thyroidectomy and central compartment nodes clearance in two RET gene mutation adult
1Department of Surgery, University of Pisa, Pisa, Italy. p.miccoli@dc.med.unipi.it
Abstract:
Activating point mutations of RET gene have been demonstrated to be causative of the familial form of medullary thyroid cancer (MTC), both isolated (FMTC) and associated to other endocrine neoplasia [multiple endocrine neoplasia (MEN) 2A and 2B]. In RET gene mutation carriers, who are prone to developing MTC, prophylactic thyroidectomy is recommended to obtain their definitive cure. The simultaneous excision of the central node compartment is mandatory when the stimulation pentagastrin test for serum calcitonin is positive. Although the minimally invasive video assisted thyroidectomy (MIVAT) is nowadays currently adopted in many centers, it has never been employed for the prophylactic thyroidectomy of RET gene mutation carriers. The fear of obtaining an incomplete lymphadenectomy of the central compartment was the main reason for this reluctance. Since RET gene mutation carriers have often normal thyroid volume and, if involved, small lymph nodes, they indeed represent the best candidates to this approach especially when considering that they are usually young and concerned about the cosmetic results and the period of hospitalization. The excellent results obtained by MIVAT in the last few years induced us to propose this procedure together with a central compartment lymphadenectomy to 2 RET gene mutation carriers recently found by genetic screening. As assessed by a negative pentagastrin stimulation test performed after 6 months from the MIVAT, they were definitively cured without any surgical complication with the exception of a transient hypoparathyroidism. They showed a great satisfaction for both the cosmetic results and the very short period of hospitalization, thus supporting the idea that MIVAT can be used in association with the central node dissection for the prophylactic treatment of RET mutation gene carriers whose thyroid volume is still normal.
Insights
Minimally invasive video-assisted thyroidectomy (MIVAT) with central lymph node dissection is a safe and effective prophylactic treatment for RET gene mutation carriers at risk of medullary thyroid cancer. This approach offers excellent cosmetic results and short hospitalization.
Area of Science:
- Endocrinology
- Surgical Oncology
- Genetics
Background:
- Activating RET gene mutations are causative in familial medullary thyroid cancer (MTC), including multiple endocrine neoplasia (MEN) 2A and 2B.
- Prophylactic thyroidectomy is recommended for RET gene mutation carriers to prevent MTC, with central lymph node dissection mandatory if calcitonin levels are elevated.
Observation:
- Minimally invasive video-assisted thyroidectomy (MIVAT) has not been previously used for prophylactic thyroidectomy in RET mutation carriers due to concerns about lymphadenectomy completeness.
- RET mutation carriers often have normal thyroid volume and small lymph nodes, making them suitable candidates for MIVAT, especially considering their youth and concern for cosmetic outcomes.
Findings:
- MIVAT combined with central compartment lymphadenectomy was successfully performed on two RET gene mutation carriers.
- Post-operative assessment showed complete cure, with no surgical complications apart from transient hypoparathyroidism.
- Patients reported high satisfaction with cosmetic results and minimal hospitalization duration.
Implications:
- MIVAT with central node dissection is a viable option for the prophylactic treatment of RET mutation gene carriers with normal thyroid volume.
- This approach addresses concerns regarding cosmetic outcomes and hospitalization, potentially improving patient compliance with prophylactic surgery.
