[Lateral endoscopic approach for thyroid and parathyroid surgery]

The endoscopic lateral approach in thyroid and parathyroid surgery is achieved by developing the plane between the carotid sheath laterally and the strap muscles medially. This approach allows direct access to the posterior aspect of the thyroid lobe, without the need for the dissection of the strap muscles and without the need for medial retraction of the thyroid during the procedure. The lateral approach aided by endoscopic magnification provides the surgeon with the ideal view with which to safely dissect the vital structures found in the retro-thyroid space such as the inferior thyroid artery, the recurrent laryngeal nerve and the parathyroid glands. This approach was initially adopted in primary hyperparathyroidism caused by a single adenoma that had been localized preoperatively. It is now also offered to patients with an isolated thyroid nodule smaller than 25 mm in diameter requiring surgical excision. Experience with 408 parathyroidectomies and the preliminary results of 38 thyroid lobectomies allows the authors to recommend this technique to appropriately selected patients.