Video. Endoscopic minimally invasive thyroidectomy: first clinical experience

Area of Science:

• Minimally Invasive Surgery
• Endoscopic Thyroidectomy
• Surgical Oncology

Background:

• Traditional thyroidectomy uses a collar incision, established by Kocher, with a low mortality rate but significant scarring and potential for swallowing disorders.
• Minimally invasive video-assisted thyroidectomy (MIVAT) reduced incision size but still involves external neck incisions.
• Extracervical endoscopic approaches (chest, axillary) relocate incisions but increase dissection and invasiveness.

Observation:

• The endoscopic minimally invasive thyroidectomy (eMIT) technique utilizes standard 3.5 mm endoscopic instruments through an intraoral approach.
• An initial animal trial in pigs demonstrated safety, minimal blood loss, and normal postoperative recovery.
• The first human clinical application in a patient with dysphagia and a right hemithyroid nodule was successfully performed.

Findings:

• The eMIT procedure was completed using a sublingual incision and carbon dioxide insufflation, with instruments inserted through vestibular incisions.
• The recurrent laryngeal nerve function was preserved, confirmed by neuro-monitoring.
• The patient experienced no postoperative complications, with rapid healing of the intraoral incision and resolution of preoperative dysphagia.

Implications:

• eMIT represents a novel natural orifice surgery for thyroid resection, offering a scarless and minimally invasive alternative.
• The intraoral approach may reduce the risk of cervical space infection compared to conventional transcervical procedures.
• This technique minimizes surgical trauma, avoids swallowing disorders, and eliminates visible skin scarring, paving the way for further clinical trials.