[Minimally invasive open access thyoid surgery--main point, indications and effectiveness]

Various new, minimally invasive techniques, using endoscopic, video-assisted and non-endoscopic, open access have recently appeared in the surgical treatment of nodular thyroid disease. Aim of this study is to examine the feasibility, indications and efficacy of the minimally invasive open approach (MOATS) in the thyroid surgery.

395 patients (368 (93.2%) females and 27 (6.8%) males, age 17 to 65 years with size of the dominant thyroid nodule less than 3.5 cm have been operated on in our institution over a four years period, using minimally invasive open access thyroid surgery. Preoperative ultrasound examination of the thyroid gland was performed in all patients and FNAB--in 121 (30.6%) of the cases. Central cervical access has been used in all patients. The surgical incision size has been measured in the beginning and at the end of the procedure, on the fourth day and when the sutures have been removed.

Partial thyroid resection of one or both thyroid lobes has been performed in 59, respectively in 17 patients; subtotal lobar resection in 106 patients; lobectomy--in 111 patients; lobectomy with partial or subtotal resection of the opposite lobe--in 34, respectively 15 patients; subtotal bilateral thyroid resection--in 25 patients and thyroidectomy in 28 patients. Pathological examination revealed nodular goiter in 168 patients (solitary variant in 99 and multinodular--in 69 patients); toxic nodular goiter--in 13 patients; follicular adenoma--in 175 patients; Hashimoto thyroiditis--in 11 and thyroid carcinoma--in 28 patients. Main peri- and postoperative parameters have been compared with those of a group of patients (well matched by sex, age, nodule size and pathological findings) in witch conventional approach has been used. Minimal collar incision and scar, possibility to apply any extent of surgery witch may be necessary, comparable operative time with the conventional method and good cosmetic results are the undoubtedly good advantages of the technique.

Our experience demonstrates that the minimally invasive open access in the thyroid surgery is a simple, safe and effective surgical technique, with very satisfactory cosmetic results in properly selected patients with small to middle-size thyroid nodules. The technique combines the advantages of an endoscopic resection with those of the conventional, classic technique.