Minimally invasive thyroidectomy and the differentiated lesions: the way to follow

Nowadays, the conventional thyroidectomy may appear an overly aggressive treatment in patients undergoing intervention for small suspicious lesions harboring in low volume glands. In these cases a minimally invasive approach may be a safe and appropriate option. This work aims to evaluate the effectiveness of minimally invasive thyroidectomy in patients indicated to surgery for small lesions with preoperative suspicion of malignancy.

71 patients, undergoing minimally invasive total thyroidectomy as a single procedure between May 2005 and April 2009, were enrolled in this study. They were indicated to surgery for small suspicious or malignant lesions (up to 20 mm lenght by US; cT1 according to UICC 2002) and satisfied the inclusion criteria of minimally invasive thyroidectomy, with gland volume up to 25 ml, no evidence of locally advanced disease and no previous neck surgery. The outcomes were considered in terms of complication rate, postoperative pain, hospitalisation stay, cosmetic results and completeness of surgical resection in malignancies.

A low complication rate was registered. The surgical completeness, with mean serum thyroglobulin of 4.41 +/- 4.03 ng/ml and radioiodine uptake of 2.91 +/- 2.46%, was considered acceptable if compared with other experiences reported in literature. Excellent results with respect to patient comfort, postoperative pain and cosmetic outcome were obtained.

This study confirms, where a correct selection of patients is made, the safety and the effectiveness of minimally invasive approach in the treatment of small suspicious and malignant nodules, which seem to represent its best indication.