Minimally invasive approach to thyroid gland surgery--indications, methods, first results

After the introduction of minimally invasive operative techniques in the surgery of organs located in body cavities, extensive work has been done in the last five years with respect to their application in thyroid gland surgery as well.

In 2011, 406 patients underwent thyroid surgery at the Department of Surgery, Kaspela General Hospital for Active Treatment EOOD - Plovdiv. The study involved 48 of these patients, chosen at random and divided into two groups (A-minimally invasive thyroidectomy (MIT) - 26 patients, and B - minimally invasive video-assisted thyroidectomy (MIVAT) - 22 patients). All patients included in the study were selected on the basis of presence of one or more indeterminate nodules (fine needle aspiration biopsy - FNAB) sized up to 3.5 cm, with normal size of the thyroid gland up to 20-25 cm2, detected by preoperative ultrasonography. The study excluded patients with recurrent goitre, malignant disease of the thyroid gland and evidence of preoperative radiation therapy in the area of the head, neck and/or upper mediastinum. The preoperative investigation included history, physical examination, blood indices, echography, gamma camera and FNAB. Sensation of pain was evaluated by the patients according to a visual analogue scale, where lack of pain was evaluated as 0, and the most severe pain was evaluated as 10.

The average duration of the hospitalization of patients undergoing MIT was 16 +/- 3.14 hours, whereas the patients undergoing MIVAT had to stay at the hospital for 18 +/- 3.56 hours. No complications were registered regarding the recurrent laryngeal nerves (RLN), as well as the operative wound. It should be noted that in all patients the course of the respective RLN was identified during the operative intervention, visually in most cases, or by electrostimulation. Postoperative hypoparathyroidism, registered by measuring the level of serum calcium, was observed in one visual analogue scale, as well as in the administration of pain-relieving agents during hospitalization. Other complications were not registered for the follow-up period, which covered an average of 6.56 +/- 3.14 months.

The clinical analysis of the patients observed gave us grounds to draw the following conclusions: 1. The minimally invasive approach in patients with thyroid gland pathology is a possible and favourable option in selected patients with size of the gland within certain limits and not suffering from severe concomitant diseases. 2. The results in both groups of patients were comparable and did not show significant difference.