IS THERE A MINIMALLY INVASIVE TECHNIQUE FOR THYROIDECTOMY?
Of course, there is.
Conventional thyroidectomy was essentially introduced in 1909 by Kocher, a technique applied to date. Since then, and especially in the last 20 years, numerous techniques have been described to reduce surgical trauma and possible post-operative scar in the neck, but without violating the general principles of conventional thyroidectomy. Some of them have stood the test of time while others have been abandoned, but they can generally be classified into the following categories:
1. Open (minimally invasive open or mini-incision) with a skin incision of approximately 4 cm.
2. Endoscopic with or without gas in the neck.
3. A video-assisted endoscope and up to 2 cm incision. The prevailing technique to date is MIVAT (minimally invasive video-assisted thyroidectomy) described in 1999 by Miccoli.
Lately, there has been a great deal of effort to introduce and consolidate the robot in the thyroid sector. The access path for endoscopic and robotic methods may be the neck, armpit, thoracic wall or even the nipple in the breast, in an attempt to eliminate the incision in a prominent aesthetic point.
A promising new endoscopic technique that has dealt with the surgical community is Anuwong’s TOETVA (transoral endoscopic thyroidectomy vestibular approach), which uses the inner surface of the lower lip as access.
uses the inner surface of the lower lip as access.
However, all methods and routes of access have specific indications-contraindications, on the one hand, and technical limitations on the other, and as a result, not all patients are candidates for all types of thyroidectomy. The type of thyroid disease, the size of the gland, the size of the possible nodules, the presence or absence of malignancy, the need for lymphadenectomy, the accompanying diseases of the patient, are some of the factors that determine the final decision on the appropriate technique. The procedure is, therefore, individualized for each patient, who should seek the advice of a specialist surgeon discussing every possible option.