Video-Assisted Thyroidectomy: Report On The Experience Of A Single Center In More Than Four Hundred Cases

Abstract Background. We report on our series of patients selected for video-assisted thyroidectomy (VAT) over a 7-years period and discuss about the results obtained. Methods. VAT is a gasless procedure performed under endoscopic vision through a single 1-5-2.0 cm skin incision, using a technique very similar to conventional surgery. Eligibility criteria were: thyroid nodules < 35 mm; thyroid volume <30ml; no previous conventional neck surgery. Small low risk papillary thyroid carcinomas (PTC) were considered eligible. Results. 473 VATs were attempted on 459 patients. Loco-regional anesthesia was used in 15 patients. Conversion was necessary 6 times (difficult dissection in 1 case, large nodule size in 3, gross lymph node metastases in 2). Thyroid lobectomy was successfully performed in 110 cases, total thyroidectomy in 343 and completion thyroidectomy in 14. In 66 patients with carcinoma central neck nodes were removed through the same access. Concomitant parathyroidectomy was performed in 14 patients. Pathology showed benign diseases in 277 cases, PTC in 175 and medullary microcarcinoma in 1. Postoperative complications included: 8 transient recurrent nerve palsies, 64 transient hypocalcemias, 3 definitive hypocalcemias, 1 post-operative haematoma and 2 wound infections. Postoperative pain was minimal and cosmetic result excellent. In patients with PTC no evidence of recurrent or residual disease was shown. Conclusions. Indications for VAT are still limited (20% of patients who require thyroidectomy). Nonetheless, in selected patients, it seems a valid option for thyroidectomy and it could be considered even preferable to conventional surgery because of its significant advantages, especially in terms of cosmetic result.