Solitary follicular thyroid nodule: A less invasive surgical approach (the "diagnostic lobectomy")

Objective: We describe the operative technique of diagnostic lobectomy (DL), for follicular thyroid neoplasm. Methods: The study is based on 48 consecutive patients operated on from January 1997 to December 2001, for follicular neoplasms of the thyroid gland. We define DL as a surgical procedure that includes a total lobectomy and isthmusectomy with preservation of the omolateral recurrent laryngeal nerve, and parathyroid glands, avoiding to digitally explore the controlateral lobe. In fact the possible necessity of a re-entry in the prior explored field for completion thyroidectomy presents increased risk of complications. Results: There were 41 follicular adenomas and 7 follicular carcinomas. In the 7 patients with thyroid cancer completion thyroidectomy was performed 2 weeks after the first surgical intervention. Completion of thyroidectomy was performed in a totally clean environment with normal anatomical cleavage plains without risk of injuries to the laryngeal nerves and parathyroid glands. Conclusions: DL is a safe procedure and should be considered as a suitable surgical procedure in patients with follicular-structured lesions of the thyroid gland. Additional study is required before DL should be accepted as the elective diagnostic/therapeutic approach for patients with follicular neoplasms of the thyroid gland.