Minimally invasive thyroid surgery for diagnostic excision of solitary thyroid nodules

OBJECTIVE: Various techniques for minimally invasive thyroid surgery (MITS), including endoscopic and video-assisted procedures, have now been described. Based on our units experience with minimally invasive parathyroidectomy via a lateral incision, a similar technique for minimally invasive thyroid lobectomy has been developed and assessed. METHODS: The last 203 consecutive thyroid procedures using the MITS technique, performed between July 2002 and June 2006, comprised the study group. Inclusion criteria for initial surgery were: initial nodule < 3.0 cm; no preoperative evidence of malignancy; absence of clinical multinodular change. A 2.5-cm lateral incision, using a headlight illumination, provided optimal exposure. RESULTS: A total of 202 patients underwent 203 MITS procedures over the 4-year period, with one patient undergoing bilateral MITS. The procedures included 155 thyroid lobectomies and 48 nodule excisions; 31 of the patients underwent a minimally invasive parathyroidectomy (MIP) during which an ipsilateral thyroid nodule was removed. The mean tumour size was 17.3 mm, but the mean size of the thyroid lobe removed was 39.5 mm. Final diagnoses included benign multinodular goitre (26%), follicular adenoma (22%) and carcinoma (20%). The complication rate was low, with one permanent recurrent laryngeal nerve (RLN) palsy (anterior division only) (0.5%), four RLN neuropraxias which recovered (2%), and one haematoma not requiring re-operation (0.5%). The rate of complications was not significantly different from 819 conventional open hemithyroidectomies performed over the same period. CONCLUSION: MITS is a safe and feasible alternative to open thyroid surgery in appropriately selected cases. It offers a valuable option for diagnostic excision biopsy in patients with thyroid nodules demonstrating an atypical fine-needle biopsy whilst avoiding the need for a standard cervical "collar" incision.     

Surgery of the thyroid gland

Records of 92 patients operated on for thyroid diseases were reviewed. There were four histologic groups: adenoma-56 (61%), thyrotoxicosis-22 (24%), cancer-10 (11%) and Hashimoto's thyroiditis-4 (4%). Among the cold nodules, 9% were malignant. Routine frozen section examination revealed three cases of cancer and three other cases were missed but were discovered on permanent section examination. The type of operations were lobectomy with or without isthmusectomy, subtotal thyroidectomy and modified radical neck dissection. Postoperative complications included two thyroid crises, two recurrent laryngeal nerve injuries, one laryngeal obstruction and hypothyroidism, and one wound infection. There was no surgical mortality.     

Minimally Invasive Thyroid Surgery for Single Nodules: An Evidence-based Review of the Lateral Mini-incision Technique

Background

Minimally invasive thyroidectomy techniques are being developed in an effort to minimize pain, shorten the length of hospital stay, and improve cosmesis. Various minimally invasive thyroid surgery (MITS) techniques have been shown to be safe and feasible with some benefits in terms of cosmesis and pain outcomes; however, no single technique has been broadly accepted. This study was designed to review the evidence in relation to MITS and our experience with the direct lateral mini-incision technique.

Methods

A review of literature published until December 2007 on minimally invasive thyroidectomy techniques was undertaken. Three issues were addressed: 1) Does MITS provide any benefit compared with conventional open thyroidectomy? 2) Is there any advantage to the use of endoscopic or video-assisted techniques compared with the direct mini-incision technique? 3) Is the lateral mini-incision technique safe and efficacious? Additional data in relation to the above issues was derived from a retrospective cohort study of patients undergoing mini-incision thyroid surgery within our unit.

Results

Issue 1: Five prospective randomized studies and eight studies at a lower level of evidence have demonstrated consistent advantages of MITS compared with open thyroid surgery in terms of reduced pain and improved cosmesis with equivalent operative safety. Issue 2: In compiling four level III and IV studies that compared open and video-assisted minimally invasive surgery, there do not seem to be significant differences in patient satisfaction with the incision. The video-assisted approaches require significantly longer operative times but also seem to be less painful. Issue 3: Three cohort studies (level IV) have demonstrated that the lateral mini-incision technique is both safe and efficacious compared with open surgery for hemi-thyroidectomy. Data from our cohort study of 1281 patients (open hemi-thyroidectomy 1054 vs. MITS 227) confirmed MITS to be a safe and effective procedure. The rate of postoperative hematoma formation and wound infection was equivalent between groups. The rate of permanent recurrent laryngeal nerve injury was 0.4% for MITS and 0.3% for CHT and not significantly different (p = 0.7).

Conclusions

MITS has demonstrated advantages over conventional open approaches for both hemi- and total thyroidectomy and the benefits do not depend on the open or video-assisted approach. For thyroid lobectomies, the lateral mini-incision approach can be performed with an operative time and postoperative complication profile equivalent to conventional hemi-thyroidectomy while providing excellent cosmesis with a 2–3 cm scar.     

经乳晕入路腔镜下甲状腺手术经中间入路显露喉返神经的体会

目的探讨全乳晕入路腔镜下甲状腺手术常规经中间入路手术路径显露喉返神经,达到预防术中喉返神经损伤的效果。从而提供一种新的显露喉返神经的方法。方法采取全乳晕入路腔镜下甲状腺中间入路的手术方法完成甲状腺手术154例,术中共显露喉返神经205条。结果1例甲状腺癌手术和1例再次甲状腺手术后出现轻度喉返神经麻痹症状,分别于1、3个月后恢复,无永久损伤。术后平均住院时间5.5d（4~8d）。结论中间入路新手术路径使腔镜下甲状腺的手术操作更加容易,降低了甲状腺手术难度,并且可以作为一种安全的喉返神经显露方法。     

超声刀FOCUS在开放甲状腺手术中的应用

目的比较超声刀FOCUS与传统手术方法在开放甲状腺手术中应用的特点。方法收集我科自2010年7月至2011年12月接受开放甲状腺手术的患者共计126例,随机分为两组,超声刀组66例,使用超声刀FOCUS进行手术;传统手术组60例,采用高频电刀结合缝扎止血。两组均由同一手术组医生进行手术。分别比较两组的手术时间、术中出血量、术后引流量、切口大小、住院时间和手术并发症发生率(喉返神经损伤、喉上神经损伤、甲状旁腺功能低下)。结果超声刀组在手术时间、术中出血量、术后引流量、切口大小、住院时间方面均短于或少于传统手术组,差异有统计学意义(P<0.05)。两组中均有1例甲状旁腺损伤,而喉上神经损伤、喉返神经损伤各1例仅见于传统手术组。两组间的手术并发症发生率差异无统计学意义(P>0.05)。结论使用超声刀行开放甲状腺手术要优于传统手术方法,可尽量兼顾美容的优点,符合现代微创外科理念,值得应用和推广。     

Minimally invasive, totally gasless video-assisted thyroid lobectomy.

BACKGROUND: Neck surgery is one of the newest fields of application of video-assisted surgery. We developed a technique for minimally invasive, totally gasless video-assisted thyroid lobectomy. METHODS: The procedure was accepted by a patient with a follicular nodule of the left lobe of the thyroid. We performed a left thyroid lobectomy through a single 20-mm horizontal skin incision, just above the sternal notch, after inserting a 5-mm 30 degrees laparoscope, by using both endoscopic and conventional instrumentation. RESULTS: The recurrent laryngeal nerve and the parathyroid glands were easily identified and preserved. The operating time was 2.5 hours. No complication occurred. The postoperative stay was 2 days. The cosmetic result was excellent CONCLUSIONS: We concluded that our technique is feasible and safe. This makes us optimistic about the future of minimally invasive, video-assisted thyroid surgery.     

Minimally invasive nonendoscopic thyroidectomy.

OBJECTIVES: Minimal-access thyroid surgery, using various techniques, is increasingly being reported. The present study reviews our experience with thyroid surgery using a minimally invasive approach (MIT). STUDY DESIGN: Between October 2002 and December 2004, a prospective nonrandomized study of patients undergoing thyroid surgery was performed to evaluate the variables that might condition the indications to minimally invasive nonendoscopic approach. RESULTS: 296 patients underwent thyroid surgery; 46 of these were eligible for MIT through a 2.5- to 3-cm incision. There was one case of transient inferior laryngeal nerve palsy and no postoperative definitive hypoparathyroidism. MIT was converted to conventional thyroidectomy only in two cases. Cosmetic results were considered excellent by all patients. CONCLUSIONS: Minimal-access thyroid surgery is a safe and feasible alternative to conventional thyroid surgery in selected cases. The advantage that this technique offers, in addition to low morbidity, is an improved cosmetic result.     

Minimally invasive parathyroidectomy and thyroidectomy--current concepts.

The introduction of various techniques for minimally invasive parathyroidectomy (MIP) and minimally invasive thyroid surgery (MITS) have changed both the conceptual and surgical approach to parathyroid disease and single thyroid nodules. Perceived advantages of minimally invasive surgery both among clinicians and patients, have been a major factor in the development of new surgical techniques, as well as refinement in preoperative localisation techniques. Worldwide the number of patients being operated on using MIP or MITS has steadily increased. At some major centres as many as 70% of patients with primary hyperparathyroidism have their operation using MIP. In this review we discuss the underlying pathology and investigative procedures, as well as the various techniques used, all of which now have excellent outcomes at a minimal cost and with minimal complications. Based on our own experience we recommend the use of a lateral focused mini-incision for both MIP and MIT since they both use standard equipment and standard dissection techniques familiar to all experienced endocrine surgeons.     

超声引导下微创组织活检技术在甲状腺外科的应用

目的 探讨超声引导下微创组织活检技术在甲状腺疾病诊治中的指导意义.方法 总结吉林大学中日联谊医院甲状腺外科2008年10月至2009年7月间,117例(共131个结节,结节直径大小在0.5～1.5 cm之间,平均直径约0.8 cm)甲状腺疾病患者,行超声引导微创组织活检的临床资料并进行分析.结果 117例患者,活检取材满意,行组织活检后均未出现明显不适及活检后并发症.其中59例患者活检后行手术治疗,仅有2例术前活检病理与术后石蜡病理未完全符合;未行手术治疗的58例患者,结合症状、查体、甲状腺功能和彩色多普勒超声等辅助检查,行对症治疗并定期复查,症状及彩色多普勒超声下影像均有明显好转,治疗效果良好.117例微创组织活检患者中8例同时行颈部肿大淋巴结活检,活检病理与术后石蜡病理结果一致(7例为转移癌,1例为反应性增生),准确率为100%.结论 超声引导下微创组织活检术对甲状腺疾病的诊治有重要的指导意义,临床符合率高,特别是对于微小结节的术前诊断具有较高的价值,既可避免不必要的过度治疗,又可减少甲状腺癌的漏诊,同时本技术具有简便易行、安全准确的优点,在甲状腺外科具有一定的临床应用价值.     

The clinical significance of an isofunctioning thyroid nodule

The management of an "isofunctioning" thyroid nodule--defined by radioiodine uptake equivalent to normal thyroid tissue--is often a dilemma. Our goal was to determine the percentage of thyroid nodules that were isofunctioning and the frequency with which carcinoma occurred in an isofunctioning nodule. Patients referred for evaluation of a thyroid nodule from 1990 to 2002 were reviewed and those with an iodine-123 thyroid scintiscan were identified. Nodule size, serum thyrotropin, fine-needle aspiration biopsy, pathology, and follow-up were determined for patients with an isofunctioning, hypofunctioning, or hyperfunctioning thyroid nodule. Of the 562 patients with a thyroid nodule 273 (49%) had a thyroid scan. Nodules were hypofunctioning in 232 (85%), isofunctioning in 29 (11%), and hyperfunctioning in 12 (4%) patients. Mean nodule size and serum thyrotropin level were respectively 2.49 +/- 0.23 cm and 1.73 +/- 0.26 microIU/mL for isofunctioning, 2.47 +/- 0.31 cm and 0.83 +/- 0.21 microIU/mL for hyperfunctioning, and 3.94 +/- 0.13 cm and 1.86 +/- 0.28 pIU/mL for hypofunctioning nodules. Seventeen patients with an isofunctioning nodule underwent thyroidectomy and 12 patients were followed for a mean 27 months without an increase in nodule size. No patient with a hyperfunctioning nodule, six patients (21%) with an isofunctioning nodule, and 44 patients (19%) with a hypofunctioning nodule had a carcinoma. We conclude that the risk of malignancy in an isofunctioning nodule is similar to that of a hypofunctioning nodule and therefore the management should be based on routine fine-needle aspiration biopsy.     

分化型甲状腺癌局部切除术后再次手术的探讨

目的探讨甲状腺结节初次手术方式的选择,以及分化型甲状腺癌局部切除术后再次手术的必要性。方法回顾性分析4年间收治的138例分化型甲状腺癌局部切除术后行再次手术的患者的临床资料。再次手术均行双侧甲状腺全切加不同范围的颈部淋巴结清扫。结果再次手术后病理检查腺体和淋巴结内有残余癌的发生率为76.8%。院外首次手术后单侧喉返神经损伤的22例及双侧损伤的1例(总发生率为16.7%),经修复后恢复19例。再次手术后新发的喉返神经损伤3例(2.2%),甲状旁腺部分损伤2例(1.4%),喉上神经损伤2例(1.4%);无食管损伤及术后出血。结论分化型甲状腺癌局部切除术后癌残留的发生率较高,应再次手术。再次手术以选择双侧甲状腺全切和颈部淋巴结清扫为宜。     

分化型甲状腺癌不同术式术后主要并发症的分析

目的对比分析分化型甲状腺癌不同手术方式术后主要并发症的情况。方法回顾性分析河北医科大学第二医院2004年1月至2012年1月经手术治疗的264例分化型甲状腺癌资料。结果患侧腺叶及峡部切除术77例,术后喉返神经损伤1例（占1.3%）,低钙血症1例（占1.3%）;患侧腺叶及峡部＋对侧大部切除术137例,术后喉返神经损伤4例（占2.9%）,低钙血症9例（占6.6%）;甲状腺全切术50例,术后喉返神经损伤2例（占4.0%）,低钙血症11例（占22.0%）。结论甲状腺全切术、患侧腺叶及峡部切除术与患侧腺叶及峡部＋对侧大部切除术术后喉返神经损伤率无统计学差异;甲状腺全切术术后低钙血症发生率明显高于患侧腺叶及峡部切除术与患侧腺叶及峡部＋对侧大部切除术。     

Minimally invasive video-assisted thyroidectomy: experience of 300 cases

Background

We report on patients selected for minimally invasive video-assisted thyroidectomy (MIVAT) over a 3-year period and evaluate the feasibility and effects of this procedure.

Methods

Between March 2005 and August 2008, 300 patients (36 male, 264 female; mean age = 54.6 years) underwent MIVAT using a single central incision with an average length of 2 cm (range = 1.5–3 cm), about 2 cm above the sternal notch. Small conventional retractors and dissectors, ultrasonic scalpel, 5-mm laparoscope, and a video screen were the instruments used.

Results

General anesthesia was used in 295 patients and regional block anesthesia in 5. MIVAT was performed successfully in 280 patients (93.3%). Conversion to open thyroidectomy with a 4-cm-long incision was required to achieve selective lymphadenectomy in 18 patients after frozen sections demonstrated differentiated thyroid carcinoma. Only two patients with benign thyroid nodules were converted because of large volume or massive hemorrhage from the upper pole vessels. Mean operative time was 35 min (range = 20–70 min) for unilateral lobectomy and 58 min (35–90 min) for bilateral thyroidectomy. No patients had wound infections, postoperative bleeding that required reoperation, permanent hypoparathyroidism, or bilateral recurrent laryngeal nerve palsy. However, permanent unilateral recurrent laryngeal nerve palsy appeared in five cases (1.7%), transient unilateral recurrent laryngeal nerve palsy in seven (2.3%), superior laryngeal nerve injury in five (1.7%), transient hypocalcemia in nine (3.0%), and mild skin burn from the ultrasonic scalpel in five (1.7%). Postoperative pain was minimal and better cosmetic results were obtained than conventional open thyroidectomy. Postoperative stay was shorter than with conventional open thyroidectomy.

Conclusions

MIVAT appears to be safe and feasible in patients with benign thyroid nodules, with minimal injury and excellent cosmetic results. Furthermore, after properly lengthening the skin incision, MIVAT can be used for patients with large benign thyroid nodules or even early–stage differentiated thyroid carcinoma.     

Minimal access thyroid surgery: technique and report of the first 25 cases

BACKGROUND: Minimal access thyroid surgery, using various techniques, is increasingly being reported. The present study reviews our experience with thyroid surgery using a lateral focused mini-incision approach, and assesses its safety and feasibility. METHODS: The study group comprised all patients undergoing minimal access thyroid surgery (MATS) during the period May 2002-May 2003. Data were prospectively gathered, including patient demographics, indication for surgery, operation performed, nodule size, final pathology, and complications. Exclusion criteria for this procedure included: family history of thyroid cancer, previous neck irradiation or surgery, carcinoma on fine needle aspiration, presence of significant thyroiditis, multinodular goitre, and nodule size >3 cm. The operation was carried out through a 2.5-cm lateral incision placed directly over the nodule, with exposure gained by dissecting the plane between the sternomastoid muscle and the lateral edge of the strap muscles. RESULTS: Twenty-five patients underwent MATS, 22 women and three men. Nineteen patients underwent hemithyroidectomy, five underwent isthmectomy, and one underwent local nodule excision. The average measured incision size was 2.63 cm at the end of the procedure. The average nodule size was 2.2 cm, and the average thyroid lobe resected measured 4.7 cm in maximal length. Final pathology revealed benign nodules in 21 patients and four thyroid cancers (two follicular and two papillary). There was one wound infection and two patients had temporary recurrent laryngeal nerve neuropraxia. CONCLUSION: Minimal access thyroid surgery is a safe and feasible alternative to open thyroid surgery in selected cases.     

Complications of thyroid surgery performed by residents

The purpose of this report is to study the incidence of complications in thyroid surgery performed by the residents in a surgical training program. This is a report of complications in 200 consecutive thyroidectomies performed by residents with attending surgeons' assistance. There were 128 female and 72 male patients, ranging in age from 16 to 89 years. Ten patients had undergone previous thyroid surgery. There were 40 total thyroidectomies, 38 subtotal thyroidectomies, and 122 lobectomies with isthmusectomy. Preoperative and postoperative evaluation of the vocal cords was a standard routine. Identification of the recurrent laryngeal nerve was routine except in patients with large goiters, who underwent intracapsular subtotal thyroidectomy. An attempt was made to identify and preserve all four parathyroid glands. Even in lobectomy procedures, the ipsilateral parathyroids were identified and preserved. Parathyroid autotransplantation into the sternomastoid muscle was performed in thirteen instances, whenever any of the parathyroids was devascularized. Complications included superior laryngeal nerve palsy (one case) and temporary recurrent laryngeal nerve palsy (one case). There was only one patient in whom temporary hypoparathyroidism developed. In three patients hematomas developed in the recovery room and reexploration was required. Two diabetic patients had wound infections develop that required drainage. Seromas and minor wound collections were noted in 6% of the patients. The incidence of major postoperative complications of thyroidectomy is low, even when residents are the primary surgeons. Thyroidectomy appears to be a safe operation in the hands of residents with close supervision and assistance by the attending surgeons.     

Endoscopic transaxillary approach to the thyroid gland: our early experience

Background Thyroid nodules are a common occurrence in clinical practice today. Most nodules are benign and can be managed nonoperatively with careful medical follow-up. However surgical extirpation occasionally becomes necessary to exclude a malignant neoplastic process. Although the majority of surgically excised thyroid lesions are histologically benign, patients are traditionally left with a permanent transverse surgical scar in a highly visible area of the neck. Materials and Methods From August 2003 to August 2005, we performed a transaxillary endoscopic thyroid lobectomy with isthmectomy in 32 patients. We used a 3-port technique with 5-mm trocars and surgical instrumentation. A 5-mm 45-degree angled endoscope was used for visualization during the procedure. The CO₂ insufflation pressure was set to 6–8 mmHg, and dissection was carried out using a 5-mm harmonic scalpel (Ethicon Endo-Surgery™). Results All patients underwent successful completion of thyroid lobectomy and isthmectomy. No conversion to open operation was required in this series. The mean operating time was 138.5 min, and the mean blood loss was 36.4 ml. The recurrent laryngeal nerve was identified in each case, and there was no permanent injury to this structure. There were two cases of temporary hoarseness that resolved spontaneously. One patient in this series had to be returned to the operating room for evacuation of a postoperative hematoma from an active bleeding vessel on the surface of the pectoralis major muscle. All patients were discharged on the first postoperative day. Conclusions Transaxillary endoscopic thyroidectomy is a safe and feasible alternative to the traditional open surgical approach in select patients requiring surgical removal of the thyroid gland. The resultant improved cosmetic outcome and enhanced operative visualization may offer a practicable alternative for select patients requiring surgical removal of the thyroid gland.     

The laryngeal mask airway for thyroid and parathyroid surgery

The role of the laryngeal mask airway for thyroid and parathyroid surgery was studied in 97 consecutive patients. In 50% the technique combined electrical stimulation of the recurrent laryngeal nerve with visualisation of vocal cord movement via a fibreoptic bronchoscope. Stimulation was required in 10% to assist in identifying recurrent laryngeal nerve position during difficult surgical dissection. In the remaining 40% stimulation was used to confirm nerve integrity and for teaching purposes. Tracheal intubation was required for seven patients but in only two of these was intubation unplanned. The incidence of postoperative recurrent laryngeal nerve dysfunction was zero. These data suggest that the technique offers a safe alternative in airway management and may provide advantages in terms of preservation of recurrent laryngeal nerve function.     

胸骨后甲状腺肿98例外科治疗分析

目的分析探讨不同分型胸骨后甲状腺肿的外科治疗和人路选择。方法回顾性分析98例胸骨后甲状腺肿患者的临床资料,其中结节性甲状腺肿89例,滤泡性甲状腺腺瘤8例,甲状腺乳头状癌1例。SINGHI型37例,Ⅱ型56例,Ⅲ型5例;全部I型和55例Ⅱ型均行颈部低领式切口,1例Ⅱ型为恶性并周围粘连明显行颈胸联合切口,Ⅲ型行颈胸联合切口。术中常规显露喉返神经;28例使用超声刀配合手术。结果98例患者手术均获成功,术后4例并发短暂的低钙血症,3例短暂声嘶,8例甲状旁腺功能减退。结论I型和Ⅱ型胸骨后甲状腺肿患者采用颈部低领式切口是可行的,胸骨后甲状腺肿为恶性并周围粘连明显以及Ⅲ型行颈胸联合切口是必要的。术中常规显露喉返神经对于减少喉返神经损伤具有重要意义。应用超声刀行胸骨后甲状腺肿切除术,减少手术时间及术中出血量,是安全、有效的手术方法。     

The minimally invasive surgical approach in thyroid diseases

AIM: The targets of minimally invasive thyroidectomy could be summarised by: achievement of the same results as those obtained with traditional surgery, better postoperative course and improved cosmetic RESULTS: In minimally invasive surgical approach the skin incision should not exceed 30 mm in length. In our experience this limit may be extended of 5 mm for thyroid between 25 and 50 mL in volume. This way allows more patients, excluded before, to take the advantages of minimally invasive approach. The aim of this work has been to demonstrate that the central neck minimally invasive approach is safe, less painful, better for cosmetic results and easily reproducible in surgical practice. METHODS: From January 2003 to June 2007, 75 patients have been selected for minimally invasive thyroidectomy. The procedure was carried out through a central skin incision performed 'high' between the cricoid and jugular notch. Our 'modified Miccoli-procedure' consists in five-easily repeatable steps. In the postoperative stay, all patients were asked to evaluate the pain that feel and the cosmetic result by means of a numeric scale. RESULTS: The skin incision performed was from 25 to 30 mm (mean 27.39 +/- 2.6 mm). We obtained in all cases excellent results about patients cure rate and comfort, few postoperative pain and attractive cosmetic RESULTS: CONCLUSION: In this study we demonstrate that the central neck minimally invasive approach is safe, less painful, better for cosmetic results, with less paresthetic consequences and easily reproducible in surgical practice. In our opinion a longer incision (up to 35 mm), does not affect negatively the advantages of minimally invasive procedure. This way allows more patients to take the advantages of minimally invasive approach.     

Near-total thyroidectomy could be the best treatment for thyroid disease in endemic regions

HYPOTHESIS: Near-total thyroidectomy, on the basis of its low morbidity rate, is an appropriate treatment option in the surgical management of various thyroid diseases in an endemic region in Turkey. DESIGN: Single-institution study of patients with various thyroid diseases treated by means of near-total thyroidectomy within 2 years in an endemic region, with comparison of the results vs the complication rates of bilateral subtotal and total thyroidectomy reported in the literature. SETTING: Tertiary academic referral center. PATIENTS: One hundred fifty-two patients who underwent near-total thyroidectomy for various thyroid diseases. MAIN OUTCOME MEASURES: Surgical treatments of various benign thyroid diseases were compared according to the complication rates and the achievable benefits of the procedures. RESULTS: In our clinic, near-total thyroidectomy was the principal surgical procedure performed for benign thyroid disease. The temporary recurrent laryngeal nerve palsy rate with respect to the nerves at risk was 3.3% (10 of 304 nerves), whereas temporary hypoparathyroidism was 7.2% (11 of 152 patients). Neither permanent recurrent laryngeal nerve palsy nor permanent hypoparathyroidism occurred. In 1 patient, wound hematoma developed and required re-exploration. Seroma in another patient needed no medical or surgical intervention. Neither wound infection nor mortality were noted. CONCLUSIONS: Near-total thyroidectomy achieves a lower complication rate of hypoparathyroidism and a similar complication rate of recurrent laryngeal nerve palsy and recurrence when compared with the rates reported in the literature for total thyroidectomy. It is an effective and safe surgical treatment option for various benign thyroid diseases.