Minimally invasive thyroidectomy: an emerging standard of care

Virtually all disciplines of surgery now offer some version of minimal access surgical techniques. Because of the challenges related to gas insufflation in the head and neck, endoscopic surgery in this region remains in its infancy. Miccoli and his group at the University of Pisa are responsible for developing a surgical approach that relies on endoscopic and ultrasonic technology, which is easily the most widely practiced technique by minimal access surgeons around the globe. Video-assisted thyroid surgical techniques have emerged as the most feasible compromise between ample exposure and minimal access surgery. In addition to the application of technology, modern thyroid surgery incorporates a number of departures from classical training, including marking of the patient upright in the holding area, no or minimal neck extension, infrequent use of a drain, and outpatient surgery. We have emphasized the concept of customizing the procedure to the patient and disease characteristics, rather than the reverse. Therefore, a spectrum of surgical techniques can be helpful, particularly for the inexperienced minimal access thyroid surgeon. Correspondingly, staging of minimally invasive thyroidectomy has been recommended in order to allow for both uniform reporting of outcome measures across patient populations and a logical basis for determining patient eligibility. With an increasingly sophisticated public, which has virtually unlimited access to medical information, the burden will be on the modern thyroid surgeon to stay abreast of surgical or technical improvements that will yield superior outcomes. Looking forward, it would seem inevitable that continued technologic advances will help surgeons achieve less invasive, safer, and more easily performed procedures.