Principles and Philosophy of Minimally Invasive and Remote Access Endocrine Surgery

Abstract

The surgical approach to the thyroid compartment has evolved considerably over the last decade. Steady progress toward defining the steps of a safe and thorough thyroidectomy has resulted in a procedure with a success rate approaching 100 % and whose complication rate is minimal. Focus within the discipline of endocrine surgery has therefore shifted beyond the safety and completeness of surgery toward optimizing the cosmetic and quality-of-life outcomes for the patient.

In order to improve the convenience of thyroid and parathyroid surgery for patients requiring surgical intervention, surgeons have learned that the use of drains is no longer necessary. It has further been demonstrated that thyroid and parathyroid surgery may be safely performed on an outpatient basis with attention to several specific cautionary methods. These concepts will be covered in greater detail in other chapters. The emphasis on cosmetic outcomes is natural, given the fact that the patient population requiring endocrine neck surgery is largely comprised of women and often young women. They are more likely to develop thyroid nodules, more likely to require surgical intervention for thyroid cancer, and more likely to suffer from hyperparathyroidism. There is a well-recognized tendency for women to harbor more concern about the appearance of a neck scar than men. Because of concomitant advances in technology, and notably the advent of advanced energy devices, the availability of robust nerve monitoring, and the application of high-resolution endoscopy to the thyroid compartment, incorporation of minimal access surgery with or without the use of endoscopes has emerged. A second and more recent trend has been the effort to completely move the scar off of the neck, represented by remote access surgery with or without use of the robot.

The performance of these procedures provides the opportunity to pursue personalized surgery which is customized to the patient and their disease characteristics, in keeping with the principles of patient- and family-centered care.