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Minimally Invasive Techniques in Thyroid Surgery

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Surgery of the Thyroid and Parathyroid Glands

Abstract

The standard access to the thyroid gland in thyroid surgery consists of a curvilinear incision of 5–10 cm in length usually situated 3–4 cm above the suprasternal notch. The incision is typically referred to as “Kocher’s incision” even though Kocher himself, in his famous speech in front of the German Surgical Society in 1883, described his incision type as being more of a Y-shape. Since its early days, Kocher’s incision has proved to be enormously successful, becoming the standard type of access for surgery of benign and malignant thyroid disease until the late 1990s. It allows for safe exposure and meticulous dissection of the thyroid gland and its surrounding structures, which in turn has produced an impressive reduction in perioperative morbidity during the last decades. Nowadays, thyroid surgery is considered to be safe with minimal morbidity and virtually no mortality in specialized hands.

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References

  1. Kocher Th (1883) Ueber die kropfexstirpation und ihre folgen. Archiv für Klinische Chirurgie 29:254–337

    Google Scholar 

  2. O’Connell DA, Diamond C, Seikaly H, Harris JR (2008) Objective and subjective scar aesthetics in minimal access vs conventional access parathyroidectomy and thyroidectomy surgical procedures: a paired cohort study. Arch Otolaryngol Head Neck Surg 134:85–93

    Article  PubMed  Google Scholar 

  3. Gauger PG, Shanks A, Morris M, Greenfield ML, Burney RE, O’Reilly M (2008) Propofol decreases early postoperative nausea and vomiting in patients undergoing thyroid and parathyroid operations. World J Surg 32:1525–1534

    Article  PubMed  Google Scholar 

  4. Worni M, Schudel HH, Seifert E, Inglin R, Hagemann M, Vorburger SA, Candinas D (2008) Randomized controlled trial on single dose steroid before thyroidectomy for benign disease to improve postoperative nausea, pain, and vocal function. Ann Surg 248:1060–1066

    Article  PubMed  Google Scholar 

  5. Steffen T, Warschkow R, Brandle M, Tarantino I, Clerici T (2010) Randomized controlled trial of bilateral superficial cervical plexus block versus placebo in thyroid surgery. Br J Surg 97:1000–1006

    Article  PubMed  CAS  Google Scholar 

  6. Andrieu G, Amrouni H, Robin E, Carnaille B, Wattier JM, Pattou F, Vallet B, Lebuffe G (2007) Analgesic efficacy of bilateral superficial cervical plexus block administered before thyroid surgery under general anaesthesia. Br J Anaesth 99:561–566

    Article  PubMed  CAS  Google Scholar 

  7. Henry JF (2008) Minimally invasive thyroid and parathyroid surgery is not a question of length of the incision. Langenbecks Arch Surg 393:621–626

    Article  PubMed  Google Scholar 

  8. Henry JF (2006) Minimally invasive surgery of the thyroid and parathyroid glands. Br J Surg 93:1–2

    Article  PubMed  Google Scholar 

  9. Tan CT, Cheah WK, Delbridge L (2008) “Scarless” (in the neck) endoscopic thyroidectomy (SET): an evidence-based review of published techniques. World J Surg 32:1349–1357

    Article  PubMed  Google Scholar 

  10. Miccoli P, Bellantone R, Mourad M, Walz M, Raffaelli M, Berti P (2002) Minimally invasive video-assisted thyroidectomy: multiinstitutional experience. World J Surg 26:972–975

    Article  PubMed  Google Scholar 

  11. Miccoli P, Pinchera A, Materazzi G, Biagini A, Berti P, Faviana P, Molinaro E, Viola D, Elisei R (2009) Surgical treatment of low- and intermediate-risk papillary thyroid cancer with minimally invasive video-assisted thyroidectomy. J Clin Endocrinol Metab 94:1618–1622

    Article  PubMed  CAS  Google Scholar 

  12. Miccoli P, Materazzi G, Berti P (2010) Minimally invasive thyroidectomy in the treatment of well differentiated thyroid cancers: indications and limits. Curr Opin Otolaryngol Head Neck Surg 18:114–118

    Article  PubMed  Google Scholar 

  13. Miccoli P, Berti P, Frustaci GL, Ambrosini CE, Materazzi G (2006) Video-assisted thyroidectomy: indications and results. Langenbecks Arch Surg 391:68–71

    Article  PubMed  Google Scholar 

  14. Lee J, Nah KY, Kim RM, Ahn YH, Soh EY, Chung WY (2010) Differences in postoperative outcomes, function, and cosmesis: open versus robotic thyroidectomy. Surg Endosc 24:3186–3194

    Article  PubMed  Google Scholar 

  15. Miccoli P, Berti P, Bendinelli C, Conte M, Fasolini F, Martino E (2000) Minimally invasive video-assisted surgery of the thyroid: a preliminary report. Langenbecks Arch Surg 385:261–264

    Article  PubMed  CAS  Google Scholar 

  16. Miccoli P, Berti P, Conte M, Bendinelli C, Marcocci C (1999) Minimally invasive surgery for thyroid small nodules: preliminary report. J Endocrinol Invest 22:849–851

    PubMed  CAS  Google Scholar 

  17. Lombardi CP, Raffaelli M, Princi P, De Crea C, Bellantone R (2006) Video-assisted thyroidectomy: report on the experience of a single center in more than four hundred cases. World J Surg 30:794–800

    Article  PubMed  Google Scholar 

  18. Miccoli P, Berti P, Materazzi G, Minuto M, Barellini L (2004) Minimally invasive video-assisted thyroidectomy: five years of experience. J Am Coll Surg 199:243–248

    Article  PubMed  Google Scholar 

  19. Schabram J, Vorlander C, Wahl RA (2004) Differentiated ­operative strategy in minimally invasive, video-assisted thyroid surgery results in 196 patients. World J Surg 28:1282–1286

    Article  PubMed  Google Scholar 

  20. Miccoli P, Berti P, Ambrosini CE (2008) Perspectives and lessons learned after a decade of minimally invasive video-assisted thyroidectomy. ORL J Otorhinolaryngol Relat Spec 70:282–286

    Article  PubMed  CAS  Google Scholar 

  21. Bellantone R, Lombardi CP, Bossola M, Boscherini M, De Crea C, Alesina PF, Traini E (2002) Video-assisted vs conventional thyroid lobectomy: a randomized trial. Arch Surg 137:301–304

    Article  PubMed  Google Scholar 

  22. Miccoli P, Berti P, Raffaelli M, Materazzi G, Baldacci S, Rossi G (2001) Comparison between minimally invasive video-assisted thyroidectomy and conventional thyroidectomy: a prospective randomized study. Surgery 130:1039–1043

    Article  PubMed  CAS  Google Scholar 

  23. Schardey HM, Schopf S, Kammal M, Barone M, Rudert W, Hernandez-Richter T, Portl S (2008) Invisible scar endoscopic thyroidectomy by the dorsal approach: experimental development of a new technique with human cadavers and preliminary clinical results. Surg Endosc 22:813–820

    Article  PubMed  Google Scholar 

  24. Schardey HM, Barone M, Pörtl S, von Ahnen M, von Ahnen T, Schopf S (2010) Invisible scar endoscopic dorsal approach thyroidectomy. A clinical feasibility study. World J Surg 34:2997–3006

    Article  PubMed  Google Scholar 

  25. Slotema ET, Sebag F, Henry JF (2008) What is the evidence for endoscopic thyroidectomy in the management of benign thyroid disease? World J Surg 32:1325–1332

    Article  PubMed  Google Scholar 

  26. Cougard P, Osmak L, Esquis P, Ognois P (2005) Endoscopic thyroidectomy. A preliminary report including 40 patients. Ann Chir 130:81–85

    Article  PubMed  CAS  Google Scholar 

  27. Gagner M, Inabnet WB (2001) Endoscopic thyroidectomy for solitary thyroid nodules. Thyroid 11:161–163

    Article  PubMed  CAS  Google Scholar 

  28. Henry JF, Sebag F (2006) Lateral endoscopic approach for thyroid and parathyroid surgery. Ann Chir 131:51–56

    Article  PubMed  Google Scholar 

  29. Palazzo FF, Sebag F, Henry JF (2006) Endocrine surgical technique: endoscopic thyroidectomy via the lateral approach. Surg Endosc 20:339–342

    Article  PubMed  CAS  Google Scholar 

  30. Sebag F, Palazzo FF, Harding J, Sierra M, Ippolito G, Henry JF (2006) Endoscopic lateral approach thyroid lobectomy: safe evolution from endoscopic parathyroidectomy. World J Surg 30:802–805

    Article  PubMed  CAS  Google Scholar 

  31. Inabnet WB III, Jacob BP, Gagner M (2003) Minimally invasive endoscopic thyroidectomy by a cervical approach. Surg Endosc 17:1808–1811

    Article  PubMed  Google Scholar 

  32. Shimizu K, Akira S, Jasmi AY, Kitamura Y, Kitagawa W, Akasu H, Tanaka S (1999) Video-assisted neck surgery: endoscopic resection of thyroid tumors with a very minimal neck wound. J Am Coll Surg 188:697–703

    Article  PubMed  CAS  Google Scholar 

  33. Maeda S, Uga T, Hayashida N, Ishigaki K, Furui J, Kanematsu T (2006) Video-assisted subtotal or near-total thyroidectomy for Graves’ disease. Br J Surg 93:61–66

    Article  PubMed  CAS  Google Scholar 

  34. Inukai M, Usui Y (2005) Clinical evaluation of gasless endoscopic thyroid surgery. Surg Today 35:199–204

    Article  PubMed  Google Scholar 

  35. Kitano H, Fujimura M, Kinoshita T, Kataoka H, Hirano M, Kitajima K (2002) Endoscopic thyroid resection using cutaneous elevation in lieu of insufflation. Surg Endosc 16:88–91

    Article  PubMed  CAS  Google Scholar 

  36. Kim JS, Kim KH, Ahn CH, Jeon HM, Kim EG, Jeon CS (2001) A clinical analysis of gasless endoscopic thyroidectomy. Surg Laparosc Endosc Percutan Tech 11:268–272

    Article  PubMed  CAS  Google Scholar 

  37. Wang M, Zhang T, Mao Z, Dong F, Li J, Lu A, Hu W, Zang L, Jiang Y, Zheng M (2009) Effect of endoscopic thyroidectomy via anterior chest wall approach on treatment of benign thyroid tumors. J Laparoendosc Adv Surg Tech A 19:149–152

    Article  PubMed  CAS  Google Scholar 

  38. Wang YL, Zhang GY, Wang L, Wang KX, Hu SY (2009) Endoscopic thyroidectomy by a modified anterior chest approach: a single institution’s 5-year experience. Minim Invasive Ther Allied Technol 18:297–301

    Article  PubMed  Google Scholar 

  39. Ikeda Y, Takami H, Sasaki Y, Takayama J, Niimi M, Kan S (2002) Comparative study of thyroidectomies. Endoscopic surgery versus conventional open surgery. Surg Endosc 16:1741–1745

    Article  PubMed  CAS  Google Scholar 

  40. Yamamoto M, Sasaki A, Asahi H, Shimada Y, Sato N, Nakajima J, Mashima R, Saito K (2001) Endoscopic subtotal thyroidectomy for patients with Graves’ disease. Surg Today 31:1–4

    Article  PubMed  CAS  Google Scholar 

  41. Ohgami M, Ishii S, Arisawa Y, Ohmori T, Noga K, Furukawa T, Kitajima M (2000) Scarless endoscopic thyroidectomy: breast approach for better cosmesis. Surg Laparosc Endosc Percutan Tech 10:1–4

    PubMed  CAS  Google Scholar 

  42. Ishii S, Ohgami M, Arisawa Y (1998) Endoscopic thyroidectomy with anterior chest wall approach. Surg Endosc 12:611

    Google Scholar 

  43. Sasaki A, Nakajima J, Ikeda K, Otsuka K, Koeda K, Wakabayashi G (2008) Endoscopic thyroidectomy by the breast approach: a single institution’s 9-year experience. World J Surg 32:381–385

    Article  PubMed  Google Scholar 

  44. Park YL, Han WK, Bae WG (2003) 100 cases of endoscopic thyroidectomy: breast approach. Surg Laparosc Endosc Percutan Tech 13:20–25

    Article  PubMed  Google Scholar 

  45. Yamamoto M, Sasaki A, Asahi H, Shimada Y, Saito K (2002) Endoscopic versus conventional open thyroid lobectomy for benign thyroid nodules: a prospective study. Surg Laparosc Endosc Percutan Tech 12:426–429

    Article  PubMed  Google Scholar 

  46. Ikeda Y, Takami H, Sasaki Y, Kan S, Niimi M (2000) Endoscopic neck surgery by the axillary approach. J Am Coll Surg 191:336–340

    Article  PubMed  CAS  Google Scholar 

  47. Kang SW, Jeong JJ, Yun JS, Sung TY, Lee SC, Lee YS, Nam KH, Chang HS, Chung WY, Park CS (2009) Gasless endoscopic thyroidectomy using trans-axillary approach; surgical outcome of 581 patients. Endocr J 56:361–369

    Article  PubMed  Google Scholar 

  48. Yoon JH, Park CH, Chung WY (2006) Gasless endoscopic thyroidectomy via an axillary approach: experience of 30 cases. Surg Laparosc Endosc Percutan Tech 16:226–231

    Article  PubMed  Google Scholar 

  49. Duncan TD, Rashid Q, Speights F, Ejeh I (2007) Endoscopic transaxillary approach to the thyroid gland: our early experience. Surg Endosc 21:2166–2171

    Article  PubMed  CAS  Google Scholar 

  50. Ikeda Y, Takami H, Sasaki Y, Takayama J, Niimi M, Kan S (2003) Clinical benefits in endoscopic thyroidectomy by the axillary approach. J Am Coll Surg 196:189–195

    Article  PubMed  Google Scholar 

  51. Ikeda Y, Takami H, Niimi M, Kan S, Sasaki Y, Takayama J (2001) Endoscopic thyroidectomy by the axillary approach. Surg Endosc 15:1362–1364

    Article  PubMed  CAS  Google Scholar 

  52. Chantawibul S, Lokechareonlarp S, Pokawatana C (2003) Total video endoscopic thyroidectomy by an axillary approach. J Laparoendosc Adv Surg Tech A 13:295–299

    Article  PubMed  Google Scholar 

  53. Ryu HR, Kang SW, Lee SH, Rhee KY, Jeong JJ, Nam KH, Chung WY, Park CS (2010) Feasibility and safety of a new robotic thyroidectomy through a gasless. Transaxillary single-incision approach. J Am Coll Surg 211:e13–e19

    Article  PubMed  Google Scholar 

  54. Kang SW, Lee SC, Lee SH, Lee KY, Jeong JJ, Lee YS, Nam KH, Chang HS, Chung WY, Park CS (2009) Robotic thyroid surgery using a gasless, transaxillary approach and the da Vinci S system: the operative outcomes of 338 consecutive patients. Surgery 146:1048–1055

    Article  PubMed  Google Scholar 

  55. Lee KE, Rao J, Youn YK (2009) Endoscopic thyroidectomy with the da Vinci robot system using the bilateral axillary breast approach (BABA) technique: our initial experience. Surg Laparosc Endosc Percutan Tech 19:e71–e75

    Article  PubMed  Google Scholar 

  56. Choe JH, Kim SW, Chung KW, Park KS, Han W, Noh DY, Oh SK, Youn YK (2007) Endoscopic thyroidectomy using a new bilateral axillo-breast approach. World J Surg 31:601–606

    Article  PubMed  Google Scholar 

  57. Strik MW, Anders S, Barth M, Barlehner E, Benecke C, Benhidjeb T (2007) Total videoendoscopic thyroid resection by the axillobilateral breast approach: operative method and first results. Chirurg 78:1139–1144

    Article  PubMed  CAS  Google Scholar 

  58. Shimazu K, Shiba E, Tamaki Y, Takiguchi S, Taniguchi E, Ohashi S, Noguchi S (2003) Endoscopic thyroid surgery through the axillo-bilateral-breast approach. Surg Laparosc Endosc Percutan Tech 13:196–201

    Article  PubMed  Google Scholar 

  59. Shimizu K, Tanaka S (2003) Asian perspective on ­endoscopic thyroidectomy – a review of 193 cases. Asian J Surg 26:92–100

    Article  PubMed  Google Scholar 

  60. Li ZY, Wang P, Wang Y, Xu SM, Cao LP, Que RS (2010) Endoscopic thyroidectomy via breast approach for patients with Graves’ disease. World J Surg 34:2228–2232

    Article  PubMed  Google Scholar 

  61. Ikeda Y, Takami H, Sasaki Y, Takayama J, Kurihara H (2004) Are there significant benefits of minimally invasive endoscopic thyroidectomy? World J Surg 28:1075–1078

    Article  PubMed  Google Scholar 

  62. Heinrich S, Schafer M, Rousson V, Clavien PA (2006) Evidence-based treatment of acute pancreatitis: a look at established paradigms. Ann Surg 243:154–168

    Article  PubMed  Google Scholar 

  63. Benhidjeb T, Harlaar J, Kerver A, Kleinrensink GJ, Wilhelm T (2010) Transoral endoscopic thyroidectomy: part 2: surgical technique. Chirurg 81:134–138

    Article  PubMed  CAS  Google Scholar 

  64. Wilhelm T, Harlaar JJ, Kerver A, Kleinrensink GJ, Benhidjeb T (2010) Surgical anatomy of the floor of the oral cavity and the cervical spaces as a rationale for trans-oral, minimal-invasive endoscopic surgical procedures: results of anatomical studies. Eur Arch Otorhinolaryngol 267:1285–1290

    Article  PubMed  Google Scholar 

  65. Wilhelm T, Metzig A (2010) Endoscopic minimally invasive thyroidectomy (eMIT): some clarifications regarding the idea, development, preclinical studies, and application in humans. Surg Endosc

    Google Scholar 

  66. Wilhelm T, Metzig A (2010) Endoscopic minimally invasive thyroidectomy: first clinical experience. Surg Endosc 24:1757–1758

    Article  PubMed  Google Scholar 

  67. Wilhelm T, Harlaar J, Kerver A, Kleinrensink GJ, Benhidjeb T (2010) Transoral endoscopic thyroidectomy. Part 1: rationale and anatomical studies. Chirurg 81:50–55

    Article  PubMed  CAS  Google Scholar 

  68. Benhidjeb T, Wilhelm T, Harlaar J, Kleinrensink GJ, Schneider TA, Stark M (2009) Natural orifice surgery on thyroid gland: totally transoral video-assisted thyroidectomy (TOVAT): report of first experimental results of a new surgical method. Surg Endosc 23:1119–1120

    Article  PubMed  CAS  Google Scholar 

  69. Kim JH, Choi YJ, Kim JA, Gil WH, Nam SJ, Oh YL, Yang JH (2008) Thyroid cancer that developed around the operative bed and subcutaneous tunnel after endoscopic thyroidectomy via a breast approach. Surg Laparosc Endosc Percutan Tech 18:197–201

    Article  PubMed  Google Scholar 

  70. Koh KW, Lee TH, Cho SY, Lee SS, Kim JM, Yi KH, Lee YY (2010) Subcutaneous implantation of adenomatous goiter: an unpredicted complication of endoscopic thyroid surgery. Thyroid 20:441–443

    Article  PubMed  Google Scholar 

  71. Lee YS, Yun JS, Jeong JJ, Nam KH, Chung WY, Park CS (2008) Soft tissue implantation of thyroid adenomatous hyperplasia after endoscopic thyroid surgery. Thyroid 18:483–484

    Article  PubMed  Google Scholar 

  72. Dionigi G, Boni L, Rovera F, Rausei S, Castelnuovo P, Dionigi R (2010) Postoperative laryngoscopy in thyroid surgery: proper timing to detect recurrent laryngeal nerve injury. Langenbecks Arch Surg 395:327–331

    Article  PubMed  Google Scholar 

  73. Duh QY (2003) Presidential address: minimally invasive endocrine surgery – standard of treatment or hype? Surgery 134:849–857

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Chirurgische Endokinologie, Kantonsspital St. Gallen, Rorschacherstrasse 95, St. Gallen, CH-9007, Switzerland

    Thomas Clerici M.D.

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  1. Thomas Clerici M.D.
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Correspondence to Thomas Clerici M.D. .

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Editors and Affiliations

  1. Chairman, Department of Surgery, University Hospital Basel, Spitalstr. 21, Basel, 4031, Switzerland

    Daniel Oertli

  2. Yale-New Haven Hospital, Department of Surgery, Yale University School of Medicine, Cedar Street 330FMB 102, New Haven, CT, 06520-8062, USA

    Robert Udelsman

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Clerici, T. (2012). Minimally Invasive Techniques in Thyroid Surgery. In: Oertli, D., Udelsman, R. (eds) Surgery of the Thyroid and Parathyroid Glands. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-23459-0_12

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  • DOI: https://doi.org/10.1007/978-3-642-23459-0_12

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