Trans-oral Endoscopic Thyroidectomy

  • Thomas Wilhelm


The development of endoscopic surgery and improvements in video technology during the past 15 years offered new horizons for many surgical disciplines. These techniques were adopted also for endoscopic procedures on the thyroid gland. Different endoscopic approaches for thyroidectomy have been described in the past years: they could be divided into cervical, minimal incision, approaches and extracervical approaches. The later ones are most widespread in the Asian region since the demand on perfect cosmetic outcomes and no visible scars in the neck region are higher here. The extracervical approaches do not appear to be minimally invasive: due to the large amount of subcutaneous dissection to reach the target area they could be addressed as being maximally invasive. We have developed a new trans-oral endoscopic and minimally invasive approach through the floor of mouth to combine minimally invasive access and perfect cosmetic outcome. Moreover this approach is gentler since anatomically defined layers of the neck are entered directly and postoperative sequelae like swallowing disorders are minimized. In preclinical anatomical and animal studies the approach could be developed and first clinical applications proved its feasibility and safety. The trans-oral endoscopic thyroidectomy and all preclinical and clinical studies are outlined in this chapter.


Recurrent Laryngeal Nerve Submandibular Gland Hyoid Bone Natural Orifice Translumenal Endoscopic Surgery Vocal Cord Palsy 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. Alvarado R, McMullen T, Sidhu SB, Delbridge LW, Sywak MS (2008) Minimally invasive thyroid surgery for single nodules: an evidence-based review of the lateral mini-incision technique. World J Surg 32:1341–1348PubMedCrossRefGoogle Scholar
  2. Arora A, Cunningham A, Chawdhary G, Vicini C, Weinstein GS, Darzi A, Tolley N (2011) Clinical applications of Telerobotic ENT-Head and Neck surgery. Int J Surg 9(4):277–284. doi:10.1016/j.ijsu.2011.01.008, Epub 2011 Jan 27PubMedCrossRefGoogle Scholar
  3. Ballantyne GH (2002) Robotic surgery, telerobotic surgery, ­telepresence, and telementoring. Review of early clinical results. Surg Endosc 16:1389–1402PubMedCrossRefGoogle Scholar
  4. Barkun JS, Aronson JK, Feldman LS, Maddern GJ, Strasberg SM, For the Balliol Colloboration (2009) Surgical innovation and evaluation 1: evaluation and stages of surgical innovation. Lancet 374(9695):1089–1096PubMedCrossRefGoogle Scholar
  5. Bärlehner E, Benhidjeb T (2008) Cervical scarless endoscopic thyroidectomy: axillo-bilateral breast approach (ABBA). Surg Endosc 22:154–158PubMedCrossRefGoogle Scholar
  6. Benhidjeb T, Anders S, Bärlehner E (2006) Total video-endoscopic thyroidectomy via axillo-bilateral-breast-approach (ABBA). Langenbecks Arch Surg 391:48–49Google Scholar
  7. Benhidjeb T, Wilhelm T, Harlaar J, Kleinrensink G-J, Schneider TAJ, 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(5):1119–1120PubMedCrossRefGoogle Scholar
  8. Bernhardt J, Gerber B, Schober H-C, Kähler G, Ludwig K (2008) NOTES-case report of a unidirectional flexible appendectomy. Int J Colorectal Dis 23:547–550PubMedCrossRefGoogle Scholar
  9. Bhattacharyya N, Fried MP (2002) Assessment of the morbidity and complications of total thyroidectomy. Arch Otolaryngol Head Neck Surg 128:389–392PubMedGoogle Scholar
  10. Brauckhoff M, Walls G, Brauckhoff K, Thanh PN, Thomusch O, Dralle H (2002) Identification of the non-recurrent inferior laryngeal nerve using intraoperative neurostimulation. Lang­enbecks Arch Surg 386:482–487PubMedCrossRefGoogle Scholar
  11. Chan WF, Lang BH, Lo CY (2006) The role of intraoperative neuromonitoring of recurrent laryngeal nerve during thyroidectomy: a comparative study on 1000 nerves at risk. Surgery 140:866–872PubMedCrossRefGoogle Scholar
  12. Diklic A, Zivaljevic V, Paunovic I, Kalezic N, Tatic S (2005) Surgical procedures in patients with thyroid autoimmune disease. Srp Arh Celok Lek 133(Suppl 1):77–83PubMedGoogle Scholar
  13. Dralle H (2009) Rekurrens- und Nebenschilddrüsenpräparation in der Schilddrüsenchirurgie. Chirurg 80:352–363PubMedCrossRefGoogle Scholar
  14. Dralle H, Sekulla C, Haerting J, Timmermann W, Neumann HJ, Kruse E, Grond S, Muhlig HP, Richter C, Voss J, Thomusch O, Lippert H, Gastinger I, Brauckhoff M, Gimm O (2004a) Risk factors of paralysis and functional outcome after recurrent laryngeal nerve monitoring in thyroid surgery. Surgery 136:1310–1322PubMedCrossRefGoogle Scholar
  15. Dralle H, Sekulla C, Lorenz K, Grond S, Irmscher B (2004b) Ambulante und kurzstationäre Schilddrüsen- und Neben­schilddrüsenchirurgie. Chirurg 75:131–143PubMedCrossRefGoogle Scholar
  16. Dralle H, Sekulla C, Lorenz K, Brauckhoff M, Machens A (2008) Intraoperative monitoring of the recurrent laryngeal nerve in thyroid surgery. World J Surg 32:1358–1366PubMedCrossRefGoogle Scholar
  17. DuBose J, Barnett R, Ragsdale T (2004) Honest and sensible surgeons: the history of thyroid surgery. Curr Surg 61:213–219PubMedCrossRefGoogle Scholar
  18. Duh Q-Y (2003) Presidential address: minimally invasive endocrine surgery – standard of treatment or hype? Surgery 134:849–857PubMedCrossRefGoogle Scholar
  19. Ergina PL, Cook JA, Blazeby JM, Boutron I, Clavien P-A, Reeves BC, Seiler CM, For the Balliol Colloboration (2009) Surgical innovation and evaluation 2: challenges in evaluating surgical innovation. Lancet 374(9695):1097–1104PubMedCrossRefGoogle Scholar
  20. Ezzat WH, O’Hara BJ, Fisher KJ, Rosen D, Pribitkin EA (2011) The minimally-invasive thyroidectomy incision: a histological analysis. Med Sci Monit 17:SC7–SC10PubMedGoogle Scholar
  21. Frick T, Largiader F (1989) Perioperative Komplikationsrate von Schilddrüseneingriffen. Helv Chir Acta 56:503–505PubMedGoogle Scholar
  22. Gaujoux S, Leenhardt L, Tresallet C, Rouxel A, Hoang C, Jublanc C, Chigot JP, Menegaux F (2006) Extensive thyroidectomy in Graves’ disease. J Am Coll Surg 202:868–873PubMedCrossRefGoogle Scholar
  23. Gemsenjaeger E (2009) Part 1 – Chapter 1: Notes on positioning the patient. In: Atlas of thyroid surgery. Principles, practise, and clinical cases. Thieme, Stuttgart/New York, p 2Google Scholar
  24. Guyot L, Duroure F, Richard O, Lebeau J, Passagia J-G, Raphael B (2005) Submandibular gland endoscopic resection: a cadaveric study. Int J Oral Maxillofac Surg 34:407–410PubMedCrossRefGoogle Scholar
  25. Helios Kliniken GmbH (2005) Medizinischer Jahresbericht 2005.
  26. Hochberger J, Menke D, Matthes K, Lamadé W, Köhler P (2009) Transluminale Interventionen (“NOTES”) – aktueller Stand. Dtsch Med Wochenschr 134:467–472PubMedCrossRefGoogle Scholar
  27. Hogan S, Cullen JP, Talamini MA, Mintz Y, Ferreres A, Jacobsen GR, Sandler B, Bosia J, Savides T, Easter DW, Savu MK, Ramamoorthy SL, Whitcomb E, Agarwal S, Lukacz E, Dominguez G, Ferraina P (2009) Natural orifice surgery: initial clinical experience. Surg Endosc 23:1512–1518CrossRefGoogle Scholar
  28. Hong KH, Yang JS (2008) Surgical results of the intraoral removal of the submandibular gland. Otolaryngol Head Neck Surg 139:530–534PubMedCrossRefGoogle Scholar
  29. Hüscher CSG, Chiodini S, Napolitano C, Recher A (1997) Endoscopic right thyroid lobectomy. Surg Endosc 11:877PubMedCrossRefGoogle Scholar
  30. Ignjatovic M, Cuk V, Ozegovic A, Cerovic S, Kostic Z, Romic P (2003) Rane komplikacije operativnog lecenja oboljenja stitaste zlezde: analiza 2100 bolesnika. Acta Chir Iugosl 50:155–175PubMedGoogle Scholar
  31. Ikeda Y, Takami H, Niimi M, Kan S, Sasaki Y, Takayama J (2002) Endoscopic thyroidectomy and parathyroidectomy by the axillary approach. A preliminary report. Surg Endosc 16:92–95PubMedCrossRefGoogle Scholar
  32. 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 196:189–195PubMedCrossRefGoogle Scholar
  33. Kalloo AN, Kantsevoy SV, Singh VK, Magee CA, Vaughn CA, Hill SL (2000) Flexible transgastric peritoneoscopy: a novel approach to diagnostic and therapeutic interventions in the peritoneal cavity. Gastroenterology 118:A1039CrossRefGoogle Scholar
  34. Kalloo AN, Singh VK, Jagannath SB, Niiyama H, Hill SL, Vaughn CA, Magee CA, Kantsevoy SV (2004) Flexible transgastric peritoneoscopy: a novel approach to diagnostic and therapeutic interventions in the peritoneal cavity. Gastrointest Endosc 60(1):114–117PubMedCrossRefGoogle Scholar
  35. Karakas E, Steinfeldt T, Gockel A, Sesterhenn A, Bartsch DK (2010a) Transorale partielle Parathyreoidektomie. Chirurg 81:1020–1025PubMedCrossRefGoogle Scholar
  36. Karakas E, Steinfeldt T, Gockel A, Westermann R, Kiefer A, Bartsch DK (2010b) Transoral thyroid and parathyroid surgery. Surg Endosc 24:1261–1267PubMedCrossRefGoogle Scholar
  37. Karayacin K, Besim H, Ercan F, Hamamci O, Korkmaz A (1997) Thyroidectomy with and without drains. East Afr Med J 74:431–432PubMedGoogle Scholar
  38. Kessler P, Bloch-Birkholz A, Birkholz T, Neukam FW (2006) Feasibility of an endoscopic approach to the submandibular neck region – Experimental and clinical results. Br J Oral Maxillofac Surg 44:103–106PubMedCrossRefGoogle Scholar
  39. Kocher ET (1909) Concerning pathological manifestations in low-grade thyroid diseases. Nobel Lecture, Stockholm, December 11 1909.
  40. Koh YW, Kim JW, Lee SW, Choi EC (2009) Endoscopic thyroidectomy via a unilateral axillo-breast approach without gas insufflation for unilateral benign thyroid lesions. Surg Endosc 23:2053–2060PubMedCrossRefGoogle Scholar
  41. Lawrence JW, Fauerbach JA, Heinberg L, Doctor M (2004) Visible vs hidden scars and their relation to body esteem. J Burn Care Rehabil 25:25–32PubMedCrossRefGoogle Scholar
  42. Lee J, Yun JH, Nam KH, Choi UJ, Chung WY, Soh E-Y (2011) Perioperative clinical outcomes after robotic thyroidectomy for thyroid carcinoma: a multicenter study. Surg Endosc 25:906–912PubMedCrossRefGoogle Scholar
  43. Lefevre JH, Tresallet C, Leenhardt L, Jublanc C, Chigot JP, Menegaux F (2007) Reoperative surgery for thyroid disease. Langenbecks Arch Surg 392:685–691PubMedCrossRefGoogle Scholar
  44. Lombardi CP, Raffaelli M, Princi P, De Crea C, Bellantone R (2006) Video-assisted thyroidectomy: report of a 7-year experience in Rome. Langenbecks Arch Surg 391:174–177PubMedCrossRefGoogle Scholar
  45. Lucha PA Jr, Wallace D, Pasque C, Brickhouse N, Olsen D, Styk S, Dortch M, Beckman WA Jr (2000) Surgical wound morbidity in an austere surgical environment. Mil Med 165:13–17PubMedGoogle Scholar
  46. Malloy KM, Cognetti DM, Wildemore BM, Cunnane MF, Keane WM, Pribitkin EA, Rosen D (2007) Feasibility of endoscopic sentinel node biopsy in the porcine neck. Otolaryngol Head Neck Surg 136:806–810PubMedCrossRefGoogle Scholar
  47. McCulloch P, Altman DG, Campbell WB, Flum DR, Glasziou P, Marshall JC, Nicholl JCM, For the Balliol Colloboration (2009) Surgical innovation and evaluation 3: no surgical innovation without evaluation: the IDEAL recommendations. Lancet 374(9695):1105–1112PubMedCrossRefGoogle Scholar
  48. Miccoli P, Berti P, Conte M, Bendinelli C, Marcocci C (1999) Minimally invasive surgery for small thyroid nodules: preliminary report. J Endocrinol Invest 22:849–851PubMedGoogle Scholar
  49. Miccoli P, Berti P, Materazzi G, Minuto M, Barellino L (2004a) Minimally invasive video-assisted thyroidectomy: five years of experience. J Am Coll Surg 199:243–248PubMedCrossRefGoogle Scholar
  50. Miccoli P, Minuto MN, Barellini L, Galleri D, Massi M, D’Agostino J, Materazzi G, Berti P (2004b) Tiroidectomia video-assistita minimamente invasiva (Mivat)–cenni di tecnica an e risultati di 4 anni di esperienza (Analisi della casistica 1999–2002). Ann Ital Chir 75:47–51PubMedGoogle Scholar
  51. Neugebauer EAM, Becker M, Buess GF, Cuschieri A, Dauben H-P, Fingerhut A, Fuchs KH, Habermalz B, Lantsberg L, Morino M, Reiter-Theil S, Soskuty G, Wayand W, Welsch T, EAES (2010) EAES recommendations on methodology of innovation management in endoscopic surgery. Surg Endosc 24(7):1594–1615PubMedCrossRefGoogle Scholar
  52. Nielsen TR, Andreassen UK, Brown CL, Balle VH, Thomsen J (1998) Microsurgical technique in thyroid surgery – a 10-year experience. J Laryngol Otol 116:556–560Google Scholar
  53. 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 10:1–4PubMedGoogle Scholar
  54. Palanivelu C, Rajan PS, Rangarajan M, Parthasarathi R, Senthilnathan P, Prasad M (2008) Transvaginal endoscopic appendectomy in humans: a unique approach to NOTES-world’s first report. Surg Endosc 22:1343–1347PubMedCrossRefGoogle Scholar
  55. Palestini N, Tulletti V, Cestino L, Durando R, Freddi M, Sisti G, Ribecchi A (2005) Post-thyroidectomy cervical hematoma. Minerva Chir 60:37–46PubMedGoogle Scholar
  56. Papaspyrou G, Ferlito A, Silver CE, Werner JA, Genden E, Sesterhenn AM (2011) Extracervical approaches to endoscopic thyroid surgery. Surg Endosc 25:995–1003PubMedCrossRefGoogle Scholar
  57. Park YL, Han WK, Bae WG (2003) 100 cases of endoscopic thyroidectomy. Breast approach. Surg Laparosc Endosc Percutan Tech 13:20–25PubMedCrossRefGoogle Scholar
  58. Richmon JD, Pattani KM, Benhidjeb T, Tufano RP (2011) Transoral robotic-assisted thyroidectomy: a preclinical feasibility study in 2 cadavers. Head Neck 33:330–333PubMedGoogle Scholar
  59. Robertson ML, Steward DL, Gluckman JL, Welge J (2004) Continuous laryngeal nerve integrity monitoring during thyroidectomy: does it reduce risk of injury? Otolaryngol Head Neck Surg 131:596–600PubMedCrossRefGoogle Scholar
  60. Röher HD, Goretzki PE, Hellmann P, Witte J (1999) Risiken und Komplikationen der Schilddrüsenchirurgie. Häufigkeit und Therapie. Chirurg 70:999–1010PubMedCrossRefGoogle Scholar
  61. Rosato L, Mondini G, Ginardi A, Clerico G, Pozzo M, Raviola P (2000) Incidence of complications of thyroid surgery. Minerva Chir 55:693–702PubMedGoogle Scholar
  62. Rosato L, Avenia N, Bernante P, De Palma M, Gulino G, Nasi PG, Pelizzo MR, Pezzullo L (2004) Complications of thyroid surgery: analysis of a multicentric study on 14,934 patients operated on in Italy over 5 years. World J Surg 28:271–276PubMedCrossRefGoogle Scholar
  63. Rosato L, Carlevato MT, De TG, Avenia N (2005) Recurrent laryngeal nerve damage and phonetic modifications after total thyroidectomy: surgical malpractice only or predictable sequence? World J Surg 29:780–784PubMedCrossRefGoogle Scholar
  64. Ruark DS, bdel-Misih RZ (1992) Thyroid and parathyroid ­surgery without drains. Head Neck 14:285–287PubMedCrossRefGoogle Scholar
  65. Samraj K, Gurusamy KS (2007) Wound drains following thyroid surgery. Cochrane Database Syst Rev 17:CD006099Google Scholar
  66. Sano D, Ouoba K, Wandaogo A, Sanou A, Soudre BR (1995) Problemes poses par la chirurgie du corps thyroide au Burkina Faso, a propos de 83 cas. Med Trop (Mars) 55:51–54Google Scholar
  67. Semm K (1983) Endoskopische Intraabdominalchirurgie in der Gynakologie. Wien Klein Wochenschr 95:353–367Google Scholar
  68. Semm K (2001) Operationen ohne Skalpell. Ein Gynäkologe als Wegbereiter der Minimal Invasiven Medizin. Ecomed, LandsbergGoogle Scholar
  69. Serpell JW, Phan D (2007) Safety of total thyroidectomy. ANZ J Surg 77:15–19PubMedCrossRefGoogle Scholar
  70. Sesterhenn AM, Folz BJ, Werner JA (2008) Surgical technique of endoscopic sentinel lymphadenectomy in the N0 neck. Oper Tech Otolaryngol 19:26–32CrossRefGoogle Scholar
  71. Shaha A, Jaffe BM (1988) Complications of thyroid surgery performed by residents. Surgery 104:1109–1114PubMedGoogle Scholar
  72. 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 13:196–201PubMedCrossRefGoogle Scholar
  73. Shindo M, Chheda NN (2007) Incidence of vocal cord paralysis with and without recurrent laryngeal nerve monitoring during thyroidectomy. Arch Otolaryngol Head Neck Surg 133:481–485PubMedCrossRefGoogle Scholar
  74. Sodergren MH, Clark J, Athanasou T, Teare J, Yang G-Z, Darzi A (2009) Natural orifice translumenal endoscopic surgery: critical appraisal of applications in clinical practice. Surg Endosc 23:680–687PubMedCrossRefGoogle Scholar
  75. Spanknebel K, Chabot JA, Di Giorgi M, Cheung K, Lee S, Allendorf J, Logerfo P (2005) Thyroidectomy using local anesthesia: a report of 1,025 cases over 16 years. J Am Coll Surg 201:375–385PubMedCrossRefGoogle Scholar
  76. Tabaqchali MA, Hanson JM, Proud G (1999) Drains for thyroidectomy/parathyroidectomy: fact or fiction? Ann R Coll Surg Engl 81:302–305PubMedGoogle Scholar
  77. Tarafder KH, Rahman SH, Hossain MA, Alauddin M, Islam MA, Hadi IA (2007) Outcome of management of differentiated thyroid carcinoma. Mymensingh Med J 16(Suppl):S46–S52PubMedGoogle Scholar
  78. Terris DJ, Haus BM, Gourin CG (2004) Endoscopic neck surgery: resection of the submandibular gland in a cadaver model. Laryngoscope 114:407–410PubMedCrossRefGoogle Scholar
  79. Thomusch O, Machens A, Sekulla C, Ukkat J, Lippert H, Gastinger I, Dralle H (2000) Multivariate analysis of risk factors for postoperative complications in benign goiter surgery: prospective multicenter study in Germany. World J Surg 24:1335–1341PubMedCrossRefGoogle Scholar
  80. Vincent G (2008) Thyroidectomy over a quarter of a century in the Belgian ardennes: a retrospective study of 1207 patients. Acta Chir Belg 108:542–547PubMedGoogle Scholar
  81. Werner JA, Sapundzhiev NR, Teymoortash A, Dunne AA, Behr T, Folz BJ (2004) Endoscopic sentinel lamphadenectomy as a new diagnostic approach in the N0 neck. Eur Arch Otorhinolaryngol 261:463–468PubMedCrossRefGoogle Scholar
  82. Wilhelm T, Benhidjeb T (2011) Trans-oral endoscopic neck surgery: feasibility and safety in a porcine model based on the example of thymectomy. Surg Endosc 25:1741–1746PubMedCrossRefGoogle Scholar
  83. Wilhelm T, Krüger J (2011) Ultrasound studies on the shift of cervical tissues in different head and neck positions – impact on trans-oral endoscopic, minimally invasive and conventional thyroid surgery. Ultrasound Med Biol 37(9):1430–1435. doi: 10.1016/j.ultrasmedbio.2011.05.015, Epub 2011 Jul 7PubMedCrossRefGoogle Scholar
  84. Wilhelm T, Metzig A (2010a) Endoscopic minimal-invasive thyroidectomy: first clinical experience. Surg Endosc 24:1757–1758PubMedCrossRefGoogle Scholar
  85. Wilhelm T, Metzig A (2010b) Endoscopic minimally invasive thyroidectomy (eMIT): some clarifications regarding the idea, development, preclinical studies and the application in humans. Surg Endosc 24. doi: 10.1007/s00464-010-1312-7, Epub 2010 Aug 24
  86. Wilhelm T, Metzig A (2011a) Endoscopic minimally invasive thyroidectomy (eMIT): a prospective proof-of-concept study in humans. World J Surg 35:543–551PubMedCrossRefGoogle Scholar
  87. Wilhelm T, Metzig A (2011b) Proof-of-Concept study on the endoscopic minimally invasive thyroidectomy (eMIT) in humans – a realistic assessment is desired. World J Surg. doi: 10.1007/s00268-011-1110-y
  88. Wilhelm T, Harlaar J, Kerver A, Kleinrensink G-J, 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 267:1285–1290PubMedCrossRefGoogle Scholar
  89. Wilhelm T, Klemm W, Leschber G, Harlaar JJ, Kerver ALA, Kleinrensink G-J, Nemat A (2011a) Development of a new trans-oral endoscopic approach for mediastinal surgery based on “natural orifice surgery”: preclinical studies on surgical technique, feasibilitiy and safety. Eur J Cardiothorac Surg 39:1001–1008PubMedCrossRefGoogle Scholar
  90. Wilhelm T, Klemm W, Nemat A (2011b) Erste klinische Anwen­dung der trans-oral endoskopischen Mediastinalchirurgie. GMS Curr Posters Otorhinolaryngol Head Neck Surg 7:Doc02 (20110414)
  91. Witzel K, Benhidjeb T (2009) Monitoring of the recurrent laryngeal nerve in totally endoscopic thyroid surgery. Eur Surg Res 43(2):72–76PubMedCrossRefGoogle Scholar
  92. Witzel K, von Rahden BHA, Kaminski K, Stein HJ (2008) Transoral access for endoscopic thyroid resection. Surg Endosc 22:1871–1875PubMedCrossRefGoogle Scholar
  93. 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 12:426–429PubMedCrossRefGoogle Scholar
  94. Yarbrough DE, Thompson GB, Kasperbauer JL, Harper CM, Grant CS (2004) Intraoperative electromyographic monitoring of the recurrent laryngeal nerve in reoperative thyroid and parathyroid surgery. Surgery 136:1107–1115PubMedCrossRefGoogle Scholar
  95. Yeung HC, Ng WT, Kong CK (1997) Endoscopic thyroid and parathyroid surgery. Surg Endosc 11:1135PubMedCrossRefGoogle Scholar
  96. Zornig C, de Heer K, Koenecke S, Engel U, Bay V (1989) Darstel­lung des Nervus recurrens bei Schilddrüsenoperationen – Standortbestimmung. Chirurg 60:44–48PubMedGoogle Scholar

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© Springer-Verlag Berlin Heidelberg 2012

Authors and Affiliations

  1. 1.Department of Otolaryngology, Head/Neck & Facial Plastic SurgeryHELIOS Klinikum BornaBornaGermany

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