ENDOSCOPIC THYROIDECTOMY

1. What is Endoscopic Thyroidectomy?

Endoscopic Thyroidectomy belongs to a type of minimally invasive procedure called Video Assisted Neck Surgery (VANS). This is a very new procedure that is also technically demanding. Only a few specialized centres worldwide are currently performing this type of operation. VANS uses small telescopes and fine instruments to operate on structures in the neck such as the thyroid and parathyroid glands. Because the neck has no anatomical potential space, the first thing we do is to create a working space under the neck using dissection and inflation with carbon dioxide. A 10 mm incision is used to insert the telescope and to remove the specimen at the end of the operation. Two or three smaller incisions (2mm to 5 mm in size) are used to for the instruments. All the incisions are placed either in the neck, over the chest or in the armpit.

2. What are the indications for Endoscopic Thyroidectomy?

In Endoscopic Thyroidectomy, we usually remove one side of the thyroid gland (similar to the conventional open operation called Hemithyroidectomy). This is done for patients with a goiter or nodule in the thyroid gland. Not all thyroid nodules need to be removed. Only those which are symptomatic, have a risk of malignancy or which are cosmetically unappealing needs to be removed.

Although we have performed Endoscopic Thyroidectomy for nodules that eventually turn out to be early cancer, we do not recommend this for those patients who have clearly have advanced thyroid cancer. This technique is also unsuitable for those nodules which are larger than 4 cm.

3. What are the benefits of Endoscopic Thyroidectomy?

Recovery after conventional open thyroid surgery is usually quick and uneventful. Therefore the main benefit of Endoscopic Thyroidectomy seems to be the superior cosmetic result. The thyroid gland is situated in the front of the neck and open surgery requires a long horizontal scar in a very visible position. Many patients (especially young females), do not want to exchange an ugly thyroid swelling with an even uglier scar. Endoscopic Thyroidectomy may be appealing for them as we need to make only keyhole incisions placed in hidden areas.

Endoscopic Thyroidectomy done by a trained surgeon is a very safe procedure. Since magnification is used we can see the delicate nerves and vessels very clearly. Nevertheless, as with all thyroid surgery, there is always a small risk that injury to the recurrent laryngeal nerves can occur as these nerves are found close to the back of the thyroid gland. If this happens there may be weakness of the voice after surgery. This is usually transient and recovers with time.

The main disadvantage of Endoscopic Thyroidectomy is cost. This approach is more expensive than conventional open surgery because special instruments are necessary.