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Mini-thyroidectomy
Mini-thyroidectomy
Mini-thyroidectomy
Mini-thyroidectomy
Mini-thyroidectomy
Mini-thyroidectomy
Mini-thyroidectomy
Mini-thyroidectomy
Mini-thyroidectomy
Mini-thyroidectomy
Mini-thyroidectomy
Mini-thyroidectomy
Mini-thyroidectomy
Mini-thyroidectomy
Mini-thyroidectomy
Mini-thyroidectomy
Mini-thyroidectomy
Mini-thyroidectomy
Mini-thyroidectomy
Mini-thyroidectomy
Mini-thyroidectomy
Mini-thyroidectomy
Mini-thyroidectomy
Mini-thyroidectomy
Mini-thyroidectomy
Mini-thyroidectomy
Mini-thyroidectomy
Mini-thyroidectomy
Mini-thyroidectomy
Mini-thyroidectomy
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Mini-thyroidectomy

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  • 1. Mini-thyroidectomy George Ferzli, MD, FACS Paul Sayad, MD; Robert Cacchione, MD Department of Laparoscopic Surgery Staten Island University Hospital
  • 2. Minimally invasive thyroid surgery
    • Endoscopic thyroid surgery
    • Video-assisted thyroid surgery
    • Mini-thyroidectomy
  • 3. I- Endoscopic thyroid surgery
    • Creation of a subplatysmal space
    • Maintenance of the space using CO2 insufflation [1,2] or neck lift device [3]
    • Placement of the trocars: anterior, lateral neck or subareolar
    Neck lift device 1 Husher Eur J Coelio 1997 2 Gagner et al 2000 3 Shimizu et al J Surg Oncol 1998 4 Ohgami et al
  • 4. Advantages
    • Precise anatomical detail due to the greatly magnified view
    • Decreased pain ?
    • Smaller scar ?
  • 5. Limitation
    • Limited to a small (<3cm) nodule
    • Contraindicated in :
      • Suspicion of malignancy
      • Multinodular goiter
      • Grave’s disease
      • Prior surgery
      • Obese patient
  • 6. Disadvantages
    • Lack of direct palpation and manipulation
    • Small working space
    • Respiratory acidosis and diffuse subcutaneous emphysema from CO2 insufflation
    • Minimal bleeding can obscure operative field
    • Long operative time
    • Multiple scars in case of conversion or reoperation for completion thyroidectomy
  • 7. II- Video-assisted thyroid surgery
    • 1.5 cm anterior incision
    • A 12 mm trocar is placed. Gas insufflation is used to help developing the space.
    • The trocar is then removed and the rest of the procedure is performed with the space maintained using external retractors.
    • A 5mm endoscope is placed through the incision
    • Laparoscopic and conventional instruments are used for the dissection.
    Miccoli et al
  • 8. Video-assisted thyroid surgery Main Access
  • 9. Advantages
    • Shorter operative time
    • Small incision
    • Prevents subcutaneous emphysema
    • Good lighting and magnification
  • 10. Disadvantages
    • Small working space
    • Minimal bleeding can obscure operative field
    • Placement of the endoscope in addition to the instruments can be cumbersome
    • Requires a second assistant
  • 11. III-Mini-thyroidectomy
    • A 2.5 to 3cm incision is performed approximately 3 to 4 cm above the sternal notch
    • Superior and inferior subplatysmal flaps are created
  • 12.  
  • 13.  
  • 14. Mini-thyroidectomy
    • The superior pole vessels are approached first
  • 15.  
  • 16. Mini-thyroidectomy
    • The thyroid gland is delivered through the incision
    • The recurrent laryngeal nerve is identified
    • The inferior pole vessels are divided
  • 17.  
  • 18.  
  • 19.  
  • 20. Patients
    • March 1997 to December 1999
    • 89 thyroid surgeries on 84 patients
    • 13 men and 71 women
    • Age 18 to 95
    • 61 thyroid masses and 23 goiters
    • Procedures: 4 nodulectomies, 54 thyroidectomies, 3 near total and 28 total thyroidectomies
  • 21. Results
    • Pathology: 33 follicular adenomas, 17 papillary carcinomas, 15 multinodular goiters, 7 colloid nodules, 7 Hashimotos, 4 nodular hyperplasia, 2 mixed papillary-follicular carcinomas, 1 follicular carcinoma and 1 lymphoma
    • Completion thyroidectomy: 5 patients (all through the same incision)
    • Specimen weight: 14 to 421 gm (44.2gm)
  • 22. Results
    • OR time: 35 to 164 min (mean 76 min)
    • Hospital stay: Few hours to 2 days (mean 1 day)
      • few hours post op: 5 patients
      • < 23 hours post op: 79 patients
      • second day post op: 5 patients
    • Complications: 1 cardiac arrhythmia and 1 transient hypocalcemia
  • 23. Results
    • Incision length: 2.5 to 10 cm (4.2)
      • 2-3 cm: 25 patients (28%)
      • 3-4 cm: 56 patients (63%)
      • >4cm: 8 patients (9%)
  • 24. Advantages
    • Short operative time
    • It can be done on an out patient basis
    • Excellent postoperative pain control
    • It can be attempted on any thyroid pathology
    • In the case of “conversion” the incision can be extended as needed
  • 25. Advantages
    • Completion thyroidectomy, when required, can be performed through the same incision
    • The procedure can be performed under local anesthesia
    • It has no complications related to neck insufflation
    • It has an excellent cosmetic result
  • 26. 45 year old patient after right thyroid lobectomy
  • 27.  
  • 28. Conclusions
    • Mini-thyroidectomy is feasible and safe
    • It has excellent cosmetic results
    • It can be applied to all patients regardless of thyroid pathology or size
  • 29. Conclusions
    • Mini-thyroidectomy (along with video assisted thyroidectomy) compared to totally endoscopic thyroid surgery, have shorter operative times, shorter hospital stays, comparable cosmetic results without complications related to neck insufflation
  • 30. Conclusions
    • The greatest advantage to mini-thyroidectomy is that it requires no additional technical expertise, and is therefore easier to teach and reproduce

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