The size criteria in minimally invasive video-assisted thyroidectomy

The aim of this work has been to verify the suitability of MIVAT and its applicability in clinical practice, not only in patients with a thyroid volume up to 25 ml but also in patients with a thyroid volume included from 25 to 50 ml.From January 2003 to February 2006, 33 patients have been selected for MIVAT. A completely gasless procedure was carried out through a central 20 to 35 mm skin incision performed "high" between the cricoid and jugular notch.The patients were separated in 2 groups. The first group (less than 25 ml) included 23 patients, the second group (from 25 to 50 ml) included 10 patients. The skin incision performed was from 20 to 25 mm (mean 23.61 mm ± 1.83) long in the first group and from 25 to 35 mm (mean 27.8 mm ± 2.20) long in the second one; this difference is significant (t test p < 0.001).Our study suggest that the MIVAT using for thyroids bigger than 25 ml and up to 50 ml in volume is feasible and safe. This way allows more patients, excluded before, to take the advantages of minimally invasive approach.The targets of minimally invasive video-assisted thyroidectomy (MIVAT) could be summarised by: achievement of the same results as those obtained with traditional surgery, less trauma, better postoperative course, early discharge from hospital and improved cosmetic results.After the first endoscopic parathyroidectomy, performed and described by Gagner in 1996 [1], several surgeons reported their experiences with minimally invasive and video-assisted surgery of the neck [2-24]. Shimizu successfully treated more than 120 patients using the anterior neck lifting method [2,3]. Ikeda particularly devoted himself to an endoscopic procedure by anterior chest approach [4-7] and Ohgami by breast approach [8]. Miccoli confirmed the suitability of MIVAT by a 15–20 mm transversal skin incision made 2 cm above the sternal notch [9-16].The patients were considered eligible on the basis of the following criteria: single nodule or small goiter (toxic or not)