Minimally invasive thyroid and parathyroid surgery is not a question of length of the incision

Abstract
Introduction  Postoperative cosmesis in the neck is often a major concern of patients, particularly women, undergoing thyroid or parathyroid
surgery. Therefore, a reduction in the length of the cervical incision, and even more so, having no scar in the neck, is particularly
appealing to these patients. Over the last years, many different so-called minimally invasive procedures have been proposed
for the treatment of thyroid and parathyroid diseases, the primary aim being to improve the cosmetic results. Nevertheless,
the concept of surgical invasiveness cannot be limited to the length or to the site of the skin incision. It must be extended
to all structures dissected during the procedure. Therefore, minimally invasive thyroidectomy or minimally invasive parathyroidectomy
should properly be defined as operations through a short, less than 3 cm, and discrete incision that permits direct access
to the thyroid or parathyroid gland, resulting in a focused dissection. In addition, type of anesthesia, duration of the operation,
postoperative pain, complication and success rates, and long-term outcome should also be taken into account to assess surgical
invasiveness.

Conclusion  Thyroid and parathyroid operations that minimize the incision but keep it in the neck may be considered minimally invasive
not only in respect of the size of the skin incision but also, and above all, in respect of the accessibility of the operative
field and extent of dissection. These operations have some advantages over conventional cervicotomy in terms of postoperative
pain and cosmetic results. Until now, there is no evidence to state that morbidity of these new approaches is at least equal
to the conventional equivalent. Operations that employ an extracervical approach, which have the advantage of leaving no scar
in the neck, cannot reasonably be described as minimally invasive, as they require more dissection than conventional open
surgery.

Content Type Journal ArticleCategory Current Concepts in Endocrine SurgeryDOI 10.1007/s00423-008-0406-3Authors
Jean–François Henry, University Hospital La Timone Department of Endocrine Surgery 264 Rue Saint Pierre, Cedex 05 Marseilles 13385 France

Journal Langenbeck's Archives of SurgeryOnline ISSN 1435-2451Print ISSN 1435-2443 (Source: Langenbeck's Archives of Surgery)  MedWorm Sponsored Message: Find out how you can get your message across here by sponsoring this MedWorm news feed.