Minimally Invasive Video-Assisted Thyroidectomy for Small Follicular Thyroid Nodules Mohamed A. F. Hegazy Ashraf A. Khater Ahmed E. Setit Mahmoud A. Amin Sherif Z. Kotb Mohamed A. El Shafei Tamer F. Yousef Osama Hussein Yousef K. Shabana Ola T. Abdel Dayem Published online: 26 July 2007 Ó Socie ´te ´ Internationale de Chirurgie 2007 Abstract Minimal access surgery in the thyroid com- partment has evolved considerably over the past 10 years and now takes many forms. This study examined the fea- sibility and reliability of minimally invasive thyroid sur- gery for the management of small benign thyroid lesions. A total of 68 patients with small thyroid nodules admitted to the Oncology Center of Mansoura University, Egypt, were enrolled in this prospective randomized trial. Patients were allotted to one of two procedures: minimally invasive vi- deo-assisted thyroidectomy (MIVAT) or minimally inva- sive open thyroidectomy using the Sofferman technique of strap muscle transection. Exclusion criteria were nodules > 4 cm, presence of thyroiditis, and thyroid gland volume > 20 ml. Preoperative diagnosis, operating time, blood loss, postoperative pain, complications, and cosmetic outcome were all evaluated. The MIVAT group included 35 pa- tients, and the Sofferman group included 33 patients. The main preoperative pathology was a benign follicular lesion (70.5%), and the main postoperative final pathology was follicular adenoma (54.4%). The two groups were com- parable regarding age, sex, and extent of thyroid surgery. Operating time was significantly longer in the MIVAT group (115.4 ± 33.5 minutes) compared to the Sofferman group (65.6 ± 23.7 minutes). The postoperative course was significantly less painful in the MIVAT group (p < 0.05). Although patients in the MIVAT group had smaller inci- sions (p < 0.05), the cosmetic outcome in the two groups was comparable. No long-term complication was encoun- tered in either group. Two distinct approaches of minimally invasive thyroidectomy are now available and can be per- formed safely in selected patients. Despite some MIVAT advantages of less postoperative pain and slightly better cosmesis, minimally invasive open thyroidectomy offers an advantage of less operating time with comparable cosmetic results. Minimal access surgery was popularized after the intro- duction of laparoscopic cholecystectomy by Mouret [1]. The first description of a minimally invasive approach to the thyroid gland was an endoscopic thyroidectomy per- formed by Gagner and Inabnet in 1996 [2]. During the following years, various minimally invasive approaches were published [3–5]. These procedures can be classified into pure endoscopic approaches [6], video-assisted endo- scopic approaches [7], and minimally invasive mini-inci- sion approaches [8]. Each of these approaches has its own advantages in terms of cosmetic results, invasiveness, tol- erability, and ease of use [9]. Endoscopic approaches to the thyroid compartment re- main a procedure in evolution. These approaches often require special surgical skills and a significant amount of technological assistance. A simple but minimally invasive approach to the thyroid compartment for thyroidectomy has recently been devel- M. A. F. Hegazy (&) Á A. A. Khater Á A. E. Setit Á S. Z. Kotb Á M. A. El Shafei Á T. F. Yousef Á O. Hussein Department of Surgical Oncology, Mansoura University Hospital, El Gomhoria St., Mansoura, Egypt e-mail: mhegazy68@yahoo.com M. A. Amin Department of General Surgery, Mansoura University Hospital, El Gomhoria St., Mansoura, Egypt Y. K. Shabana Department of Otorhinolaryngology, Mansoura University Hospital, El Gomhoria St., Mansoura, Egypt O. T. Abdel Dayem Departments of Anesthesia and Intensive Care, Mansoura University Hospital, El Gomhoria St., Mansoura, Egypt 123 World J Surg (2007) 31:1743–1750 DOI 10.1007/s00268-007-9147-7