gms | German Medical Science

Introduction: During the past 15 years thyroid surgery changed to endoscopic and minimal invasive approaches. We have developed an transoral endoscopic approach for minimal invasive thyroidectomy (eMIT) based on natural orifice surgery.

Methods: Between 2009 and 2013 61 patients with benign thyroid changes underwent endoscopic minimal invasive thyroidectomy at two tertial referral centers in Germany and China.

Results: In the initial phase of this prospective observational study conversions to open thyroid surgery due to thyroid size were necessary in three cases; therefore in the evaluation 58 patients (3♂, 55♀, age: 36±10 y) were analyzed. The median cut-suture-time was 123±68 min and mean blood loss estimated 24±18 ml. In all procedures (isthmus resection, hemi-/subtotal and total thyroidectomies) a learning curve could be observed being steeper in the more extensive procedures. Resected volumes reached up to 115 ml (mean: 12.9 ± 16.1 ml). We observed a permanent unilateral vocal cord paly in 1 patient (case 6, 1,7%), transient mental paresthesia in 15 patients (25,9%), 6 local infections (N=1/1,7% enoral, N=5/8,6% at the neck site), 3 cases of CO₂-embolsm (5,2%) as well as 1 small mediastinal emphysema (1,7%). All complications excepting the vocal cord palsy healed well and without sequelae and without a need for revision surgery.

Conclusion: The transoral endoscopic approach for thyroidectomy proofed safe and feasible in this bi-centric study. Therefore we could establish a completely scar less and minimal invasive approach for the surgical treatment of benign thyroid changes.