Minimally invasive thyroidectomy using the Sofferman technique

Objectives: Access to the thyroid compartment has traditionally been achieved by a Kocher incision followed by subplatysmal flap elevation and strap muscle retraction. A combination of novel access techniques was used to allow for minimally invasive thyroidectomy (MITh). Methods and Materials: A prospective, nonrandomized evaluation of consecutive patients undergoing thyroidectomy was performed. A minimally invasive incision (≤6 cm) was used in conjunction with the Sofferman technique (transection of the strap muscles) and videoendoscopic assistance to perform hemithyroidectomy or total thyroidectomy in eligible patients. Prospectively collected data include age, sex, pathology, incision length, duration of surgery, and blood loss and complications were considered. Results: Forty-four patients underwent 48 thyroid surgeries between September 2003 and May 2004. There were 13 men and 31 women, with a mean age of 41.9 (range 19-73) years. Thirty-one (64.6%) of these were eligible to be performed by MITh; the remainder (n = 17, 35.4%) underwent conventional thyroidectomy. The mean incision length in the MITh cohort was 4.9 ± 1.0 cm compared with 9.1 ± 1.5 cm for conventional thyroidectomy. The mean surgical time for minimally invasive hemithyroidectomy was 115.7 minutes (n = 23), and for total thyroidectomy was 147.4 minutes (n = 8). There were no cases of permanent hypocalcemia or recurrent laryngeal nerve paralysis in either group. No patients in the MITh group had to be converted to a conventional thyroidectomy. The cosmetic results were excellent, although one patient in the MITh group developed a mildly hypertrophic scar that responded to triamcinolone injection. Conclusions: MITh is safe in carefully selected patients and probably results in more rapid wound healing. The cosmetic result is superior to that achieved with conventional thyroidectomy.