Minimally invasive video-assisted thyroidectomy

This is a video in real time demonstrating the minimally invasive approach to a right hemithyroidectomy performed via a 1.5 cm incision in the suprasternal region of the neck. A video-endoscope is used to provide a magnified view and specialised instruments are used for the dissection of the gland.

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Minimally invasive video-assisted thyroidectomy

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Abstract

This is a video in real time demonstrating the minimally invasive approach to a right hemithyroidectomy performed via a 1.5 cm incision in the suprasternal region of the neck. A video-endoscope is used to provide a magnified view and specialised instruments are used for the dissection of the gland.

Keywords

thyroidectomy, neck, gland, video-assisted, thyroid, laryngeal, MIVAT

Media type

Surgical video

Duration

18'30''

Publication

2007-02

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E-publication

WeBSurg.com, Feb 2007;7(02).
URL: http://www.websurg.com/doi-vd01en2059.htm

Minimally invasive video-assisted thyroidectomy

1. Division of middle thyroid vein 00'22''

The patient lies in a supine position with his neck not extended. Skin is protected with a sterile plastic adhesive film. A 1.5cm long incision is performed 2cm above the sternal notch. And electrocautery completely isolated but on its extreme tip it is used to open platysma and midline on a bloodless plane. The operative space is maintained solely by means of 2 modified Army-Navy retractors. A 5mm 30 degree endoscope is introduced in this unique central port.

2. Isolation and division of superior thyroid vessels 02'32''

From this moment on, the procedure is performed entirely under endoscopic vision using small reusable spatulas. One of them has also got a hole on its tip to aspirate steam and blood. The first step is the division of the middle thyroid vein, which is carried out using a Harmonic scalpel. After rotating the camera with the angle upward, the upper third pedicle comes into view. After a complete dissection of the vessels has been performed, the Harmonic is used first to divide the artery, and then the vein. The inactive blade of the shears, white color, is kept towards the external branch of the superior laryngeal nerve, which is well visible after the pedicle has been fully dissected. The artery pulsation can be easily observed in order to check the perfect coagulation of the vessel.

3. Identification of recurrent laryngeal nerve 05'32''

At this point, the camera is rotated to its former position with the angle downwards in order to dissect the recurrent laryngeal nerve. Once the nerve is in view, it is traced until its entrance into the larynx at the level of Berry’s ligament.

4. Superior parathyroid dissection 06'32''

The upper parathyroid gland is dissected.

5. Division of pyramidal lobe 07'47''

The lobe can now be extracted by rotating first the superior pole, which is completely free. The operation from now on does not differ from a standard thyroidectomy.

6. Inferior parathyroid dissection 10'32''

Particular caution is necessary when dissecting the Berry’s ligament. The isthmus is then divided using a Harmonic scalpel.

7. Division of Berry’s ligament 11'32''

The recurrent nerve can be checked again by direct view and so are the parathyroid glands that are completely dissected and separated from the thyroid lobe.

8. Division of thyroid isthmus 12'32''

After final check of the hemostasis by means of the endoscope, the midline is sutured with a single stitch. No drain is necessary. A running subcuticular suture is used to close the wound. No external suture but just sealant is applied on the skin.