Mini incision thyroidectomy: alternative approach to cosmetic thyroidectomy

Abstract

BACKGROUND: Technique of thyroidectomy has evolved from conventional open technique to minimally access techniques over the past few years. Regardless of the technique, outcome depends on meticulous surgical technique used. Mini incision is defined as surgical incision less than 3 cm or less in length. Once the small incision is made, retraction is used and thyroidectomy done in the conventional manner. Main advantage is the superior cosmetic outcome compared to conventional method. Size of the gland is a main factor before deciding on a mini incision thyroidectomy (MIT) and careful patient selection must be done as large glands cannot be retrieved with the mini incision. METHODS: A longitudinal descriptive study was carried out on all patients undergoing MIT between 2008 to 2015 in Professorial Surgical Unit, University of Kelaniya, Sri Lanka. Patients with small sized glands and nodules less than 2cm were included. Skin incision was marked by measuring 3 cm with a sterile measuring tape and Methyline blue dye. The thyroid gland was delivered in to the incision and both pedicles were ligated. Capsular dissection with nerve encountering technique was adhered to. Recurrent laryngeal nerves, external branch of the superior laryngeal nerves and parathyroid glands were demonstrated and preserved. Drains were not used and routine closure was done after absolute haemostasis. RESULTS: Twenty nine MITs were performed (Male -3 , Female – 26, median age 34.26 years, range 22 – 42 years, total thyroidectomy -18, hemi-thyroidectomy -11). The commonest indication for total thyroidectomy was small MNG. None had recurrent laryngeal nerve injuries or significant haematoma formation. Transient hypocalcaemia was seen in 3%. The cosmetic outcome was satisfactory. The longest follow up is 7 years. CONCLUSIONS: MIT is a safe alternative to conventional approach in carefully selected patients and also it gives a superior cosmetic outcome.