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The endoscopic thyroidectomy (ET) using high CO2 insufflation pressures (CIP) are prone to complications, such as hypercarbia,acidosis, pneumomediastinum and cardiac arrhythmias. The purpose of this study was to analyse the perioperative events and CO2 relatedmorbidity in five cases of endoscopic thyroidectomy in our experience.Methods: Between Febraury 2010 and August 2010 (6 months), five cases of benign goiters operated with extracervical ET technique inendocrine surgery department of a teritiary care hospital of southern India were studied. Clinicopathological, operative and morbidity datawere documented and analyzed.Results: All the five patients were women and mean age was 37.2 years (25-46). CIP of 12 to 14 mm Hg was used for creation of workingspace and CIP of 8 to 10 mm Hg for its maintainence. Average operative time was 135 minutes (65-212). Two cases had to be convertedinto open procedure due to gas related complications, such as hypercarbia, acidosis and ventricular tachycardia.Conclusions: CO2 insufflation pressure (CIP) of 10 to 12 mm Hg for creation of working space and 6 to 8 mm Hg for maintainence of spaceis optimal. A protocol based on CIP, monitoring and intermittent desufflation is recommended for safe ET with minimum complications.Keywords: Endoscopic thyroidectomy, CO2 insufflation, Hypercarbia, Acidosis, Subcutaneous emphysema.

What is the Ideal CO2 Insufflation Pressure for Endoscopic Thyroidectomy? Personal Experience with Five Cases of Goiter