Minimally Invasive Video-assisted Thyroidectomy and Parathyroidectomy

The history of endoscopic endocrine surgery of the neck started in 1992 with the first endoscopic parathyroidectomy. Less simple procedures were proposed after this preliminary experience, some still involving gas insufflation and some not involving it at all, better defined as video-assisted parathyroidectomy. Not much later also thyroid gland started to be operated endoscopically although thyroid diseases quite soon proved to constitute a big limit in the diffusion of these techniques because of the large size typical of most goiters and/or tumors which represent the most common indication for thyroid surgery. All these procedures though are largely utilized and certainly have heavily stimulated all surgeons to reduce the length of their incision and consequently the invasiveness of both thyroidectomy and parathyroidectomy. Furthermore, in spite of the scepticism existing among endocrine surgeons, some significant advantages offered by these techniques have been reported in prospective studies even though they involved a scarce number of patients. It must be stressed that endoscopic or video-assisted parathyroidectomy is at present much more widespread than thyroidectomy to the point that it must be considered a valid option for most of the cases of primary hyperparathyroidism (PHPT) and in some centers it is regarded as the first option.