Minimal incision thyroidectomy

In recent years there has been a considerable movement among thyroid surgeons to both standardize and minimize the open thyroid incision. This trend reflects the increasing ambitions of modern surgical practice to produce less morbidity and improved cosmesis. These advances have been predicated on the development of more sophisticated surgical techniques and instruments. We present the development of our techniques with an initial 80 patients over 12 months, and then discuss how this technique was refined over an additional 164 cases in 36 months. We identified the following four principles as key tenants to the successful development of this technique. Specifically these are: judicious patient selection, an appropriately placed incision allowing adequate exposure and mobilization, identification of the recurrent laryngeal nerve in its more lateral position near the inferior parathyroid gland, and meticulous haemostasis. Adherence to these principles resulted in the successful removal of 70% of all selected patients thyroid pathology through an incision that is between 3.5 cm and 4.4 cm with a very acceptable complication rate.