Minimally invasive thyroidectomy and the differentiated lesions: the way to follow.

Background and Objectives: Nowadays, the conventional thyroidectomy may appear an overly aggressive treatment in pa - tients undergoing intervention for small suspi - cious lesions harboring in low volume glands. In these cases a minimally invasive approach may be a safe and appropriate option. This work aims to evaluate the effectiveness of minimally inva - sive thyroidectomy in patients indicated to surgery for small lesions with preoperative sus - picion of malignancy. Patients and Methods: 71 patients, undergo - ing minimally invasive total thyroidectomy as a single procedure between May 2005 and April 2009, were enrolled in this study. They were indi - cated to surgery for small suspicious or malig - nant lesions (up to 20 mm lenght by US; cT1 ac - cording to UICC 2002) and satisfied the inclu - sion criteria of minimally invasive thyroidecto - my, with gland volume up to 25 ml, no evidence of locally advanced disease and no previous neck surgery. The outcomes were considered in terms of complication rate, postoperative pain, hospitalisation stay, cosmetic results and com - pleteness of surgical resection in malignancies. Results: A low complication rate was regis - tered. The surgical completeness, with mean serum thyroglobulin of 4.41 ± 4.03 ng/ml and ra - dioiodine uptake of 2.91 ± 2.46%, was consid - ered acceptable if compared with other experi - ences reported in literature. Excellent results with respect to patient comfort, postoperative pain and cosmetic outcome were obtained. Conclusion: This study confirms, where a correct selection of patients is made, the safety and the effectiveness of minimally invasive ap - proach in the treatment of small suspicious and malignant nodules, which seem to represent its best indication.