The number of thyroid pathologies is currently high both due to the increase in ultrasound investigations and to the attention that today turns to endocrine pathologies : of these diseases, however, only a few are indicated for surgical treatment and tumors are part of this category
If malignancy has occurred following biopsies performed on thyroid nodules, the solution of choice is surgery, while for benign ones such therapy is indicated only if the nodules compress or move the trachea from its axis. In the case of hyperfunctioning forms, instead, surgery is resorted to when the medical therapies carried out for more or less long periods have not controlled hyperthyroidism or if radioiodine therapy was contraindicated.
Partial or total thyroidectomy ?
In many cases, the choice was made to remove the thyroid only partially to preserve its residual function and to allow the patient to live without replacement therapy, but it was seen that this intervention caused a recurrence of the disease, an increase in postoperative complications in reoperations and an increase in the incidence of hypothyroidism. For all these reasons, the indication for total thyroidectomy has been extended in practically all cases and the advancement of technologies has made it possible to carry out this intervention in minimally invasive surgery in many cases, offering patients a faster recovery and a decrease in intra risks. and post operators.
What is Video-Assisted Minimally Invasive Thyroidectomy?
The Video Assisted Minimally Invasive Thyroidectomy (MIVAT) is a minimally invasive technique that allows the total removal of the thyroid through a small incision of maximum 2 cm. This surgery is very “delicate” and requires great skill and precision on the part of the surgeon, as it is necessary to be careful not to injure the lower laryngeal nerve and the parotid glands : nerve palsy, in fact, causes post-operative dysphonia while the lesion of the parotids causes hypocalcaemia. Following the operation, the patient will have to maintain a small drain for about 24 hours and if no complications arise, she will be discharged within 24-48 hours after the operation.
What are the advantages and contraindications of MIVAT?
Compared to conventional surgery, MIVAT offers several advantages to patients who undergo it, especially in terms of aesthetic results and postoperative pain. However, it also has some contraindications related to the type of tumor: this technique can in fact be used only in the case of unique nodules with a maximum diameter of 3 cm and placed in the context of small thyroid glands. In summary, MIVAT cannot be used in the case of:
- Goiters recurring after a previous intervention
- Presence of chronic thyroiditis
- Large malignant tumors
It is also possible to carry out this intervention also for malignant tumors of parathyroid origin, but only from the diagnostic tests was the precise location of the carcinoma identified ; during the operation one or both glands can be removed.
