indications and considerations in minimally invasive video-assisted thyroidectomy

background the phrase “minimally invasive” is used loosely due to the wide range of surgical options and generally means a procedure not involving a large open incision. in 1998, dr. paolo miccoli at the university of pisa developed a technique of minimally invasive video-assisted thyroidectomy (mivat) for patients presenting with small thyroid nodules. the procedure involves a smaller incision, limited exposure, and endoscopic magnification to better visualize the smaller surgical field. from this point, thyroidectomy or hemi-thyroidectomy is performed using endoscopic instrumentation. indications were initially limited to single, small non-malignant thyroid nodules, however the indications have gradually expanded since this surgery’s initial implementation. objectives we feel that this article provides an up-to-date research on the mivat procedure, while highlighting its rapidly expanding indications and excellent outcomes. patients and methods the current patient selection criteria includes small thyroid nodules (<35 mm in diameter), a relatively normal thyroid gland (about <25 cubic cm), no evidence of severe thyroiditis, and no previous neck surgery or radiation. results the advantages of mivat compared with conventional thyroidectomy include improved cosmetic results, less postoperative pain and reduced hospital stay without any difference in safety, completeness or morbidity compared with the conventional approach. the primary drawback appears to be an increased operative time, which can be reduced as the surgeon becomes more comfortable with the procedure. conclusions as shown in the literature, mivat is a safe and effective alternative in the treatment of some thyroid diseases within the selection criteria. with the same level of complications, it offers a few significant advantages over the conventional thryoidectomy.