Minimally Invasive Endocrine Surgery

Since the first report of endoscopic subtotal parathyroidectomy in 1996, a variety of endoscopic surgical approaches has been reported. These endoscopic approaches include the minimally-invasive video-assisted thyroidectomy (MIVAT), the endoscopic lateral approach, the lateral mini-incision approach, the anterior/chest (hybrid) approach, the transaxillary approach, the axillobreast approach, the post-auricular and axillary approach, and other novel experimental approaches. Some of these approaches could be done with the assistance of the da Vinci robot (i.e. robotic-assisted thyroidectomy). For simplification, these approaches could be categorized into the cervical/direct approach and the extra-cervical/indirect approach. Each technique or approach has its own benefits and weaknesses. Currently, there is no preferred approach in the literature and the choice seems to be determined by the surgeon’s own experience and the patient’s preference. In our experience, the transaxillary approach was a technically more challenging procedure and was associated with longer hospital stay, longer operating time, more immediate pain, and increased overall RLN injury and morbidity than MIVAT. The 6-month scar appearance and patient satisfaction were similar between the two procedures.