Objective To assess the value of Miccoli's endoscopic thyroidectomy with some technical modifications.Methods From April 2002 to October 2004, 530 cases of nodular goiter and/or adenoma were consecutively Miccoli's, endoscopical thyroidectomy. The operation was conducted by using mainly the ultrasonic scalpel(Harmonic Scalpel?誖,Johnson & Johnson,USA), aided by suction-dissector or other supplementary instruments. The procedure was applied by: ① pre-coagulation + alternative cuting,suction,coagulation and dissecting or ②sequencial dissection,coagulation and cutting in dividing branches of major thyroid vessels and in controlling bleeding during dissection of the thyroid gland. To utilize maximally the working space, a specially designed space-modulating device was employed for regulating the suspending angle. Results All the procedures were completed successfully. Temporary hoarseness occurred in 2/530 cases (0.38%), but no case of postoperative tetany was observed. Conclusions Ultrasonic scalpel-based and space-regulating techniques are beneficial additive measures in performing endoscopic thyroidectomy. Application of these innovative techniques helps to render this minimally invasive approach simple and reliable.
Journal of Surgery Concepts & Practice