Thyroidectomy Procedures

Thyroidectomy is one of the most commonly performed operations in general surgery. Absolute indications include compression of the trachea and malignancy or suspicion of malignancy. Currently, an increasing number of “total thyroidectomies” are being performed in specialist endocrine surgery units, and the indications include multinodular goiter and Graves’ disease. Conventional (open) thyroidectomy has many advantages. There is no need to divide any muscle, except the platysma. This operation has a high success rate with negligible operative mortality and morbidity. Most of the procedures can be carried out through cervical incisions of 4–6 cm in length, in <90 min, with an excellent cosmetic result. The “flapless” conventional thyroidectomy is a safe and technically feasible surgical modality, which is therefore an effective alternative to conventional thyroidectomy. Many different techniques have been developed for minimally invasive thyroid surgery (MITS) over a short period; these can be broadly classified into minimally-invasive/mini-incision open surgery, minimally invasive video-assisted thyroidectomy (MIVAT), and pure/or completely closed endoscopic techniques (supraclavicular approach, axillary approach, anterior chest approach, and breast approach). However, some authors believe that the extra-cervical endoscopic approaches, while they have the advantage of avoiding a cervical incision, require extensive dissection that exceeds that of conventional surgery, and in this regard cannot be considered minimally invasive. This chapter describes the different thyroidectomy procedures and discusses the indications, advantages, and disadvantages of each.