Thyroglossal duct cysts (TDCs) are the most common congenital cervical abnormalities. The Sistrunk procedure, requiring a large skin incision high in the neck, is the standard surgical treatment. Since most of the patient are young, the cosmetic results is of utmost importance. We developed a video-assisted technique of the conventional procedure in order to improve the cosmetic result.

Exclusion criteria were: previous neck surgery, suspicion of malignancy and large goiter. When indicated video-assisted thyroidectomy was performed through the same incision. A 2 cm horizontal skin incision was performed at the level of the cricoid cartilage. When necessary the cyst's fluid was aspirated. The strap muscles were divided in the midline. Two conventional retractors were used to maintain the operative space. The endoscope (5 mm 30°) and the surgical instruments were inserted through the single skin incision. The TDC was mobilized under endoscopic vision from the thyroid cartilage. The hyoid bone was isolated and transected.

Nine patients (one male and eight females) with a mean age of 30.8 + 14.2 years (range 10-51) were included. Four patients underwent concomitant video-assisted thyroidectomy. No conversion to conventional operation was necessary. Final histology showed benign disease in all the patients. Two patients who underwent concomitant video-assisted total thyroidectomy experienced transient hypocalcemia. All the patients considered excellent the cosmetic results.

Video-assisted Sistrunk procedure is a feasible and safe technique and allows for an excellent cosmetic result. It can be considered an alternative approach for the treatment of TDCs, especially in young patients.