Minimally invasive videoassisted thyroidectomy (MIVAT) was set up in our Department in 1998.

The procedure is based on a unique incision in the central neck, 2 cm above the sternal notch, using small conventional retractors and needlescopic (2mm) reusable instruments. Haemostasis is achieved by a harmonic scalpel. 1059 patients underwent minimally invasive video-assisted thyroidectomy since June 1998. There were 915 females and 145 males (ratio 4:1). Lobectomy was performed in 370 patients, total thyroidectomy in 670 patients. In 19 cases (RET oncogene mutation carriers) MIVAT was associated to central neck dissection. Mean operative time of lobectomy was 33,8 (range 20-120) minutes; for total thyroidectomy was 45,6 (30-130) minutes. Mean time for video-assisted central compartment lymphadenectomy was 62 minutes.

Conversion to standard cervicotomy was required in 24 cases (2,2%); Operative complications were represented by transient monolateral recurrent nerve palsy (24 cases 2,2%), definitive monolateral recurrent nerve palsy (13 cases 1,2%). Twenty-nine patients exhibited a hypoparathyroidism, which corresponds to 3,9% of total thyroidectomies performed, but only 2 showed a permanent hypoparathyroidism.

MIVAT can be considered a safe operation offering significant cosmetic advantages with possible new promising indications such as prophylactic thyroidectomy in RET gene mutation carriers.