Health News/July/27/2007/Page 006 Weekly Highlights Endoscopic thyroid surgery should be done with caution Luo Gang, Correspondent Yao Hongwei (Correspondent Luo Gang, Correspondent Yao Hongwei) At the second national training course on minimally invasive laparoscopic surgery organized by the Department of General Surgery of Peking University Third Hospital, experts pointed out that the minimally invasive effect of endoscopic thyroid surgery is not as pronounced as that of laparoscopic cholecystectomy. The objective choice of surgical approach should be made on the premise that the patient is informed. The controversy over endoscopic thyroidectomy focuses on whether the procedure is minimally invasive or cosmetic. According to Professor Xiu Dianrong, director of the Department of General Surgery at Peking University Third Hospital, the minimally invasive effect seems to be less pronounced than laparoscopic cholecystectomy compared to open cholecystectomy, and the operating time is slightly longer and the cost of the procedure is relatively high (about $1,600 higher). However, the advantage of the procedure is that the scars are small and mostly hidden in the axilla and areola, which significantly reduces the psychological trauma to the patient, and the magnification of the endoscope allows the operator to identify the nerves, blood vessels, and parathyroid glands more clearly, minimizing side effects. Experts agree that a reasonable surgical approach should be chosen with the patient’s knowledge, and that the indications for endoscopic thyroidectomy should be strictly controlled – usually only for benign thyroid disease, including substantial single thyroid nodules up to 4 cm, primary or secondary hyperthyroidism up to grade II enlargement, and cystic thyroid nodules. For malignant tumors requiring extended resection and lymph node dissection, large goiter (grade III enlargement or greater), substantial single thyroid nodules greater than 4 cm, intolerance of general anesthesia, severe coagulation disorders, short neck, and history of radiation therapy are all contraindications to surgery. In addition, endoscopic thyroidectomy requires not only expensive equipment, but also extensive experience in open thyroid surgery and proficiency in endoscopic techniques and ultrasonic knife operation.